# Intubation in the OR



## TammyW (Jun 12, 2013)

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

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


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## Michele Hannon (Jun 13, 2013)

What kind of anesthesia did the patient receive? MAC with topicalization or General with an inhalation induction?
You might consider the unlisted code 01999 and submit the records.

Some things to consider......the patient cannot remain intubated indefinitely. Definitive treatment would include a trach or removal of the mass. Were either of these accomplished at a later time? If so, within 24 hours, etc. Definitive treatment would include securing the airway as part of the anesthetic......and even though more work was involved.....it is still considered part and parcel of the anesthesia package.

Would be interested in others thoughts.


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## TammyW (Jun 19, 2013)

Hello Michele,    Thank you for responding!

The patient received General anesthesia with IV induction of Propofol on the 24th for the procedure listed above.   Then returned to the OR on the 28th for a tracheostomy.    

I see what you're saying ... and that makes sense.   Hhhmm.


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