# Stumped



## Gemini18 (Dec 22, 2011)

I don't know if my brain is on Holiday mood (LOL), BUT -- I can't seem to get this.  Can someone assist me with the CPT.  I am looking at 31625 and 31730.  I have the ICD9 codes.

THANK YOU SO MUCH
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PREOPERATIVE DIAGNOSES:  Acute pancreatitis and respiratory failure.

POSTOPERATIVE DIAGNOSES:  Acute pancreatitis and respiratory failure.

PROCEDURES PERFORMED:  Percutaneous tracheostomy, bronchoscopically guided.

BLOOD LOSS:  Minimal.

INDICATIONS FOR PROCEDURE:  Patient has been ventilated for 2 weeks due to acute pancreatitis, therefore tracheostomy was indicated.

OPERATIVE REPORT IN DETAIL:  The patient was prepped and draped in sterile fashion, and her neck was extended.  An incision was made in the suprasternal notch.  The skin and subcutaneous tissues were divided, and then blunt dissection was utilized to dissect down to the airway.  Flexible bronchoscope was placed through the endotracheal tube, and under direct vision, a needle was utilized to access the anterior wall of the trachea.  Wire was inserted, and then, using Seldinger technique, dilation of the tract from skin to
trachea was made, and then a percutaneous tracheostomy tube was placed without difficulty.  Ventilation was excellent at the completion of the procedure.  The trach was secured to the skin with nylon suture, and the endotracheal tube and bronchoscope were withdrawn.


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## Lujanwj (Dec 23, 2011)

31600-22.  Code doesn't describe what tools are used to establish the ostomy.  I'm assuming this was more work than the DR normally does so -22 could/should be warranted.


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## colorectal surgeon (Dec 25, 2011)

sounds like a fairly routine percutaneous tracheostomy to me.  I would guess the bronchoscopy would be coded separately? Not sure why to add the -22.


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## ajs (Dec 27, 2011)

Gemini18 said:


> I don't know if my brain is on Holiday mood (LOL), BUT -- I can't seem to get this.  Can someone assist me with the CPT.  I am looking at 31625 and 31730.  I have the ICD9 codes.
> 
> THANK YOU SO MUCH
> ==========================================================
> ...



It looks like a planned tracheostomy with a bronchosopy.  There were no biopsies done or other procedures.  From that is would look like 31600 and 31615, they are not bundled in the CCI edits.


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