ED Intubations Are Always an Emergency
Question: If a patient in the emergency department (ED) has a mandible fracture and the physician preformed intubation to protect the airway, should I report 31500? Because the decision to intubate was for airway protection, not an "emergency procedure," I'm unsure which code to report.
Arizona Subscriber
Answer: You can still report 31500 (Intubation, endotracheal, emergency procedure) in the circumstances you describe.
All unplanned intubations in the ED qualify as emergent; physicians never perform elective intubations in the ED. An anesthesiologist usually performs an elective intubation, meeting the patient prior to a procedure, usually on a different date of service.
You're right to question whether the scenario is emergent rather than just urgent. Your physician still performed an emergent procedure, however, because if the physician had waited and not performed intubation, the situation would have become emergent.
Insertion Method Determines Thoracentesis Code
Question: How should I code the following situation: The physician uses a thoracentesis needle and catheter mechanism to enter the pleural space. She obtains auburn-colored fluid from the wound, which is clear and not bloody, and then uses intravenous tubing to drain about 400 cc into the Vacutainer. Code 32000 does not seem to apply. I don't think the physician would make an incision for a service reported by 32000, so should I report 32002?
Michigan Subscriber
Answer: Indeed, you should report 32002 (Thoracentesis with insertion of tube with or without water seal [e.g., for pneumothorax] [separate procedure]). For this service, a catheter and stylet mechanism puncture the pleural space, and the physician removes the stylet and leaves the catheter in place. Your physician can remove multiple syringes of pleural fluid using this technique.
Code 32000* (Thoracentesis, puncture of pleural cavity for aspiration, initial or subsequent) involves using a metal needle, which the physician sticks into the pleural space to remove one syringe of fluid. For the other relevant code, 32020 (Tube thoracostomy with or without water seal [e.g., for abscess, hemothorax, empyema] [separate procedure]), the physician makes the incision and inserts a formal chest tube.
- Reader Questions reviewed by Sarah Goodman, MBA, CPC-H, CCP, president of SLG Inc. Consulting in Raleigh, N.C.
