2025 CPT code 6010F
(Active) Effective Date: N/A Revision Date: N/A Performance Measurement - Patient safety practices Category II Codes > Patient Safety Feed
Dysphagia screening performed before the patient receives any food, fluids, or medication orally.
Category II codes do not utilize modifiers.
Medical necessity for a dysphagia screening is established when a patient presents with symptoms or conditions that suggest potential swallowing difficulties. This includes post-stroke patients, individuals with neurological disorders, patients recovering from throat surgery, or those who display signs of choking, coughing, or aspiration.
The clinical responsibility for performing a dysphagia screening may vary depending on the healthcare setting and the patient's condition.Nurses, speech-language pathologists, or other qualified healthcare professionals may conduct the screening. The ordering physician remains responsible for ensuring appropriate screening takes place before oral intake.
In simple words: This code means a quick check to see if someone has trouble swallowing before they eat, drink, or take medicine by mouth. This helps prevent choking or other problems.
This Category II CPT code, 6010F, represents a dysphagia screening conducted prior to the administration of any food, fluids, or medication by mouth.The screening aims to identify swallowing difficulties that could lead to complications like pneumonia, malnutrition, or dehydration.The procedure involves a brief assessment to determine if a patient experiences difficulty swallowing before allowing oral intake.
Example 1: A patient presents to the emergency room post-stroke. Before administering any oral fluids or medications, a nurse performs a bedside dysphagia screening (code 6010F) to evaluate swallowing ability and prevent aspiration., Following a surgical procedure affecting the throat, a physician orders a dysphagia screening (code 6010F) before the patient resumes oral nutrition. The screening is performed by a speech-language pathologist to determine the safety of oral intake., A patient with a neurological condition such as Parkinson's disease is admitted to a rehabilitation facility.Before commencing oral intake, a screening (code 6010F) is conducted to assess swallowing function and modify the plan of care as needed.
* Documentation should include the date and time of the screening.* A clear statement indicating whether the screening was performed.* The results of the screening (pass/fail) should be documented.* If the patient fails the screening, documentation should include the specific reasons and the plan of care to address the dysphagia.* If applicable, documentation should include the name and credentials of the healthcare professional who performed the screening.
** * This code is used for performance measurement and quality improvement purposes and does not affect the billing for other services.* It is crucial to note that the use of this code is optional.
- RVU: No relative value units are associated with Category II codes.
- Global Days : Not applicable to Category II codes.
- Payment Status: Active
- Modifier TC rule: Not applicable to Category II codes.
- Fee Schedule : Category II codes do not have associated fee schedules.
- Specialties:* Neurology* Speech-Language Pathology* Otolaryngology* General Surgery
- Place of Service:* Inpatient Hospital* Outpatient Hospital* Skilled Nursing Facility* Office* Other Place of Service