Proper Coding for Endotracheal Intubation
CPT® provides a single code to report endotracheal intubation—31500 Intubation, endotracheal, emergency procedure—but application of this code isn’t always straightforward. Per CPT® and National Correct Coding Initiative (NCCI) guidelines, 31500 describes an emergency endotracheal intubation and should not be reported for elective endotracheal intubation. CPT Assistant (Dec. 2009) clarifies, “Code 31500… should be reported for a stand-alone emergent or semi-emergent endotracheal intubation, such as rapid sequence intubation either using a rigid or flexible type of endoscope (ie, laryngoscope, bronchoscope).” There is no CPT® code for elective endotracheal intubation.
Additional points to keep in mind when considering 31500 include:
- Do not separately report 31500 with any anesthesia procedure. NCCI guidelines confirm, “Airway access is necessary for general anesthesia and is not separately reportable.”
- Endotracheal intubation is bundled in (included in) pediatric and neonatal critical care service codes (99293-99296).
- Per CPT®, “Visualization of the airway is a component part of an endotracheal intubation, and CPT codes describing procedures that visualize the airway (e.g., nasal endoscopy, laryngoscopy, bronchoscopy) should not be reported with an endotracheal intubation. It is a misuse of diagnostic and therapeutic endoscopy codes to report visualization of the airway for endotracheal intubation.”
Note, however, that the Dec. 2009 CPT Assistant allows, “If a critically-ill patient is intubated with a bronchoscope, and the airway is then examined to exclude, for example, obstruction, infection or other processes contributing to the respiratory failure, code 31622, Bronchoscopy, rigid or flexible, with or without fluoroscopic guidance; diagnostic, with or without cell washing (separate procedure), should be reported.”
The Dec. 2009 CPT Assistant also confirms, “Moderate sedation may be reported in addition to the endotracheal intubation procedure, provided the criteria for reporting the codes 99143-99150 are met,” and continues:
When providing moderate sedation, the following services are included, and are not separately reported
- Assessment of the patient (not included in intraservice time)
- Establishment of IV access and fluids to maintain patency, when performed
- Administration of agent(s)
- Maintenance of sedation
- Monitoring of oxygen saturation, heart rate, and blood pressure
- Recovery (not included in intraservice time)