National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Transcutaneous Neuromuscular Electrical Stimulation (NMES) for oropharyngeal dysphagia, in May 2014.


Difficulty in swallowing (dysphagia) can result from neurological impairment affecting the muscles of the oropharynx. It can occur as a result of stroke, traumatic brain injury, disorders of cerebral development, neurodegenerative conditions and major head and neck surgery such as removing cancer.  Dysphagia may lead to malnutrition, dehydration or aspiration pneumonia. This guidance only applies to adults with oropharyngeal dysphagia.

Treatment options depend on the cause and severity of the dysphagia. Conservative treatments (traditional therapy) involve swallowing therapy to help the patient relearn swallowing techniques and strengthen oropharyngeal muscles. In severe cases nasogastric tubes or percutaneous endoscopic gastrostomy tubes may be used to provide nutritional support.

Coding recommendations

A70.7 Application of transcutaneous electrical nerve stimulator

Z92.3 Neck NEC

Code Y70.3 First stage of staged operations NOC or Y71.1 Subsequent stage of staged operations NOC may be assigned after A70.7 if performed as a staged procedure during separate attendances.

In addition ICD-10 code R13.X Dysphagia is assigned.

Your responsibility

This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.

Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

  • National Institute for Health and Care Excellence (NICE)