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MP 6.01.15 Videofluoroscopic Evaluation of Velopharyngeal Dysfunction

 

Medical Policy    
Section
Radiology
Original Policy Date
7/31/96
Last Review Status/Date
Reviewed with literature search/3:2003
Issue
3:2003
  Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.

 


 

Description

Velopharyngeal dysfunction (VPD) refers to excessive nasal resonance or hypernasality during speech as the consequence of anatomical abnormalities of the velopharyngeal sphincter involving the velum (soft palate) and/or pharyngeal walls that compromise the seal between the nasopharynx and oral cavity. Normal phonation requires the generation of a column of air that flows from the subglottis into the upper airway. When (VPD) is present, air escapes through the nose during speech, resulting in the characteristic nasal resonancy. VPD is most commonly associated with cleft palate; it may be the only sign of a submucous cleft palate, or may persist after closure of an overt cleft palate.

Velopharyngeal dysfunction can usually be diagnosed by the speech/language pathologist based on the presence of hypernasal speech, compensatory misarticulations, escape of air through the nose, insufficient oral pressure for consonant production, and aberrant facial movements. Imaging options include fiberoptic nasoendoscopy and videofluoroscopy. Videofluoroscopy is a noninvasive radiologic technique intended to assess the competency of velopharyngeal closure. Videotape recording produces a continuous record of the velopharyngeal mechanism. A barium coating of the pharyngeal structures can be used to provide contrast in the videofluoroscopic image. Frontal and basal viewing angles can be used alone or in combination. The procedure is used to assess various forms of velopharyngeal insufficiency, including cleft palate. Videofluoroscopy is frequently performed as an adjunct to surgical planning in patients who do not respond to conservative treatment such as speech therapy.

 


 

Policy

Based on a strict evidence-based approach, videofluoroscopic evaluation is considered investigational as a technique to assist in surgical planning for treatment of velopharyngeal insufficiency. For further discussion, see Rationale.

 


 

Policy Guidelines

No applicable information

 


 

Benefit Application

BlueCard/National Account Issues

Videofluoroscopic evaluation of velopharyngeal closure may be offered by clinics specializing in treatment of cleft palate or craniofacial abnormalities.

 


 

Rationale

Evaluation of a diagnostic technology typically involves a 3-pronged approach, i.e., determining the technical feasibility of the test, its diagnostic parameters (i.e., sensitivity, specificity, positive and negative predictive value) compared to a gold standard, and whether or not management based on the results of the diagnostic test are associated with an improved health outcome. In the absence of a gold standard, it is particularly important to determine that the diagnostic test ultimately results in an improved health outcome.

Videofluoroscopy of velopharyngeal closure has been performed for many years, and in many articles and textbooks, it is identified as a standard component of surgical planning for velopharyngeal insufficiency. In 1988, an international working group established a system for quantifying, recording, and describing movements of the relevant anatomy. A recommendation was also made that suggested that all patients with velopharyngeal deficiency be studied with both videofluoroscopy and nasopharnygoscopy (1), and the Ad Hoc Committee of the American Cleft Palate-Craniofacial Association suggest videofluoroscopy as one technique that may be helpful in evaluating velopharyngeal insufficiency. (2) For example, it is thought that defining the velopharyngeal closure pattern is particularly important to determine the appropriate surgical intervention. The 3 most common surgical approaches to velopharyngeal dysfunction include pharyngoplasty, pharyngeal flap, or posterior wall augmentation. However, even within these broad categories of surgical approaches, the results of videofluoroscopy have been used to tailor the surgery to the individual patient. (3) Therefore, it is not surprising that a search of the literature did not identify any controlled studies that were specifically designed to investigate the role of videofluoroscopy in surgical planning. In addition, pre- and postsurgery videofluoroscopy would be ideally necessary to compare clinical assessments of speech and anatomic function. Postoperative studies are not routinely performed. In the future, MRI may replace videofluoroscopy. (4,5)

References:

  1. Golding-Kushner KF, Argamaso RV, Cotton RT et al. Standardization for the reporting of nasopharyngoscopy and multiview videofluoroscopy: a report from an international working group. Cleft Palate J 1990; 27(4):337-48.
  2. Dalston RM, Marsh JL, Vig KW et al. Minimal standards for reporting the results of surgery on patients with cleft lip, cleft palate or both: a proposal. Cleft Palate J 1998; 25(1):3-7.
  3. Ysunza A, Pamplona C, Ramirez E et al. Velopharyngeal surgery: a prospective randomized study of pharyngeal flaps and sphincter pharyngoplasties. Plast Reconstr Surg 2002; 110(6):1401-7.
  4. Vadodaria S, Goodacre TE, Anslow P. Does MRI contribute to the investigation of palatal function? Br J Plast Surg 2000; 53(3):191-9.
  5. Witt PD, Marsh JL, McFarland EG et al. The evolution of velopharyngeal imaging. Ann Plast Surg 2000; 45(6):665-73.

 

Codes

Number

Description

CPT 

70370 

Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique 

 

70371 

Complex dynamic pharyngeal and speech evaluation by cine or video recording 

ICD-9 Procedure 

87.06 

Contrast radiogram of nasopharynx 

 

87.09 

Other soft tissue x-ray of face, head and neck (non-contrast) 

ICD-9 Diagnosis 

749 

Cleft palate and cleft lip, code range 

HCPCS 

 

Type of Service 

Radiology 

Place of Service 

Outpatient 

 


 

Index

Fluoroscopy, Video of Velopharyngeal Closure
Speech Pathology, Videofluoroscopic Evaluation
Velopharyngeal Closure Evaluation
Videofluoroscopic Evaluation of Velopharyngeal Closure

 


 

Policy History

Date

Action

Reason

07/31/96

Add to Radiology section

New Policy

04/15/02

Replace policy

Policy reviewed without literature review; new review date only

04/29/03

Replace policy

Policy updated with literature review; policy statement unchanged, but additional discussion in the Rationale section