CODING CORNER: Follow These 4 Steps to Ensure Correct Tracheostomy Coding

Leave 31603 unless there's an immediate, life-threatening reason for the procedure

Don’t let avoidable tracheostomy coding mistakes cost your facility loads of lost revenue--let our experts guide you through these four steps so you can master tracheostomy coding.

Step 1: Define ‘Emergency’
CPT makes a primary distinction between “planned” and “emergency” tracheostomy, so you must determine which of these conditions best describes the  procedure when selecting a code. What’s the difference?
“An emergency procedure is just that,” says M. Trayser Dunaway, MD, FACS, a general surgeon in Camden, S.C. “Essentially, the patient is immediately imperiled if the physician doesn’t perform the procedure.” In other words, the patient’s airway is so compromised that he is already obstructed or may obstruct at any moment.
Use common sense: Just because the doctor sees a patient and decides to perform a tracheostomy that same day doesn’t mean you have an emergency. Rather, an emergency tracheostomy must occur because of an immediate, life-threatening situation.
You should report such emergency procedures using one of two codes:
• 31603--Tracheostomy, emergency procedure; transtracheal
• 31605--… cricothyroid membrane.
These two procedures differ according to the location at which the doctor makes her incision.

Your most likely choice: The incision for transtracheal tracheostomy (31603) occurs in the trachea itself, usually between the second and third rings. This is the more typical procedure.
 
The surgical cricothyroidotomy (31605) involves an incision in the cricothyroid membrane. Although easier to perform than 31603, 31605 puts the vocal cords at risk of injury and is therefore less common, Dunaway says. “In the emergency department, these trachs are rare.”

Step 2: Check for Flaps
If the physician uses skin flaps to create a more permanent stoma (opening)--such as for patients with multiple sclerosis, amyotrophic lateral sclerosis (ALS) or other chronic conditions that cause breathing difficulties--you should turn to 31610 (Tracheostomy, fenestration procedure with skin flaps).
Watch for: Sometimes physicians will use the terms “Bjork flap” or “inferior tracheal flap” to describe skin flaps used in this type of tracheostomy.
Step 3: Be Sure Planned Is Also Separate
Because CPT defines all planned tracheostomies as “separate procedures,” you must be sure that any trach the doctor provides is not integral to a more extensive procedure. If the trach is incidental (that is, performed as a part of another procedure), you may not report it separately, says Barbara J. Cobuzzi, MBA, CPC, CPC-H, CHBME, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Shrewsbury, N.J.
When you can code: Insurers will allow for a separate, planned tracheostomy when:
• the surgeon performs only the tracheostomy

• the tracheostomy occurs for a different reason than that prompting the primary procedure. [...]

- Published on 2006-04-17