To alleviate confusion concerning coding for tracheostomies, answer the following questions to guide you to the correct procedural code.
(For tips on reporting related post-tracheostomy procedures and services, see Resolve Post-Tracheostomy Billing Issues With Three Questions"" in next month's issue.)"
1. Is the Tracheostomy Planned or Is It an Emergency?
CPT lists four codes that describe tracheostomy with no additional procedures:
And one code for tracheostomies with skin flaps:
The key difference between 31600-31601 and 31603-31605 are the terms "planned" and "emergency. You should choose between these code sets based on the events surrounding the tracheostomy. If the patient may obstruct sometime and the otolaryngologist schedules the procedure assign a planned tracheostomy (31600-31601) says Charles F. Koopmann MD MHSA professor and associate chairman of the department of otolaryngology physician billing director and a member of the faculty group practice at the University of Michigan in Ann Arbor. "If the patient's airway is so tenuous that the physician cannot postpone the tracheostomy report an emergency tracheostomy (31603-31605)."
The events surrounding the trach can often point you to the correct code set. For instance planned trachs (31600-31601) frequently occur after a patient has been intubated for a long period or requires long-term ventilatory support. The tracheostomy helps to suction secretions and increase air delivery to the lungs. The attending physician usually requests that an otolaryngologist perform the procedure. For these elective planned tracheostomies you should report 31600 or 31601.
On the other hand doctors perform emergency tracheostomies when a patient's airway is so compromised that he may obstruct at any moment. For example a patient presents with wheezing (786.07) which is quickly progressing to upper-airway obstruction. The otolaryngologist performs a tracheostomy. For emergent situations that require an opening of the windpipe assign 31603-31605.
Some coders question whether an emergency trach requires a dire situation or if a situation that requires a same-day tracheostomy qualifies as urgent. "Emergency tracheostomy is just what it says it is it is an emergent situation " says Barbara Cobuzzi MBA CPC CPC-H an otolaryngology coding and reimbursement specialist and president of Cash Flow Solutions a medical billing firm in Lakewood N.J.
Stedman's Medical Dictionary defines emergency as "an unexpected development or happening; a sudden need for action." "You cannot describe a set amount of time to define an emergency versus planned trach " Koopmann explains. An emergency trach instead requires a sudden need for action due to the condition of the patient's airway.
For instance an adult patient has an abscess (e.g. 42300* [...]