About FEES
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About FEES
FEES is a procedure used to evaluate patients with dysphagia. It is done throughout the US and in all countries that have established programs to evaluate and treat patients with dysphagia. In many countries it has become the most common instrumental procedure because it is easy to implement in multiple clinical settings (inpatient, outpatient, rehab, mobile). FEES also has an advantage over fluoroscopy in that it can easily be taken to bedside, it requires less staffing and infrastructure, the equipment costs less, it does not involve radiation, and there are no time limits on exam length facilitating assessment of natural eating, comprehensive trialing of compensatory maneuvers, and use as a biofeedback tool. For those who are not familiar with the procedure, using a flexible laryngoscope and camera allows for visualization of the base of tongue, throat and larynx. When the person eats and drinks, the examiner is able to assess whether the swallow is normal or impaired. If impaired, the nature of the problem can be determined. Using dietary, behavioral, and postural interventions, the examiner then attempts to remediate the problem and determine how the patient can eat most safely and effectively. Speech Language Pathologists are the main practitioners who evaluate oropharyngeal swallowing with this tool but some physicians have also developed expertise in using FEES in their practice. In some countries, such as Japan, physicians are the primary endoscopists and the speech pathologist may assist in the exam. In order for any practitioner to be proficient in this procedure, training is needed. This takes the form of skill training (how to handle a laryngoscope) and knowledge-based training (how to identify abnormal findings and know what interventions might be effective). To read more about FEES, the following book and articles are recommended: Langmore SE. Endoscopic Evaluation and Treatment of Swallowing Disorders. Hardcover: 263 pages; Publisher: Thieme; 2 edition (January 15, 2001) Langmore SE, Scarborough DR, Kelchner LN, et al. Tutorial on Clinical Practice for Use of the Fiberoptic Endoscopic Evaluation of Swallowing Procedure With Adult Populations: Part 1. American journal of speech-language pathology / American Speech-Language-Hearing Association. Jan 18 2022;31(1):163-187. doi:10.1044/2021_ajslp-20-00348 Langmore SE. History of Fiberoptic Endoscopic Evaluation of Swallowing for Evaluation and Management of Pharyngeal Dysphagia: Changes over the Years. Dysphagia. 2017 Feb;32(1):27-38. Giraldo-Cadavid LF, Leal-Leaño LR, Leon-Basantes GA, et al: Accuracy of endoscopic and videofluoroscopic evaluations of swallowing for oropharyngeal dysphagia. Laryngoscope 2017; 127:2002–2010 Warnecke T, Teismann I, Oelenberg S, et al. The safety of fiberoptic endoscopic evaluation of swallowing in acute stroke patients. Stroke; a journal of cerebral circulation. Feb 2009;40(2):482-6. doi:10.1161/STROKEAHA.108.520775 Langmore SE, Schatz, K, Olsen, N. Fiberoptic endoscopic examination of swallowing safety: A new procedure. Dysphagia. December 1988, Volume 2, Issue 4, pp 216–219 |
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FEES Milestones
First publication: Langmore, Schatz, and Olson, Dysphagia, 1988.
FEES was first developed in response to a need for a more portable exam to replace the bedside clinical exam for inpatients. As its value as a stand-alone exam became better appreciated and as technology advanced, FEES has evolved to the point where today FEES is a standard instrumental exam that is widely done throughout the US and internationally.
FEES included in the SLP scope of practice by ASHA, 1991.
By identifying FEES as an evaluation procedure that is within the scope of practice of SLPs, ASHA established its credibility. They emphasized that training is needed to perform and interpret the exam and followed this document with a Position Statement on the role of the SLP and further documents that provided Knowledge and Skills needed to perform the exam. The ASHA website has these documents available to anyone.
FEES made a billable CPT procedures, 1994 (CPT – 92612)
In 1994, The Centers for Medicare and Medicaid Services determined that FEES should have its own CPT code, thus establishing it as a procedure that is separate and distinct from other procedures that utilize a laryngoscope. From that time on, FEES was no longer confused with CPT code # 31575, Diagnostic Laryngoscopy, as typically performed by otolaryngologists as their standard laryngoscopy exam to assess for laryngeal pathology.
First publication: Langmore, Schatz, and Olson, Dysphagia, 1988.
FEES was first developed in response to a need for a more portable exam to replace the bedside clinical exam for inpatients. As its value as a stand-alone exam became better appreciated and as technology advanced, FEES has evolved to the point where today FEES is a standard instrumental exam that is widely done throughout the US and internationally.
FEES included in the SLP scope of practice by ASHA, 1991.
By identifying FEES as an evaluation procedure that is within the scope of practice of SLPs, ASHA established its credibility. They emphasized that training is needed to perform and interpret the exam and followed this document with a Position Statement on the role of the SLP and further documents that provided Knowledge and Skills needed to perform the exam. The ASHA website has these documents available to anyone.
FEES made a billable CPT procedures, 1994 (CPT – 92612)
In 1994, The Centers for Medicare and Medicaid Services determined that FEES should have its own CPT code, thus establishing it as a procedure that is separate and distinct from other procedures that utilize a laryngoscope. From that time on, FEES was no longer confused with CPT code # 31575, Diagnostic Laryngoscopy, as typically performed by otolaryngologists as their standard laryngoscopy exam to assess for laryngeal pathology.