2025 ICD-10-CM code R13.13
(Active) Effective Date: N/A Revision Date: N/A Deletion Date: N/A Symptoms - Dysphagia Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99) Feed
Dysphagia, pharyngeal phase; difficulty swallowing in the pharynx.
Medical necessity for diagnostic testing and treatment depends on the severity of symptoms, impact on nutritional status, and potential for aspiration pneumonia.In cases of severe dysphagia with aspiration risk, a VFSS or FEES is medically necessary to determine the location and severity of the impairment and guide management.
The clinical responsibility involves identifying and documenting the presence of dysphagia, determining the phase of swallowing affected (in this case, the pharyngeal phase), and investigating potential underlying causes through a thorough history, physical examination, and possibly further investigations such as videofluoroscopic swallowing study (VFSS) or fiberoptic endoscopic evaluation of swallowing (FEES).
- Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified (R00-R99)
- Symptoms and signs involving the digestive system and abdomen (R10-R19)
In simple words: This code means the patient has trouble swallowing because of a problem in the back of their throat.It doesn't say what's causing the problem, just that there's difficulty swallowing in that specific area.
This ICD-10-CM code signifies difficulty in swallowing specifically related to impaired function within the pharynx (the part of the throat behind the mouth and nasal cavity).The etiology of this dysphagia is not specified by this code; it indicates a symptom rather than a diagnosis.It is used when the swallowing problem originates in the pharyngeal phase of swallowing and can result from various muscular or neurological disorders. The code should be used in conjunction with any underlying medical conditions contributing to the dysphagia.
Example 1: A 70-year-old patient with a history of stroke presents with difficulty swallowing liquids and solids.A videofluoroscopic swallow study (VFSS) reveals impaired pharyngeal peristalsis, resulting in aspiration.R13.13 is used to code the dysphagia, along with the code for the underlying cerebrovascular accident (CVA)., A 65-year-old patient with Parkinson's disease reports difficulty swallowing, particularly with solid foods.A FEES examination reveals reduced pharyngeal contraction and residue in the valleculae. The physician codes R13.13 along with the code for Parkinson's disease., A 50-year-old patient post-thyroidectomy experiences difficulty initiating and coordinating the swallow due to nerve damage resulting in pharyngeal dysfunction.VFSS confirms impaired pharyngeal transit time and aspiration. R13.13 and the postoperative complication code are applied.
Detailed history of swallowing difficulties, including onset, duration, consistency of affected foods/liquids, associated symptoms (coughing, choking, aspiration), and impact on nutrition and hydration.Documentation should include the results of any diagnostic testing such as a VFSS, FEES, or other relevant evaluations to confirm the pharyngeal phase involvement.Note if there is evidence of aspiration, residue, or other specific findings that contribute to diagnosis.
** Consider using additional codes to specify the underlying cause and any associated complications such as aspiration pneumonia.Always ensure proper documentation supports the selected code.
- Payment Status: Active
- Specialties:Otolaryngology, Neurology, Gastroenterology, Speech-Language Pathology
- Place of Service:Office, Hospital (Inpatient and Outpatient), Skilled Nursing Facility, Rehabilitation Facility