Search all medical codes
Flexible endoscopic evaluation of swallowing by cine or video recording; interpretation and report only
CPT4 code
Name of the Procedure:
Flexible endoscopic evaluation of swallowing (FEES) by cine or video recording; interpretation and report only.
Summary
Flexible endoscopic evaluation of swallowing (FEES) is a procedure that uses a thin, flexible tube with a camera on the end (endoscope) to visually examine the swallowing process. The procedure is recorded on video for later analysis and interpretation to diagnose swallowing disorders.
Purpose
- Medical condition addressed: FEES is used to evaluate swallowing difficulties (dysphagia).
- Goals and outcomes: The aim is to identify abnormalities in the swallowing mechanism, determine the safest dietary recommendations, and guide treatment strategies.
Indications
- Symptoms/conditions: Chronic cough, frequent choking, unexplained weight loss, pneumonia or respiratory issues related to swallowing problems.
- Patient criteria: Individuals experiencing symptoms of dysphagia, especially those with neurological conditions, head and neck cancers, or post-surgical changes.
Preparation
- Pre-procedure instructions: Patients may be asked to fast for a few hours prior to the procedure.
- Diagnostics: A comprehensive review of the patient's medical history and symptoms. No specific tests are generally required, but previous imaging or swallowing studies might be reviewed.
Procedure Description
- Step-by-step:
- A topical anesthetic is applied to the nose and throat.
- The endoscope is gently inserted through the nasal passage and positioned just above the vocal cords.
- The patient is given different food textures and liquids to swallow.
- The swallowing process is recorded for analysis.
- Tools/equipment: Flexible endoscope, video recording equipment, food and liquids of varying consistencies.
- Anesthesia/sedation: Typically, only a topical anesthetic is used; sedation is not required.
Duration
The procedure typically takes about 20 to 30 minutes.
Setting
FEES is usually performed in an outpatient clinic, hospital, or specialized swallowing disorder center.
Personnel
- Healthcare professionals: The procedure is often conducted by a speech-language pathologist (SLP) with specialized training in FEES, sometimes assisted by a nurse or a medical assistant.
Risks and Complications
- Common risks: Mild discomfort or gagging, nosebleeds, slight sore throat.
- Rare complications: Laryngospasm, vasovagal response, or, very rarely, more significant bleeding.
- Management: Most complications are minor and resolve quickly. Severe complications are managed according to medical protocols.
Benefits
- Expected benefits: Accurate diagnosis of swallowing disorders, better management and treatment plan tailored to individual needs.
- Realization: Benefits are often apparent immediately through tailored dietary adjustments and interventions.
Recovery
- Post-procedure care: Usually, no special care is required post-procedure. Patients can resume normal activities and diet unless otherwise advised.
- Recovery time: Recovery is immediate; any minor discomfort typically resolves within a few hours.
- Follow-up: A follow-up appointment may be scheduled to discuss findings and treatment options.
Alternatives
- Other options: Barium swallow study, Modified Barium Swallow (MBS), Videofluoroscopic Swallow Study (VFSS).
- Pros and cons:
- MBS/VFSS: Provides a more detailed view of the entire swallowing process but involves exposure to radiation.
- FEES: No radiation exposure, provides direct visualization of the throat, but may be less comfortable.
Patient Experience
- During the procedure: Patients might feel mild discomfort from the endoscope and experience slight nasal irritation or gagging.
- After the procedure: Temporary sore throat or nasal discomfort may occur. Pain is usually minimal and can be managed with over-the-counter medications if necessary.
- Comfort measures: Gentle technique, use of topical anesthetics, and providing reassurance and support throughout the procedure.