Pulmonology Coding Alert

Question: A rehabilitation hospital admitted a patient who developed a problem with an existing tracheotomy tube (our physician placed the original trach tube about two to four weeks ago while the patient was still in the acute care hospital). Our pulmonologist removed the original tube and replaced it with another. How should we code the tube replacement?

Pennsylvania Subscriber

Answer: Report the tracheotomy tube replacement with the subsequent hospital care codes (99231-99233), depending on the complexity of the patient's care. Some pulmonology coders may be tempted to use 31502 (Tracheotomy tube change prior to establishment of fistula tract), but the code's definition states that it is for tube changes prior to fistula tract establishment. Typically, the fistula tract is established within a few days of the original tube placement. Because the physician replaced the tracheotomy tube two to four weeks after its initial insertion, 31502 would most likely be inappropriate.

Insurers will not reimburse your pulmonologist for changing a tube once he has established the fistula tract.