Pulmonology Coding Alert

You Be the Coder:

Tracheostomy

Published on Wed Nov 01, 2000

Question: A patient had a percutaneous dilational tracheostomy at a clinic. The patient is now in the hospital to have the tracheostomy removed. The clinic staff couldnt remove it because of a trach tube granulation into the neck with the presence of endotrach granulation tissue. Is there a procedure code for the removal? A bronchoscopy was used in the removal of this trach tube.

Also, if a bronchoscopy is used to aid in the removal of this trach tube, should I use CPT 31899 (unlisted procedure, trachea, bronchi) and attach the report with the HCFA 1500 form, or is this billed as part of the evaluation and management code?

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Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Answer: Normally, the removal is covered in the initial code for the tracheostomy, 31610 (tracheostomy, fenestration procedure with skin flaps), but this is an unusual case. Use 31899 (unlisted procedure, trachea, bronchi). Attach the operative report to a hard copy of the 1500 form to show that this circumstance is not ordinary.

Answer to You Be the Coder provided by Cynthia Thompson, CPC, senior consultant at Gates, Moore & Co., a physician-practice management-consulting firm in Atlanta.

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