FREQUENTLY ASKED QUESTIONS

FEES is confusing. We're here to answer any questions you might have about Mobile FEES generally, dysphagia diagnosis and/or treatment, swallowing disorders, and Medicare billing.

Have additional questions?

Don't hesitate to "Contact Us" and ask- We are happy to assist!

QUESTIONS FOR PROFESSIONALS

What is FEES?

FEES stands for Fiberoptic Endoscopic Evaluation of Swallowing.

This assessment is designed to investigate what happens when you swallow to make sure you do not have a swallowing disorder.

Your clinician will be able to determine if foods or liquids are going "down the wrong pipe" and into your airway or if foods or liquids are getting stuck anywhere when you swallow.

Your clinician may also be able to see if foods or liquids have a tendency to come back up (i.e. reflux or backflow).

FEES is a simple, well-tolerated procedure with low risk for complications.

What is the benefit of FEES versus MBSS/VFSS?

FEES is an endoscopic assessment that is portable and can be brought to your facility at the resident’s bedside with no radiation and no barium.

FEES shows real tissue including inflammation, nodules, strictures, airway protection, secretions pooling, inadequate vocal fold closure or paralysis, etc.

MBSS/VFSS is provided in an outpatient hospital setting, uses radiation, uses barium coated food/drink, and requires transportation out of the facility.

Which one is the "gold standard" in diagnosing swallowing disorders?

This really comes down to what information is needed, where the patient is located, and if they can be transported. In some patient situations, BOTH procedures may be necessary to completely understand the complexity of their disorder. Current clinical literature supports that both FEES and MBSS/VFSS are their own “gold-standards.”

Who should be referred for a Mobile FEES assessment?

Any resident displaying swallowing difficulty will benefit from FEES - Especially people with the following:

Choking or frequent coughing
Recurrent pneumonia
Too medically compromised or weak for transport out to hospital
Requires a Hoyer lift or max assist to transfer out of bed or wheelchair
Morbid obesity
Isolation due to infectious health condition
Dementia or cognitive confusion (needs familiar surroundings and care partners)
Caregiver not available to accompany resident to hospital

Who needs to be present for the FEES appointment?

1. Facility nurse or a caregiver familiar with the resident is highly beneficial

2. We require a nurse to be in the building if not present at the appointment

3. Facility SLP is encouraged to attend and may bill for CPT code 92526 (swallowing treatment)

4. Family members are always welcome and encouraged to attend

How is FEES paid for?

Mobile FEES is covered by Medicare and almost all private insurances.

FEES is a therapy service and must follow Medicare consolidated billing rules.

The facility pays E's Mobile FEES directly. We charge a one-time flat charge (no hidden costs).

For Med A, your facility typically spends significantly less overall for Med A residents paying the one-time flat charge for FEES due to reducing recurrent pneumonia, re-hospitalization, modified diet/thickener costs, etc.

Your facility can be reimbursed for Med B residents by billing for CPT code 92612.

Are there any insurance limitations?

Not really - Mobile FEES is covered by Medicare and almost all private insurances.

FEES is considered a therapy service, so it falls under Medicare consolidated billing rules.

The consolidated billing requirement confers on the SNF the billing responsibility for the entire package of care that residents receive during a covered Part A SNF stay and Physical Therapy, Occupational Therapy, and Speech Therapy services received during a non-covered stay.

QUESTIONS FOR RESIDENTS & FAMILIES

What is dysphagia and how is it pronounced?

Dysphagia is pronounced - “Dis - fay - ja”

Dysphagia is the medical term for swallowing difficulty. It is typically caused by medical conditions such as a stroke, a brain injury, Parkinson’s Disease, MS, ALS, mouth/throat cancer, reflux, esophagus issues, dementia, or even normal aging.

Dysphagia can cause serious health issues including:

Development of an aspiration pneumonia (infection of the lungs caused by foods/liquids and bacteria), which can be life threatening
Weight loss
Dehydration
Choking
Being placed on pureed or modified foods and thickened liquids due to swallowing difficulties/swallowing impairment

What are the symptoms of dysphagia?

Signs and symptoms of dysphagia include:

Coughing or choking during or right after eating/drinking
Clearing throat during or right after eating/drinking
Weakness or difficulty chewing
Wet or gurgly sounding voice during or after eating/drinking
Excessive secretions or saliva
Recurrent pneumonia
Food/liquids coming out of the nose
Complaints of food “sticking” or “fullness” in the throat
Unexplained weight loss or dehydration
Avoiding certain foods

Is the FEES procedure safe?

FEES is a safe and well-tolerated procedure.

Susan Langmore, Ph.D., and colleagues coined the term FEES in 1986 and published the first data demonstrating the effectiveness of the procedure in 1988. FEES is widely used in medical settings across the United States.

Here's some data to back this up:

The effectiveness, safety, and sensitivity of FEES is well-documented and extensively researched.
There are too many studies to list, so please feel free to view some of these research studies here.

We listen to you as well! If someone is not tolerating the procedure, we will listen compassionately, make adjustments, and, if needed, end the procedure.

Does the FEES procedure hurt?

This exam usually lasts about 15 minutes and will not hurt you. There is a slight discomfort as the tube is inserted, but this feeling goes away once the tube is in place.

Some have compared it to the feeling of getting water in your nose.

In a study of 500 people, 99% of the participants reported they would be willing to do a repeat exam and 82% of the participants rated their discomfort level at none to mild.

We do not use any type of topical anesthesia for this exam, as we do not want to numb your throat. If the sensation in your throat is decreased, it may negatively impact your swallowing.

Extensive research has been done on FEES, and most patients tolerate this procedure very well.

What can I expect during the FEES exam and how does it work?

During the FEES procedure, a very small, flexible tube will be inserted through your nose, allowing visualization of the inside of your throat. The tube is attached to a camera that will display the image on a computer screen.

If you would like, you can see the inside of your throat and watch the exam while it is taking place. You will be asked to eat/drink various textures of foods and liquids that may be colored with a very small amount of food coloring to help us see the movement.

E's Mobile FEES will come to your facility, so you do NOT need to go anywhere for this procedure.

Can family members attend the FEES appointment?

YES! We encourage family to be present to provide added support to the person having FEES completed and to provide additional information to our Speech-Language Pathologist.

Collaboration and understanding typically leads to the best therapy outcomes.

E's Mobile FEES will teach and answer any questions or concerns throughout the assessment.

Your Facility Speech-Language Pathologist is also encouraged to attend!

Is there anything I need to do to prepare for the FEES exam?

No, you do not need to do anything special to prepare for the FEES exam and you may eat and drink up until your appointment time.

You will be asked to sit up in your chair or we will elevate the head of your bed as much as you are able to tolerate. If you usually wear dentures when you eat and drink, you should have those in for the FEES exam. We want everything to be as natural as possible.

We simply request that you be available and ready to eat and drink a little bit during your appointment.

The Speech-Language Pathologist performing FEES will come to you.

Are there any possible complications with FEES?

The risk for any complication is very minimal with FEES.

The most likely complication is a sneezing episode, and there is a very small risk for a minor nose bleed.

Other possible, but highly unlikely, complications include:

Brief involuntary closure of the vocal folds or a brief drop in blood pressure.

Research has been completed using FEES for several decades with very low risk of complications.

Is FEES right for me or my loved one?

If your healthcare provider has concerns regarding your ability to swallow foods/liquids safely, they may recommend a video swallow study.

FEES is one of two options for that video swallow study.

Your healthcare provider might specifically recommend a video swallow study if you have been diagnosed with a pneumonia.

Prior to your appointment, your provider, who scheduled you for this exam, should discuss the reasons for recommending FEES.

When will I receive the results?

The Speech-Language Pathologist performing the FEES exam and your primary provider will explain the results of the test as soon as the FEES is completed. Additionally, our Speech-Language Pathologist will provide education throughout the completion of the FEES exam.

Our formal assessment documentation will typically be provided within 24 hours of our exam.

Feel free to ask our clinician questions at any time before, during, or after the exam.