Pulmonology Coding Alert

Question: Our nurse practitioner saw a patient in our office this week who required a trach tube change. Is there a way to collect for this?

Arizona Subscriber

Answer: Although CPT^® includes a code for removing a tracheotomy tube (31502, Tracheotomy tube change prior to establishment of fistula tract), the descriptor is clear that this can only be reported if the procedure is performed prior to the establishment of the fistula tract. While there are no specific CPT^® guidelines that define when this occurs, the tract usually becomes established a week to 10 days after the patient has had a tracheostomy. Before that time, changing the tube is difficult and is usually performed by an otolaryngologist.

It’s most likely that your nurse practitioner performed the removal after the patient’s fistula tract was established, so you will most likely report the procedure as part of an E/M service using 99202-99215 (Office or other outpatient visit …). But be sure to check with your provider before billing for the service to make sure you have full documentation concerning the date of the tracheostomy and the status of the tract at the time of the encounter.