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 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 (and reporting has been allowed more often lately in light of the COVID-19 pandemic).

The correct code for emergency intubation is 31500 (Intubation, endotracheal, emergency procedure). This code is reported when the patient is not having an anesthesia procedure and the anesthesia department was called to intubate the patient for a lifesaving emergency. However, if this occurs, keep in mind that the CRNA cannot be “medically directed” for a surgical procedure they are performing. For example, if this is a Medicare patient and the CRNA performed the emergency intubation, 31500 is reported by the CRNA using their own provider number. Medical direction modifiers do not apply to surgical codes.

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.

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