01
What is FEES?
FEES, or Fiberoptic Endoscopic Evaluation of Swallowing, is a diagnostic procedure used to assess swallowing function in individuals with dysphagia. During the exam, a thin, flexible tube with a camera is inserted through the nose and into the throat, allowing healthcare providers to visualize the swallowing process in real time. This method enables clinicians to observe the anatomy and physiology of swallowing, helping to identify any abnormalities or issues. FEES is particularly valuable for developing tailored treatment plans that improve patient safety, hydration, and overall quality of life.
02
What is the benefit of FEES over a Video Swallow Study (MBSS/VFSS)?
FEES offers several advantages over a Video Swallow Study (MBSS/VFSS), making it a valuable tool for assessing swallowing function. One key benefit is that FEES can be performed at the patient's bedside or in a more familiar environment, reducing the stress associated with transporting individuals to a radiology suite. Additionally, FEES provides direct visualization of the pharyngeal and laryngeal structures during swallowing, allowing for a detailed assessment of the swallowing mechanism in real time. Unlike MBSS, which involves exposure to radiation and may be limited in duration, FEES allows for longer evaluations without any radiation risks. Furthermore, FEES enables clinicians to assess the effects of various food consistencies and strategies in a more controlled setting, enhancing the ability to tailor treatment plans to individual patient needs.
03
Who should be referred for a Mobile FEES assessment?
A Mobile FEES assessment is ideal for individuals experiencing swallowing difficulties, or dysphagia, that may affect their nutrition and quality of life. Referrals should be considered for residents:
*who show signs of aspiration
*have a history of swallowing disorders
*have recently experienced changes in their ability to swallow safely. *have neurological conditions, such as stroke or Parkinson's disease
*any patient recently recovering from surgeries affecting the throat or esophagus
*who have episodes of choking or frequent coughing
*who have a history of recurrent pneumonia
*too medically compromised or weak to transport to a hospital
*require a Hoyer lift or max assist to transfer out of bed or wheelchair
*on isolation precautions, yes, this includes COVID!
*who have dementia or cognitive confusion that require their familiar surroundings
*for a facility with limited staffing and are unable to have a caregiver accompany a resident
04
Who needs to be or can be present for the FEES appointment?
Several key players are essential for a successful FEES procedure. First and foremost is the patient, whose cooperation and comfort are crucial. A facility nurse or caregiver familiar with the resident can provide valuable insights and support during the procedure. While having a nurse present in the building is beneficial, it is not a strict requirement. The facility's Speech-Language Pathologist (SLP) is also an important participant; we highly encourage their attendance as it allows your facility to bill CPT code 92526 (swallow treatment). Additionally, family members are always welcome and encouraged to attend, providing emotional support and engagement throughout the process.
05
How is a FEES procedure paid for?
Billing and reimbursement for swallow studies in the SNF setting can be quite confusing! Here, we tackle some of the most frequently asked questions regarding FEES billing and reimbursement in SNFs. We're always here to answer your questions and help you navigate these complex issues!
Mobile FEES is covered by Medicare and almost all commercial insurances.
FEES is a therapy service and must follow Medicare consolidated billing rules. All therapy services fall under consolidated Billing rules as of the Balanced Budget Act of 1997.
Marigold Speech charges a one-time flat charge (with no hidden fees). Your facility pays Marigold Speech directly.
For Med A, on average your facility spends significantly less overall for Med A residents paying the one-time flat charge for FEES due to reducing recurrent pneumonia, re-hospitalizations, modified diet/thickener costs, etc.
For Med B, your facility can be reimbursed by billing for CPT code 92612.
We understand this is a lot. Click the button below for a more in-depth explanation!
06
Are there any insurance limitations?
No! Mobile FEES is covered by Medicare and most commercial insurances. FEES is considered a therapy service, therefore it falls under Medicare consolidated billing rules.
The consolidated billing requirement assigns the SNF the responsibility for billing for the complete package of care that residents receive during a covered Part A SNF stay, as well as for PT, OT, and ST services provided during a non-covered stay.
We understand this is a lot. Click the button below for a more in-depth explanation!
07
How Do I Gain Access to your Services?
Contact us via email or phone and we will set up a meeting with you and/or your facility Administrator to obtained a signed contractual agreement for our services. Once a contract is signed, we provide a "Welcome Packet," with additional information regarding referral process for the Endoscopist in your area as well as billing information.
08
What locations do you serve?
We can provide FEES to acute care and rehabilitation hospitals, skilled nursing facilities, assisted living facilities, outpatient rehabilitation clinics, long-term acute care hospitals, and physician clinics (e.g., ENT, GI, and pulmonology offices). We are based in Janesville, Wisconsin, but our mobile capabilities allow us to serve an approximate 4 hour radius.
09
Do you provide any other services?
We are always available to provide informational in-services and consultation on a variety of topics, including (but not limited to):
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General Dysphagia
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Frazier Free Water Protocol
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Dysphagia within Specific Disorders (e.g., Parkinson’s, Dementia, ALS, MS, and CVA)
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Oral Care Hygiene Programs
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International Dysphagia Diet Standardization Initiative (IDDSI) for Dysphagia Diet Guidelines
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Strategies to Alleviate Xerostomia (Dry Mouth)
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Aspiration and Reflux Precautions
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Laryngopharyngeal Reflux (LPR)
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Voice Disorders
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Respiratory Disorders
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Neurological Diseases
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Tracheostomies
Frequently Asked Questions for Residents & Families
We're here to answer any questions you may have about Mobile FEES, dysphagia diagnosis, dysphagia treatment, swallowing disorders, the rehabilitation process, and billing.
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Have additional questions? Don't hesitate to contact us!
01
What is a swallowing disorder?
Dysphagia, pronounced "dis-FAY-juh."
Dysphagia refers to difficulty swallowing, which can occur due to various medical conditions affecting the muscles and nerves involved in the swallowing process. This condition can manifest as pain while swallowing, a sensation of food getting stuck in the throat, or the inability to swallow solid or liquid foods altogether. Dysphagia can arise from neurological disorders, structural abnormalities, or certain medical treatments, and it may significantly impact an individual's nutrition, hydration, and quality of life.
Dysphagia can lead to serious health issues, including aspiration pneumonia, which occurs when food or liquid enters the lungs, increasing the risk of infection. It can also result in malnutrition and dehydration due to difficulties in consuming adequate nutrients and fluids. Additionally, dysphagia can contribute to weight loss and muscle wasting, as individuals may avoid eating or drinking due to discomfort or fear of choking. Being placed on modified diets and thickened liquids can result in several important changes for individuals with dysphagia. While these adjustments are designed to enhance safety during swallowing and reduce the risk of aspiration, they can also lead to potential challenges. Patients may experience a limited variety of food choices, which can affect their enjoyment of meals and overall nutrition. Thickened liquids may be perceived as less palatable, making it difficult for individuals to stay adequately hydrated. Additionally, the social aspects of eating may be impacted, leading to feelings of isolation during mealtimes. Prompt evaluation and management are essential to mitigate these risks and improve quality of life for those affected.
02
What are symptoms of a swallowing disorder/dysphagia?
Symptoms of a swallowing disorder, or dysphagia, can vary but often include:
-Difficulty Swallowing: A sensation of food getting stuck in the throat or chest.
-Pain While Swallowing: Discomfort or pain during the swallowing process.
-Coughing or Choking: Frequent coughing or choking episodes during meals or when drinking.
-Regurgitation: The return of food or liquid back into the mouth after swallowing.
-Aspiration: Food or liquids entering the airway, which can lead to coughing or choking and may increase the risk of aspiration pneumonia.
-Changes in Eating Habits: Avoiding certain foods or liquids due to difficulty swallowing, leading to weight loss or malnutrition.
-Voice Changes: A gurgly or wet voice after eating or drinking, indicating potential aspiration.
-Drooling: Difficulty controlling saliva, which may lead to excessive drooling.
03
Is this FEES procedure safe?
The FEES procedure demonstrated a strong safety profile in 300 subjects, with no serious complications reported and over 80% of patients indicating excellent tolerance (Warnecke, et al., 2009).
FEES is safe and well-tolerated.
Request a list of research articles from us that focus on the effectiveness, safety, and sensitivity of FEES if you need further information. FEES is well documented and extensively researched dating back to the 1980s.
We are here to listen to you! If you’re having difficulty with the procedure, we will respond with compassion, make necessary adjustments, and, if needed, halt the procedure.
04
Does the FEES procedure hurt?
This procedure will not hurt you. This procedure usually lasts about 15 minutes. There is a slight discomfort as the tip is inserted into your nostril and trails through your nose. Some experience watery eyes and have sneezing episodes. This uncomfortable feeling typically goes away once the scope is in place.
Some compare the discomfort to getting water in their nose.
We do not use any type of topical anesthesia for this exam as we do not want any chance that it might numb the throat as that could negatively impact your swallow.
One study found that 81% of patients reported either no discomfort or only mild discomfort during the flexible endoscopic evaluation of swallowing, suggesting a high willingness to repeat the procedure due to its safety and acceptability (Aviv, J., Kaplan, S., Thomson, J., et al., 2000).
05
What can I expect during the FEES procedure? How does this work?
Marigold Speech will come to your facility. You do not need to go anywhere for this procedure! During the FEES procedure, you'll be seated comfortably, and a thin, flexible endoscope is gently inserted through your nostril into your throat. On the end of the scope is a camera which allows the clinician to visualize the inside of your throat. It also allows the clinician to observe your swallowing as you consume various foods or liquids, sometimes mixed with green dye for better visualization. The camera will display the image on a computer screen. If you would like, you can see the inside of your throat and watch the procedure while it is taking place. The procedure typically lasts about 10 to 20 minutes and provides real-time insights into your swallowing function.
06
Can family members attend a FEES appointment?
Yes! Family members are always welcome and encouraged to attend a FEES appointment. Their presence can provide emotional support for the patient and help facilitate communication. Family members can also gain valuable insights into the assessment process and contribute to discussions about the patient’s care and treatment options. Having loved ones present can enhance the overall experience and support the patient’s comfort during the procedure.
Marigold Speech will teach and answer your questions or concerns throughout the assessment. Collaboration and understanding typically leads to the best therapy outcomes!
07
Is there anything I need to do to prepare for the FEES exam?
Nope! You do not need to do anything special to prepare for the FEES procedure. We simply request that you be available and ready to eat and drink a little bit during your appointment.
08
Are there any possible complications with FEES?
While FEES is generally a safe and well-tolerated procedure, it's good to be aware of some possible mild side effects. Patients may experience minor discomfort or a gag reflex during the insertion of the endoscope, which is typically brief. Some might notice slight nasal bleeding, especially if their nasal passages are sensitive, but this usually rate and if it occurs it resolves quickly. Rest assured that research has been completed using FEES for several decares finding that overall, FEES offers very low risk of complications.
09
Is FEES right for me or my loved one?
FEES may be an excellent option for you or your loved one if there are concerns about swallowing difficulties, or dysphagia, especially if your healthcare provider vocalizes concern. FEES is one of two options for swallow studies. If your healthcare provider recommended a video swallow study, a FEES can be completed in its place.
10
When will I receive the results?
On the day of the procedure! Your results will be communicated to your facility SLP and she will follow up with you to offer education as well as to answer any questions you may have. Feel free to ask the endoscopist questions before, during or after the procedure as well.
11
I've had a video swallow study already. Should I do that again or can I have the FEES procedure?
Your choice! A repeat video swallow study is NOT your only solution. You can have a FEES procedure and gather the same information. One benefit to choosing FEES is you will get more immediate results!