# Stuck on a Trach Tube Change Procedure



## BABS37 (Jun 2, 2013)

I'm having trouble deciding which is the correct way to charge out this procedure. The patient has been coming in for over a year who is tracheotomy dependent. He comes in for a change and the physician decides to do a revision flap tracheotomy-which would lead me to 31830 series but he is also replacing the tube which would toss me back to 31614 series... i just don't know what to do as I haven't had any situations like this one. Thoughts on how to code this one?

Procedure:
Revision Flap Tracheotomy with Bronchoscopy and tracheotomy tube change

...a tracheotomy tube change was attempted. The #6 shiley trach tube was removed. A #7 tube was utilized and this was not possible. Therefore, a #6 was placed into the trachea through the tracheotomy site and was ventilated. At this point, I made the decision to go forward with a formal flap tracheotomy. The standard flap incisions were designed on the anterior neck. A dissection of the tracheotomy tract from the skin to the trachea was carefully carried out, with the excision of the entire scar band of the tracheotomy tract leaving a large open wound. The subcutaneous undermining of the skin flaps were performed circumferentially. Each flap was then carefully sewn to the trachea using 3-0 suture. A 4-0 suture was used to close the margins of the skin flaps. At this point, a #8 shiley tube was placed with no difficulty. A flexible bronchoscopy was performed evaluating the tracha and mainstream bronchi, and secondary bronchi, revealed no bleeding site of abnormality. At this stage, the procedure was termed. 

Lost!


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## BABS37 (Jun 8, 2013)

No Experts in Trach coding?


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## jessica81680@comcast.net (Jun 10, 2013)

I agree with the 31614 for the tracheotomy.  I would use a separate code for the bronchoscopy, most likely 31622.


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## kvangoor (Jun 10, 2013)

I would use the 31614. I am no expert but when reading the lay descriptions, it seems they are describing what you have in your note for the 31614. 31830 decribes just revising an old scar.


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## Candice_Fenildo (Jun 10, 2013)

Babs I will email you tomorrow with my thoughts


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## Candice_Fenildo (Jun 11, 2013)

Okay Babs. Sorry, I did not have my resources in front of me last night. sounds like you should code 31614 and 31622. Good Luck


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