Pulmonology Coding Alert

Question: If a pulmonologist performs a trach change, should I report 31502? How about appending a modifier?

Arizona Subscriber

Answer: Code 31502 (Tracheotomy tube change prior to establishment of fistula tract) is specifically for a change in the tracheostomy tube prior to the establishment of a mature fistula tract, per CPT descriptor. This generally is within the first week of the tracheostomy. The code is not meant for patients who have long term established tracheostomies. If patients get a tracheostomy tube change on an established tracheostomy, capture the work in an E/M code. (e.g., 99212-99215, Office or other outpatient visit ...) depending on the documentation of the complexity of the additional services provided to the patient.

Code 31502 is billable alone, which means you need not append any modifier when performed. However, if the pulmonologist performs a separately identifiable E/M service on the same day, report both 31502, and the proper E/M code with a 25 modifier on the E/M service.