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ICD-10 Guide
ICD-10 CodesR13.12

R13.12

Dysphagia, oropharyngeal phase

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R13.12 is a billable code used to indicate a diagnosis of dysphagia, oropharyngeal phase.

Key Diagnostic Point:

Dysphagia, oropharyngeal phase, refers to difficulty in swallowing that occurs during the oropharyngeal phase of the swallowing process. This phase involves the movement of food from the mouth through the pharynx and into the esophagus. Symptoms may include a sensation of food being stuck in the throat, coughing or choking during meals, drooling, and difficulty initiating swallowing. Patients may also experience pain while swallowing (odynophagia) and may avoid certain foods or liquids due to fear of choking. The condition can result from various underlying causes, including neurological disorders (e.g., stroke, Parkinson's disease), muscular disorders (e.g., myasthenia gravis), structural abnormalities (e.g., tumors, strictures), and inflammatory conditions (e.g., infections, gastroesophageal reflux disease). Accurate diagnosis often requires a thorough clinical evaluation, including a detailed history, physical examination, and possibly imaging studies or endoscopic evaluation to assess the swallowing mechanism.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of underlying causes requiring differential diagnosis
  • Potential overlap with other swallowing disorders
  • Need for detailed documentation of symptoms and clinical findings
  • Variability in presentation among different patient populations

Audit Risk Factors

  • Inadequate documentation of symptoms leading to misclassification
  • Failure to specify the phase of dysphagia
  • Lack of supporting clinical findings or diagnostic tests
  • Coding without a clear link to the underlying cause

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Comprehensive history of swallowing difficulties, including onset, duration, and associated symptoms.

Common Clinical Scenarios

Patients presenting with unexplained weight loss, recurrent aspiration pneumonia, or chronic cough.

Billing Considerations

Consideration of comorbidities such as diabetes or neurological disorders that may complicate dysphagia.

Emergency Medicine

Documentation Requirements

Acute assessment of airway compromise, vital signs, and immediate interventions.

Common Clinical Scenarios

Patients presenting with acute choking episodes or aspiration events.

Billing Considerations

Rapid evaluation of the patient's airway and the need for potential emergency interventions.

Coding Guidelines

Inclusion Criteria

Use R13.12 When
  • Follow ICD
  • CM guidelines for coding symptoms and signs
  • Ensure that the documentation supports the diagnosis of oropharyngeal dysphagia specifically, and consider any underlying conditions that may be contributing

Exclusion Criteria

Do NOT use R13.12 When
No specific exclusions found.

Related CPT Codes

92610CPT Code

Evaluation of swallowing function

Clinical Scenario

Used when a patient is evaluated for swallowing difficulties.

Documentation Requirements

Document the clinical rationale for the evaluation and findings.

Specialty Considerations

Speech-language pathology may be involved in the assessment.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of dysphagia, enabling better tracking of the condition and its causes, which can improve patient management and outcomes.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of dysphagia, enabling better tracking of the condition and its causes, which can improve patient management and outcomes.

Reimbursement & Billing Impact

The transition to ICD-10 has allowed for more specific coding of dysphagia, enabling better tracking of the condition and its causes, which can improve patient management and outcomes.

Resources

Clinical References

  • •
    American Speech-Language-Hearing Association (ASHA)
  • •
    National Institute of Health (NIH) - Dysphagia

Coding & Billing References

  • •
    American Speech-Language-Hearing Association (ASHA)
  • •
    National Institute of Health (NIH) - Dysphagia

Frequently Asked Questions

What are the common causes of oropharyngeal dysphagia?

Common causes include neurological disorders (e.g., stroke, Parkinson's disease), muscular disorders (e.g., myasthenia gravis), structural abnormalities (e.g., tumors), and inflammatory conditions (e.g., infections).

How is oropharyngeal dysphagia diagnosed?

Diagnosis typically involves a detailed clinical history, physical examination, and may include imaging studies or endoscopic evaluations to assess swallowing function.