Frequently Asked Questions
What locations do you serve?
We provide FEES in acute care and rehabilitation hospitals, skilled nursing facilities, assisted living facilities, outpatient rehabilitation clinics, LTACHs, and physician clinics. We are based in Gallatin County and service facilities throughout Gallatin, Park, Madison, and surrounding counties.
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Who is a candidate for FEES?
FEES can be performed on most patients, including those with dementia, feeding tubes, isolation precautions, supplemental oxygen, ventilator-dependent, tracheostomy tubes, speaking valves, and medically complex patients. Contraindications for FEES are bilateral nasal obstruction; facial, maxillary or nasal fractures, or severe epistaxis.
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Do you use topical anesthesia?
We typically use a topical anesthesia. However, this depends on the patient, the patient's comfort level, medical history, and specific physician orders.
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How does our facility get started with your services?
Contact us via email or phone and we will set up a meeting with you and/or your facility Administrator to obtained a signed contractual agreement for our services. Once a contract is signed, we provide a "Welcome Packet," with additional information regarding referral process for the Endoscopist in your area as well as billing information.
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How Does my Facility Get Billed?
FEES procedure is considered a Speech Language Pathology therapy cervice (CPT Code 92612). All therapy services fall under consolidated Billing rulesas of the Balanced Budget Act of 1997. If a FEES procedure is completed in the subacute setting, we bill the facility directly per CMS guidelines.
Helpful Links
Our FEES System
www.ndohd.com NDŌʜᴅ High Definition Endoscopy Systems
Creator of FEES - Susan Langmore, PhD’s FEES® resource site
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The American Speech-Language-Hearing Association's Statement Regarding FEES and the Speech-Language Pathologist
http://www.asha.org/policy/PS2005-00112/
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Billing Information
www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/SNFPPS/Downloads/historyQA.pdf
FEES in the Literature
Efficacy of FEES
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Bastian R. Video endoscopic evaluation of patients with dysphagia: an adjunct to the modified barium swallow. Otolaryngol-Head & Neck Surg 1991; 104(3):339-50.
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Crary, M.A., Baron, J. (1997) Endoscopic and Fluoroscopic Evaluations of Swallowing: Comparison of Observed and Inferred Findings. Dysphagia, 12(2).
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Langmore, S.E., Schatz, K., & Olsen, N. (1991). Endoscopic and videofluoroscopic evaluations of swallowing and aspiration. Annals of Otalgia, Rhinology & Laryngology. 100(8), 678-681.
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Mu, C.H., Hsiao, T.Y., Chen, J.C., Chang, Y.C., &Lee, S.Y. (1997). Evaluation of swallowing safety with fiberoptic endoscope: Comparison with video fluoroscopic technique. Laryngoscope, 107, 396-401.
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Literature Examining Safety of FEES
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Aviv, J.E., Kaplan, S.T., Thompson, J.E., Spitzer, J., Diamond, B., Close, L.G. The safety of flexible endoscopic evaluation of swallowing with sensory testing: an analysis of 500 consecutive evaluations. Dysphagia. 2000;15:39-44.
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Cohen, M.A., Setzen, M., Perlman, P.W., Ditkoff, M., Mattucci, K.F., Guss, J. The safety of flexible endoscopic evaluation of swallowing with sensory testing in an outpatient otolaryngology setting. Laryngoscope. 2003;113:21-24.
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Aviv, J.E., Murray, T., Zschommler, A., Cohen, M., Gartner, C. Flexible endoscopic evaluation of swallowing with sensory testing: patient characteristics and analysis of safety in 1340 consecutive examinations. Annals of Otology, Rhinology & Laryngology. 2005;114:173-176.
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Literature Addressing Patient Comfort and Anesthesia
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Leder, S.B., Ross, D.A., Briskin, K.B., Sasaki, C.T. A prospective, double-blind, randomized study on the use of a topical anesthetic, vasoconstrictor, and placebo during transnasal flexible fiberoptic endoscopy. Journal of Speech, Language and Hearing Research. 1997;40:1352-1357.
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Singh, V., Brockbank, M.J., Todd, G.B. Flexible transnasal endoscopy: is local anesthetic necessary? Journal of Laryngology and Otology. July 1997;111:616-618.
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Literature Citing the Need for Objective Swallow Assessment
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McCullough, G. H., Rosenbek, J. C., Wertz, R. T., McCoy, S., Mann, G., & McCullough, K. (2005). Utility of clinical swallowing examination measures for detecting aspiration post-stroke. J Speech Lang Hear Res, 48, 1288–1293.