ED Coding and Reimbursement Alert

Question: When the ED physician performs rapid sequence induction (RSI) prior to an endotracheal intubation, should I consider the RSI part of procedure 31500, or part of the E/M level or critical care services? Should I report it separately?


Utah Subscriber

Answer: Code 31500 (Intubation, endotracheal, emergency procedure) does not appear in Appendix G of the CPT book, so from a strict coding perspective, the sedation is not considered an inherent part of the service and you could bill it separately. 

There is not a code for RSI. The patients who receive this service are usually critical care patients, and the time the physician spends preparing the patient for intubation might be best recognized by counting it toward critical care minutes for codes 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) and +99292 (-each additional 30 minutes).

However, remember that from a clinical perspective, most providers consider administration of the drugs as an inherent part of intubation.