Tracheostomy coding

Understanding coding Tracheostomy

A tracheostomy is a surgically created opening in the neck leading directly to the trachea (the breathing tube). It is maintained open with a hollow tube called a tracheostomy tube.

A tracheostomy is usually done for one of several reasons:

1. to bypass an obstructed upper airway (an object obstructing the upper airway will prevent oxygen from the mouth to reach thelungs);
2. to clean and remove secretions from the airway;
3. prolonged mechanical ventilation (breathing machine); and
4. to more easily, and usually more safely, deliver oxygen to the lungs.
5. It is important to understand that a tracheostomy, as with all surgeries, involves potential complications and possible injury from both known and unforeseen causes. Because individuals vary in their tissue circulation and healing processes, as well as anesthetic reactions, ultimately there can be no guarantee made as to the results or potential complications. Tracheostomies are usually performed during emergency situations or on very ill patients. This patient population is, therefore, at higher risk for a complication during and after the procedure
6. The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. It is listed here for information only in order to provide a greater awareness and knowledge concerning the tracheostomy procedure.
7. Airway obstruction and aspiration of secretions (rare).
8. In very rare situations, the need for blood products or a blood transfusion.
9. Damage to the larynx (voice box) or airway with resultant permanent change in voice (rare).
10. Need for further and more aggressive surgery
11. Infection
12. Air trapping in the surrounding tissues or chest. In rare situations, a chest tube may be required
13. Scarring of the airway or erosion of the tube into the surrounding structures (rare).
14. Need for a permanent tracheostomy. This is most likely the result of the disease process which made the a tracheostomy necessary, and not from the actual procedure itself.
15. Impaired swallowing and vocal function
16. Scarring of the neck

Obviously, many of the types of patients who undergo a tracheostomy are seriously ill and have multiple organ-system problems.

Code 31600 Tracheostomy, planned (separate procedure)describes a planned tracheostomy; however, if the patient is under two years of age, turn to 31601Tracheostomy, planned (separate procedure); younger than 2 years. Planned tracheostomy frequently occurs after a patient has been intubated for a long period, or requires long-term ventilatory support.

A planned tracheostomy (31600 or 31601) is a ?separate procedure? and usually would not be billed if performed at the same time as a more extensive, related procedure; however, per CPT Assistant (August 2010) instructs, ?A tracheostomy (code 31600) may be reported in addition to a neck dissection (code 38700, 38720, or 38724), if performed due to potential airway obstruction when the lymph channels are removed, or due to tumor impingement as it is not an inclusive component of the neck dissection.?

Providers perform emergency tracheostomies when a patient?s airway is so compromised that it may obstruct her or his breathing at any moment. For example, if a patient presents with wheezing, which is quickly progressing to upper?airway obstruction, the provider may perform a tracheostomy. When a tracheostomy is performed in an emergency, report 31603 Tracheostomy, emergency procedure; transtracheal for a transtracheal approach, or 31605 Tracheostomy, emergency procedure; cricothyroid membrane if the incision is made in the neck over the cricothyroid membrane. Emergency codes 31603 and 31605 are reported rarely because of the risk involved.

Finally, if the provider uses skin flaps to create an opening, report 31610 Tracheostomy, fenestration procedure with skin flaps.