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Mary Posted Tue 22nd of October, 2013 12:42:26 PM

Tracheostomy stomal stenosis around a No. 4 trach tube insertion-physician states patient admitted to surgical service for correction of stomal stenosis and reinsertion of larger trach tube. Small incision was made in tracheal cartilage. Using No. 11 blade scalpel, incision opening of denoted trach site was accomplished in bilateral planes. Tracheal hook was then applied to cricoid ring of trachea where No. 4 trach tube was removed and a well lubricated No. 8 cuffed trach tube with the cuff was inserted without difficulty. The only cpt code I come up with is 31502 - but that is probably not right -any help would be appreciated!!!!

SuperCoder Answered Wed 23rd of October, 2013 08:27:50 AM

If the tracheostomy tube change has been done prior to an establishment of fistula tract from anterior neck portion to trachea, the change can be reported with the code 31502 (Tracheotomy tube change prior to establishment of fistula tract). Usually the establishment of a fistula tract takes about seven days. A tracheostomy tube change prior to the fistula tract becoming fully established is the only scenario under which the above mentioned code can be used for the claim.

If a tube change has been done as a separate procedure in the operating room under general anesthesia in a patient with an established fistula tract, then the procedure can be reported using 31899 (Unlisted procedure, trachea, bronchi).

However, in most circumstances, a tracheostomy tube change is considered a part of the E/M and is just billed as a component of the E/M that is being reported for the visit. But, under some appropriately documented circumstances, the change of a tracheostomy tube may change the level of the E/M to a higher level due to the increase in the level of decision making from your pulmonologist.

If your pulmonologist goes in for a tracheostomy tube change in the 90-day global period of an unrelated procedure that he (or a same-specialty group member) also performed, then a separate E/M can be billed. However, you have to add a modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M to make it known that it is an evaluation and management for an unrelated issue.

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