Name of the Procedure:

Discharge status assessment for swallowing functional limitation, also known as Functional Communication Measures (FCMs) for swallowing or G8998 HCPCS code.

Summary

This procedure involves assessing a patient's ability to swallow safely and effectively at the end of speech-language pathology therapy or when reporting concludes. It determines the status of the patient's throat muscles and swallowing capabilities.

Purpose

This assessment helps identify the level of improvement in a patient's swallowing function and determines whether additional therapy or intervention is needed. The goal is to ensure the patient can eat and drink safely without the risk of aspiration.

Indications

• Difficulty swallowing (dysphagia)
• History of choking or aspiration pneumonia
• Neurological conditions affecting swallowing (e.g., stroke, Parkinson's disease)
• Head and neck cancer affecting eating/drinking functions

Preparation

• No specific fasting required unless other medical assessments demand it.
• Review any dietary restrictions or medications affecting swallowing.
• Initial swallowing assessment or diagnostic tests like videofluoroscopic swallow study (if not previously done).

Procedure Description

1. The healthcare provider reviews the patient's medical history and previous therapy outcomes.
2. The patient may be asked to swallow different consistencies of food and liquid under observation.
3. The provider evaluates the patient's swallowing mechanics and safety.
4. Any signs of difficulty such as coughing, choking, or regurgitation are noted.
5. Functional limitations are documented using the G8998 code for discharge status.

Duration

Approximately 20-40 minutes.

Setting

Typically performed in an outpatient clinic, rehabilitation center, or hospital setting.

Personnel

• Speech-language pathologist (SLP)
• The patient's primary healthcare provider may also be involved, particularly in complex cases.

Risks and Complications

• Minimal risks as it is a non-invasive assessment.
• Potential discomfort due to the swallowing of various test substances.
• Rarely, temporary aspiration if substances aren't swallowed properly, which requires prompt attention.

Benefits

• Accurate determination of swallowing ability.
• Personalized recommendations for further treatment or dietary adjustments.
• Enhanced patient safety by reducing the risk of aspiration and related complications.

Recovery

• Immediate return to normal activities post-assessment.
• Follow any specific dietary recommendations provided by the SLP.
• Attend any follow-up therapy sessions if necessary.

Alternatives

• Fiberoptic Endoscopic Evaluation of Swallowing (FEES)
• Modified Barium Swallow Study (MBSS)
• Pros: These alternatives provide detailed, visual analyses of swallowing.
• Cons: They may be more invasive or require specialized equipment and settings.

Patient Experience

• The patient might feel cautious or anxious about swallowing test substances but is constantly reassured by the healthcare provider.
• Pain or discomfort is minimal, mostly related to the effort of swallowing if difficulty exists.
• Comfort measures include appropriate seating and the presence of water to clear any residue.