Otolaryngology Coding Alert

Question: What is the proper code for tracheotomy tube change? And can it be billed with an office visit?

Lorrie Matzas, Office Manager
Dr. G.J. Pollack
New York, NY

Answer: If all the otolaryngologist did is change the trach tube, all you can bill is an office visit, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding and reimbursement specialist in North Augusta, SC. Callaway-Stradley recommends that CPT code 31502 (tracheotomy tube change prior to establishment of fistula tract) be used only when the patient will receive a permanent tracheotomy and the otolaryngologist is waiting for the skin to heal. Once the opening heals and a fistula tract is established, changing the tube is part of the E/M service performed by the physician, she says. It should be noted, however, that changing the trach can be a contributing factor to the medical decision-making component of the E/M service affecting risk and management options, so it may help raise the level of the E/M service if it is documented correctly. Of course, appropriate documentation would need to be provided. Medicare has established a 90-day post-op period for trachs. So any trach change within that period would fall under the original procedures global period.