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Frequently

Asked

Questions

Why mobile FEES?

Patients in Wyoming and Montana often travel long distances to receive the highest quality healthcare.  But they shouldn't have to!  We believe that local residents deserve more convenient access to high-definition video swallowing evaluation tools.  By bringing our equipment directly to your facility, we cut down on healthcare costs associated with patient transportation to the hospital for modified barium swallow studies (MBS).  And because we are portable, we can go places MBS can't -- like the ICU, ENT office, or pediatric clinic -- and get your patients eating regular foods sooner than a bedside assessment alone.

What types of locations do you serve?

Because we are mobile, we provide FEES directly at your location in Wyoming or Montana, including: hospitals, skilled nursing facilities, assisted living facilities, long-term care facilities, outpatient SLP and physician clinics (e.g. ENT, speech-therapy, pediatrics), rehabilitation clinics, and home health companies.

Who is a candidate for FEES?

Most anyone suspected to have pharyngeal dysphagia is a candidate for FEES. It is the preferred procedure over videoflouroscopy (MBS) for: patients with voice changes, suspected silent aspiration, severe dysphagia, possible absent swallow reflex, and poor management of secretions. FEES provides a great portable option for patients who are bed-bound or in the ICU, those with tracheostomy tubes or on mechanical ventilation, bariatric patients, and weak patients who may not tolerate transportation to the hospital or upright positioning for MBS.  It can also be used to assess fatigue or swallow status over the course of a meal, and is repeatable to ass change or try treatment strategies using biofeedback.  FEES is also preferred any time there is a need to visualize the pharynx and larynx directly for signs of trauma, structural/functional issues, or edema post intubation or surgery. 

FEES is NOT indicated for those with bilateral nasal obstructions, unhealed facial, maxillary, or nasal fractures, or severe epistaxis (nose bleeds). Medically fragile patients, easily agitated or tactilely defensive patients, and those on on high-flow nasal oxygen may also not be candidates for the procedure.

What is the minimum age of participation for pediatrics?

While the scope we use is typically sized for adults, pediatric patients above age 9 have been known to tolerate the procedure, especially when using a topical anesthetic. FEES provides a radiation-free alternative to MBS for children and teenagers.  Wyoming Dysphagia Diagnostics aims to have infant and pediatric scoping capabilities in the near future. 

Who can be in the room during FEES?

Besides the patient, close family members may also be present in the room during the study if space allows. SLPs are encouraged to participate and can actually help administer food and liquids or cue the patient to use compensatory strategies during the study (which can actually be billed as a speech therapy treatment code).  CNAs, nurses, the dietician, or MD may also participate as appropriate.

My patient needs a swallow study.
What next?

A signed contract (with no fees or monthly minimums) is required before we can see your patients. Simply follow the instructions and download the form below.  When you have a patient in need of services, the physician needs to sign an order for "fiberoptic endoscopic evaluation of swallowing (CPT 92612)," and an order for "2% topical lidocaine gel as needed" if desired. Contact us to schedule an appointment and we'll send you a patient intake form.  We typically complete the assessment 1-4 business days after you contact us. There is no special preparation needed by the patient prior to the procedure.

What does the day of the procedure look like?

After you contact us, at the time of your appointment we bring our equipment directly to your facility.  We first review the patient's medical history and intake form and may discuss any concerns with the nurse or MD in the building before setting up our equipment.  If the SLP would like to participate, they can assist with feeding trials and even bill for treatment during portion of the study if compensatory strategies are used during the procedure.  Topical anesthetic or lubrication will be applied as needed, the sterile scope inserted through the nose, and the patient asked to perform some non-swallow tasks to assess function of structures at baseline.  Then, trials of food, liquid, and/or mock medications will be administered and swallowing assessed.  We disinfect our equipment & provide your facility with a detailed report, including high definition color images and recommendations on-site following the assessment. 

How long does it take?

The scoping portion of FEES and food/liquid trials typically take about 15 minutes to complete. With equipment set-up, chart review, and disinfecting, plan for 1-1.5 hours to complete the entire procedure.  We provide you with a detailed report the same day of the procedure and like to discuss results & recommendations with family members and providers.

What kinds of foods & liquids do you use?

We typically administer a variety of textures of food and liquids including:  pureed, chopped, and solid foods, ice, regular thin liquids, and thickened liquids, and even empty medicine capsules, depending on the needs and abilities of the patient.  If an SLP would also like to try typical foods for the patient, we do ask that they provide them during the study.  We add white and green food coloring to enhance the appearance of foods and liquids on the video and help visualize aspiration. 

Is FEES Painful?

While inserting the scope may be slightly uncomfortable for some patients, it is tolerated in most cases. There is no general sensitivity once inserted, and the scope does not interfere with swallowing.  Depending on the patient's preference, topical anesthetic (e.g. lidocaine gel) as well as a lubricant may be administered to improve comfort during scope placement.  If needed, the anesthetic can be ordered by the physician.

Is it safe?

For over 30 years FEES has been proven to be a safe, well-tolerated diagnostic procedure. Risks are minimal (occurring <2% of the time) and most often include mild discomfort and nosebleeds (which are usually self-limiting and do not affect study participation). Rarely, laryngospasm and fainting have occurred.  Unlike fluoroscopy (MBS), FEES does not involve radiation exposure or risk of aspirating barium-coated materials during the study.

Our endoscopist is a licensed, certified speech-language pathologist with extensive knowledge and experience in identifying and treating swallowing disorders in the medical setting. She has received training in the procedure directly through the developer of the FEES procedure, Dr. Susan Langmore, additional competency thorough hospitals in Phoenix, and advanced education courses throughout the country. She also maintains up-to-date basic life support training.  About Me>>

What is the standard for repeating FEES?

While there is no set standard, FEES can be repeated any time a patient has a change in status or to ensure the patient is on the correct diet and that strategies addressed in therapy are effective.  Too long between studies risks costly over-use of thickened liquids or altered diet textures or possible silent aspiration not detected during bedside swallow evaluations.  

What is the advantage of
FEES over MBS?

MBS and FEES are both GOLD STANDARD swallowing assessment tools that each have unique advantages and disadvantages. And unlike a bedside evaluation, both can visualize silent aspiration and underlying structural or functional causes of dysphagia. Because it's high-definition color image of the pharynx, FEES is actually more sensitive than MBS at visualizing penetration, aspiration, and residue.  Another advantage of FEES over MBS is it's portability - the procedure can be completed in the patient's room, dining room, ICU, etc. FEES doesn't require transportation to the hospital or costs associated with transportation or use of a radiologist, barium, or radiology suite like MBS does.  As such, FEES costs about 1/4 the price of MBS.  FEES also doesn't expose patients to radiation, and can be completed over a longer duration than MBS to assess performance over a meal or effectiveness of compensatory swallowing strategies (e.g. chin tuck).                                               Read More >>>

Isn't a Bedside Swallow Evaluation
good enough?

Clinical Bedside Swallowing Evaluations (CSE) conducted by Speech-Language Pathologists have been shown to be widely inaccurate.  Research shows that dysphagia is over-identified in nearly 70% of patients at the bedside. This means that many patients are inappropriately put on thickened liquids and altered diets, or receive therapy they may not actually need - at a large cost to the patient & facility. Additionally, silent aspiration (which is aspiration that occurs without a cough or other outward sign) accounts for about half of all aspiration cases.  SLPs can't assess silent aspiration at the bedside, which can lead to missing aspiration pneumonia and patient re-hospitalizations.  

                                                                                                                        Read More>>

As SLPs, we don't have x-ray vision, and we can't treat what we can't see. In order to provide effective treatment of pharyngeal swallow impairments, we need access to instruments that allow us to see the pharynx and larynx. And FEES can often show anatomical abnormalities that are very treatable & not caught at the bedside, including: masses, edema, laryngeal webbing, strictures, dislodged feeding tubes, excess secretions, thrush in the throat, paralyzed vocal folds, and even foreign bodies (including broken glass!) lodged in the pharynx and larynx. 

 

A picture is worth a thousand words, and the high definition video offered by FEES really can help us develop the most effective treatment plans for our patients.

How does billing work?

The FEES procedure is considered a speech-language pathology therapy service. As such, it's billed under CPT Code 92612. All therapy services fall under the Consolidated Billing rules as of the Balanced Budget Act of 1997. If the procedure is completed in a subacute setting, the facility is responsible for making payment for the procedure directly to Wyoming Dysphagia Diagnostics LLC per CMS guidelines. The facility then bills the patient's fiscal intermediary for reimbursement. For more information, please visit: http://www.cms.gov/SNFPPS/05_ConsolidatedBilling.asp

How can my facility gain access to
your services?

Call or Text us to set up a meeting or request a contract to sign. We require a signed service agreement prior to initiating our services.  After this is done and you have a patient who needs FEES, that patient's physician writes an order for FEES (CPT 92612) and someone from your facility (Scheduling coordinator, program director, MD, SLP, etc) calls us to set up a time to come out to your facility.

Call: 307-215-9626  or    Fax: 1-307-316-0366  or  email:  info@wydysphagiadiagnostics.com

Is our agreement exclusive?

No, our agreement is not exclusive. You are still able to utilize the hospital or other outpatient providers for MBS or FEES as you need.

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