ED Coding and Reimbursement Alert

Question: A patient is brought to the ED with chronic obstructive pulmonary disease (COPD) with acute exacerbation. The ED physician inserts a laryngoscope equipped with a small camera and light into the patient’s mouth and throat, allowing them to visualize the larynx and the surrounding structures on a video monitor. Is this considered an intubation?

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Answer: Yes. The technique you described is a video laryngoscopy, which is considered an intubation and can thus be coded with 31500 (Intubation, endotracheal, emergency procedure) with J44.1 (Chronic obstructive pulmonary disease with (acute) exacerbation) appended to represent the exacerbation.

There are several different techniques your ED physician might use that you’d report with 31500. Here’s a look at the other 31500-eligible techniques:

• Direct laryngoscopy: The ED physician inserts a laryngoscope into the patient’s mouth and throat to provide a clear view of the larynx, or voice box, and the surrounding structures.
• Bougie insertion: The ED physician inserts a bougie into the patient’s trachea to help guide the placement of the endotracheal tube.
• Nasal tracheal intubation: The ED physician inserts a tube through the nose that passes down into the trachea.
• Digital intubation: The ED physician inserts an endotracheal tube into the trachea using their fingers to guide the tube, rather than relying on instruments like a laryngoscope.
• Laryngeal mask airway (LMA): This technique might be considered intubation, but there have been reports of payers that don’t consider LMA 31500-eligible. Check with your payer before reporting 31500 for LMA.