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Intubation in the OR under General Anesthesia

Tammy Posted Wed 12th of June, 2013 16:42:22 PM

I need your coding help and thoughts with a case please. :confused:

Our patient was taken to the OR for an "elective emergent intubation" under general anesthesia. The patient had a mass and the surgeon thought they may run into trouble and would have to perform an emergency trach.

Anesthesiologist says "this was like a main OR case .. he was supervising the CRNA. CRNA is the one that did the intubation."

My thoughts are .... If this case is just like a main OR case .. airway access is necessary for general anesthesia and is not separately reportable. We can't say we sedated the patient, protected the airway .. so we can ~ well ~ protect the airway.

On the other side we have '31500'. CPT lists the description as "emergency intubation." This case does not meet the description of an emergency.

I know an emergency response requires personnel to respond immediately ... an immediate response is one in which the provider begins as quickly as possible to take the steps to respond.

Keeping in mind that ASA (page 44 of the RVG) says an emergency is defined as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part .. surgeon's OP dictation says "The patient was taken to the OR for controlled intubation due to her history of laryngeal mass and airway obstruction." And his Progress note that was dictated at 12:39 says "I have discussed with the patient that we should proceed to securing her airway in an elective fashion at this point. She understands the great benefit of this as opposed to waiting and having a possible airway emergency. I have discussed with the anesthesiologist and we have planned for intubation today at 3:30 in the OR, with the need for possible tracheostomy."

There is no CPT code for an elective intubation.

Any thoughts on how to bill this case would GREATLY be appreciated!

Thank you! Tammy

SuperCoder Answered Fri 14th of June, 2013 01:23:01 AM

Hi,

My Senior editor will be working on this. You will hear from him soon. Thanks for being patient.

SuperCoder Answered Fri 14th of June, 2013 06:20:35 AM

Elective intubation is a part of gen. anesthesia, as you know, and therefore would not be separately paid. Bill 31500 for emergency intubation along with gen. anesth. code (main ASA code for anesth. service) only if your documentation can prove the absolute medical necessity to perform an intubation anticipating possible complexity later during surgery. Insurances in general would not be interested to pay for 31500 separately, even though physician apprehends a possible airway complexity and tries to avoid a trach.

If tracheostomy was performed during surgery, by the anesthesiologist/CRNA, bill 31600.

Append anesthesia modifier appropriately, based on payer policy, since this case was being performed by CRNA, under Anesthesiologist's supervision.

Tammy Posted Wed 19th of June, 2013 19:33:53 PM

Thank you very much SuperCoder!

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