Anesthesia Coding Alert

Question: A patient was taken to the OR for an “elective emergent intubation” under general anesthesia. The patient had a mass and the surgeon thought they might run into trouble and need to perform an emergency tracheostomy.

The surgeon’s dictation states, “The patient was taken to the OR for controlled intubation due to her history of laryngeal mass and airway obstruction.” His progress note states, “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.”

The anesthesiologist says this situation “ was like a main OR case ... he was supervising the CRNA. CRNA is the one that did the intubation.”

I think that if the case was like a main OR case, airway access is necessary for general anesthesia and is not separately reportable. What’s your advice on billing this case?

Montana Subscriber

Answer: Elective intubation is a part of general anesthesia, as you know, and therefore would not be separately paid. That’s why CPT^® does not include a code for the service.

You can, however, sometimes report an emergency intubation.

The correct code for emergency intubation is 31500 (Intubation, endotracheal, emergency procedure). Only bill this with a general code for anesthesia services if your documentation supports medical necessity for performing the intubation in anticipation of possible complexity later during surgery. Most insurers are not inclined to pay 31500 separately, and CPT^® does not include an anesthesia cross-code for the service.

The American Society of Anesthesiologists (ASA) defines an emergency as existing when delay in treatment of the patient would lead to a significant increase in the threat to life or body part. When applying this guideline, the case you describe does not meet the criteria of an emergency. Therefore, you should not submit 31500. Instead, submit the appropriate anesthesia code such as 00320 (Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; not otherwise specified, age 1 year or older) and associated anesthesia time units. 

Different scenario: If the surgeon performed a tracheostomy, he would report 31600 (Tracheostomy, planned [separate procedure]). The anesthesiologist or CRNA should submit the associated code 00320 with a base value of 6 units.