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If a cause is on the chart, it changes the lead code: Post-stroke goes to I69.391 first, R13.1x second GERD causing esophageal dysphagia goes to K21.9 first, K22.4 second Esophageal stricture goes to K22.2 first Parkinson's with dysphagia goes to G20 first, R13.1x second Outpatient vs inpatient at a glance This framework catches most of the coding errors before they reach a payer

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If no improvement appears after six months of consistent use, consider whether the protocol needs modification