Pulmonology Coding Alert

Question: Our pulmonologist wants to bill for changing a trach tube for an established tract. I have been looking and the only CPT® code that I can find is 31502. Can an established tract tube change be reported using this code or is there any other code that is more appropriate?

Nevada Subscriber

Answer: If the tracheostomy tube change has been done prior to an establishment of fistula tract from anterior neck portion to trachea, the change can be reported with the code 31502 (Tracheotomy tube change prior to establishment of fistula tract). Usually the establishment of a fistula tract takes about seven days. A tracheostomy tube change prior to the fistula tract becoming fully established is the only scenario under which the above mentioned code can be used for the claim.

If a tube change has been done as a separate procedure in the operating room under general anesthesia in a patient with an established fistula tract, then the procedure can be reported using 31899 (Unlisted procedure, trachea, bronchi).

However, in most circumstances, a tracheostomy tube change is considered a part of the E/M and is just billed as a component of the E/M that is being reported for the visit. But, under some appropriately documented circumstances, the change of a tracheostomy tube may change the level of the E/M to a higher level due to the increase in the level of decision making from your pulmonologist.

If your pulmonologist goes in for a tracheostomy tube change in the 90-day global period of an unrelated procedure that he (or a same-specialty group member) also performed, then a separate E/M can be billed. However, you have to add a modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M to make it known that it is an evaluation and management for an unrelated issue.