Fiberoptic Endoscopic Evaluation of Swallowing (FEES)

FEES is a 10 to 20 minute, instrumental procedure conducted by a speech-language pathologist that has advanced training in dysphagia and endoscopy.

The procedure involves inserting a small, specialized scope through a patient’s nose. The scope then hangs in the pharynx while the patient eats and drinks. The scope has special cameras that allow the endoscopist/SLP to view the swallow of oral intake trials on live video.

The endoscopist/SLP is then able to discern a variety of diagnostic indicators from the video of the swallowing mechanism and bolus. Information gathered includes:

  • notation of any anatomical variations

  • presence and management of secretions, which could be particularly important in NPO patients

  • safety of oral intake

  • underlying anatomical or physiological factors contributing to swallowing problems

  • recommendations for oral intake consistencies

  • recommendations for oral intake strategies or compensations to improve safety

  • recommendations for therapy methods or strategies based on anatomical and physiological factors

  • possible need for further referrals

  • while the study does have emphasis on the pharyngeal phase of the swallow, we are able to capture some indicators that allow us to make inferences about possible oral phase and esophageal phase issues (for example, we may see that food items were not adequately chewed or we may see backflow from the esophagus after the swallow that reenters the pyriform sinuses, posterior-cricoid space, or even the laryngeal vestibule)

More About FEES

  • Most patients with active dysphagia, a history of dysphagia, or suspected dysphagia are candidates for FEES. These may include but are not limited to patients with the following comorbidities: stroke, TIA, neurological disorders, brain injury, COPD, trach/vent, head/neck cancer, chronic cough, globus sensation, vocal fold pathologies, current NPO or current consistency alterations, current feeding tube, thyroidectomy, pneumonia, reflux, laryngeal differences, asthma, cardiac issues, etc.

  • FEES is contraindicated for patients with recent facial trauma that is not healed due to the scope tubing being inserted into the nasal passage and the endoscopist needing to anchor his/her hand on the patient’s nose and and/or cheek bone.

    FEES is also contraindicated for patients that are severely agitated and may pull away from the endoscopist, push the endoscopist away, and/or attempt to pull the scope from their own nose.

    Severe nasal obstruction bilaterally can also prevent comfortable passage of the scope. The scope can usually be passed with an NG tube in place.

    If you’re unsure if your patient is a candidate, please feel free to contact me and I can guide you further.

  • It is advisable but not required that the patient’s treating SLP participate in the exam. Often times, the treating SLP is an invaluable resource for the endoscopist. If unable to attend, we would love to schedule a call with you before the exam.

    If the patient consents, he/she may have a loved one present during the exam.

  • We conduct FEES exams inside any facility that has established and executed a contract with us. We typically complete the procedure in the patient’s room. The patient can be in bed, in a wheelchair, in any specialized medical chair he/she uses, a recliner, etc. The exam can be conducted outside of the patient’s room, as long as the patient’s privacy can be protected.

    We can establish a contract with a variety of facility types. These can include skilled nursing facilities, inpatient rehabilitation facilities, post-acute facilities, long-term care hospitals, outpatient clinics, physician’s offices, and more.

  • As with any procedure, there are risks; however, the risks associated with a FEES exam are shown in the scientific literature to occur rarely. Risks include: nose bleeds, mucosal scratches/lacerations, gagging, sneezing, fainting, discomfort, or laryngospasms. Endoscopists are trained to respond appropriately to these reactions.

  • Due to Medicare’s consolidated billing requirement, our company submits an invoice to your facility after the procedure is complete. Your facility may bill the patient’s insurance for the FEES exam using CPT Code 92612.

    It would be deemed unethical and illegal for us to bill insurance due to the consolidation rule and other insurance regulations.

  • I’m thrilled that you are interested in initiating this service for your patients. Dysphagia Imaging of Louisiana is a service provided under the umbrella of Play & Say, LLC. Please email me at hello@louisianadysphagia.com and I’d be happy to schedule a meeting at your location or a zoom conference with you to discuss the details of a contract.

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