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 needed 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. I have discussed with the patient that we should proceed to securing her airway in an elective fashion at this point. …  she understands the benefits … 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.” However, our anesthesiologist says this situation “was like a main OR case” with him supervising the CRNA; the CRNA performed intubation and no tracheostomy was needed later. 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?

Montana Subscriber

Answer: Elective intubation is a part of general anesthesia and therefore would not be separately paid. That’s why CPT^® does not include a code for the service. You can, however, report an emergency intubation as long as the code description is met and the patient did not have surgery. An example of this would be if the anesthesiologist is called to intubate a patient for respiratory distress.

The correct code for an emergency intubation is 31500 (Intubation, endotracheal, emergency procedure).

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.  However, if no other procedure was performed, you may report an unlisted anesthesia code with the associated time and send a copy of the anesthesia record and operative report with your claim.

Different scenario: If the surgeon had 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.