ICD-9 787.22 for Dysphagia in Oropharyngeal Phase

While coding for your pulmonology practice, you may encounter various coding confusions such as this:

Scenario: Our pulmonogist diagnosed a patient with nasopharyngeal carcinoma status post radiation and chemo with subsequent dysphagia and nasopharyngeal stenosis. As such can I code the dysphagia as oropharyngeal phase when the note does not specifically mention the condition as such?

Well, if the pulmonologist does not specify the type of dysphagia the patient has in her notes, you should go for dysphagia unspecified or 787.20. ICD-9 787.22 (pharyngeal walls,"Dysphagia; oropharyngeal phase) represents ‘impaired structure/ physiology of tongue base and pharyngeal walls," according to the American Speech-Language-Hearing Association (ASHA). On the other hand, 787.21 (… oral phase) describes “impaired structure/physiology of palate, tongue, lips, cheeks", while 787.23 (… pharyngeal phase) represents “impaired structure/ physiology of pharynx and larynx."

ICD-9 787.22 has more specificity of the affected swallowing disorder phase. For example, a patient with oral dysphagia has difficulty in the voluntary transfer of food from the mouth to the pharyx. In the pharyngeal dysphagia, the patient has difficulty in reflexive transfer of food from pharynx to initiate involuntary esophageal phase of swallowing while protecting airway from misdirection of food. In this situation, the patient normally undergoes testing to identify the affected phase. If the test reveals difficulty with preparation of the bolus, premature loss over back of tongue, some penetration into upper laryngeal vestibule and residue in pyriforms with risk of aspiration, the physician or speech language pathologist would diagnose oropharyngeal dysphagia (787.22).