Otolaryngology Coding Alert

Coding and billing for tracheostomies or related procedures can be confusing because many of the applicable codes represent separate procedures. Additionally, some trach-related services, such as trach tube changes, usually are not separately payable.

CPT lists six trach-related codes:

31502 tracheotomy tube change prior to establishment of fistula tract; 2.21 relative value units (RVUs)

31600 tracheostomy, planned (separate procedure); 6.26 RVUs

31601 ... under 2 years; 7.78 RVUs

31603 tracheostomy, emergency procedure; transtracheal; 6.94 RVUs

31605 ... cricothyroid membrane; 5.96 RVUs

31610 tracheostomy, fenestration procedure with skin flaps; 19.17 RVUs.

In addition, 31500 (intubation, endotracheal, emergency procedure), although not a tracheostomy procedure per se, is often performed prior to or with a number of the procedures listed above.

Note: According to Dorlands Medical Dictionary, a tracheostomy is defined as the creation of an opening in the anterior trachea for insertion of a tube to relieve upper airway obstruction and to facilitate ventilation. A tracheotomy is defined simply as incision of the trachea. Although most physicians and associated healthcare personnel use the terms interchangeably, some physicians distinguish between tracheotomy and tracheostomy as follows: A tracheotomy is used when the opening that is created is expected to be permanent or long-lasting; tracheostomy refers to a temporary opening.

Is the Trach Long- or Short-term?

Long-term tracheostomies for ventilation may be required by patients with multiple sclerosis, as well as some stroke patients or those with amyotrophic lateral sclerosis (ALS, or Lou Gehrigs disease). These and other chronic conditions may cause breathing difficulties.

In some cases, the otolaryngologist may use skin flaps to create a more permanent stoma, or opening. This more extensive procedure (31610) is the only tracheostomy with a 90-day global period.

More typically, however, the otolaryngologist will perform a planned tracheostomy that does not require the construction of a permanent stoma. Most elective tracheostomies are requested for patients who have been intubated for an extended time, or for those who may require long-term ventilatory support.

Patients with an infection or malignancy may also require a short-term tracheostomy. Initially their condition may have been treated with an endotracheal intubation (31500). After several weeks the otolaryngologist determines that the intubation tube needs to be pulled and a tracheostomy is performed to allow the patient to recuperate.

Children under age 2 may require planned tracheostomies for a variety of conditions, including sub-glottal stenosis, a benign laryngeal tumor or paralyzed vocal cords. Such cases are more difficult, and should be reported using 31601, which reimburses at a higher rate than a planned tracheostomy on an adult.

Emergency Tracheotomies

Emergency tracheotomies are coded differently than planned tracheostomies. A planned trach involves an intubated patient and a request to the otolaryngologist, says Lee Eisenberg, MD, an [...]