WHAT IS A FEES EXAM?

 

A flexible endoscopic evaluation of swallowing (FEES) exam is a procedure used to assess how well a patient swallows. During the procedure, a speech-language pathologist (SLP) passes a thin, flexible instrument through the nose. Then the SLP views parts of the patient's throat as they swallow. A FEES test can help assess if the patient is having any problems with the part of the process when food and liquid pass through their throat and help prevent aspiration and aspiration-centric complications.

 

WHY A PATIENT MAY NEED A FEES EXAM

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A patient may need this test if they are having trouble swallowing (dysphagia). With dysphagia, something is wrong with the muscular coordination needed for normal swallowing. Dysphagia can lead to food or fluid going into the airway or lungs (aspiration). This can lead to pneumonia and other problems. Because of this, it’s important to promptly identify and treat dysphagia if the patient has it.

 

A patient might need a FEES if they have any symptoms of dysphagia, such as a sense of food sticking in their throat or pain with swallowing.

A patient may also need an FEES if they have a medical condition that puts them at high risk of dysphagia, even if they don’t have symptoms.

Some people with dysphagia don’t have any symptoms.

 

Other conditions that might cause dysphagia include:

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• Head and neck cancer.

• Head injury.

• Conditions that lead to decreased saliva (such as Sjogren’s syndrome).

• Parkinson’s disease or other neurologic conditions.

• Muscular dystrophies.

• Obstruction in the esophagus (such as from cancer).

 

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BENEFITS OF A FEES EXAM OVER AN MBSS  (Modified Barium Swallow Study)

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​There are advantages of Flexible Endoscopic Evaluation of Swallowing (FEES) over Modified Barium Swallow Studies.  Advantages include that FEES is mobile and can be provided at the patient’s bedside.  Therefore, the patient does not have to travel which is necessary with MBSS.  Since there is no travel for the patient, this keeps costs down for patients who are living in a facility or must pay for transportation.  It’s also been shown to be safer and more sensitive to aspiration and residue. 

 

FEES is most advantageous for the following:

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• Facility or home-bound patients

• Medically complex patients or patients who have difficulty transporting

• Patients who require longer studies 

• May be more sensitive to microaspiration and residual

• Can assess secretions

• Less expensive

• Real food

• Direct visualization of the structures including vocal fold function

 

BENEFITS OF A FEES EXAM FOR THE ADMINISTRATOR AND ONSITE SLP

 

• It’s safe: FEES uses a small camera that is inserted in the nose and looks down the throat at the larynx.  There are certain inherent risks associated with a scope pass including fainting and nosebleeds (research articles and data that demonstrate the safety of FEES.) 

 

• It’s quick: Tests are typically scheduled and conducted within the same week, as opposed to a modified barium swallow study (MBSS) at the hospital which may take up to a month to schedule.  This quick turn-around is important to the resident & their diet recommendations, to the treating SLP and their course of treatment, and to the facility and their reimbursement. 

 

• FEES is an effective way to help diagnose dysphagia. 

 

• It costs money (But less than a denial or MBS): We bill the facility a flat fee for the procedure. The SNF can in turn bill Medicare Part B or other payors on the UB-04 and recoup a significant portion of their investment. There is an opportunity for demonstrable savings under Part A.  By sending a patient on Part A out of the facility for a procedure like barium swallow, the SNF is responsible for the bill under consolidated billing.  This will impact the SNF’s margin quickly!  Since FEES is less costly to the facility, the savings go right to the bottom line. Lastly, reports from our FEES provide supportive documentation, help to dispute denied claims, and support the coding of a swallowing disorder for the entire Part A length of stay under PDPM.

 

• It’s a measurable asset to your SLP and their job: SLP’s love having the opportunity to see what is going on inside during the swallow.  SLPs can try multiple strategies, food consistencies, and postures in a controlled setting during the FEES.  Clinicians love to be involved in this process and be part of the evaluating team.

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Our on-site FEES service is affordable, convenient, and effective.