Master Tracheostomy Coding

Master Tracheostomy Coding

Tracheostomy is an incision into the trachea to maintain a patient’s airway, and either may be scheduled or performed on an emergency basis. Be sure to differentiate tracheostomy from tracheotomy: A tracheotomy is used to describe a temporary opening into the trachea, while a tracheostomy signifies a permanent opening or access to the trachea.

Code 31600 Tracheostomy, planned (separate procedure) describes a planned tracheostomy; however, if the patient is under two years of age, turn to 31601 Tracheostomy, 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.

2017-code-book-bundles-728x90-01

John Verhovshek

John Verhovshek

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.
John Verhovshek

About Has 406 Posts

John Verhovshek, MA, CPC, is Managing Editor at AAPC. He has covered medical coding and billing, healthcare policy, and the business of medicine since 1999. He is an alumnus of York College of Pennsylvania and Clemson University, and a member of the Asheville-Hendersonville AAPC Local Chapter.

8 Responses to “Master Tracheostomy Coding”

  1. Rhonda Paysinger says:

    I would love to know what constitutes a skin flap – I know a bjork flap would qualify for 31610 – but what about when they bring the 2nd tracheal ring flap out and attach it to the skin? would that be a 31600 or a 31610??

  2. Rhonda Paysinger says:

    Here is an example of what I am talking about when I say they are doing an flap from the second tracheal ring – I have been coding this as 31600 – since it doesn’t say bjork flap – but this could possibly be 31610 – please advise.

    The patient was then prepped and draped in the usual sterile fashion. I began
    with a tracheotomy through a separate incision in the low anterior midline neck.
    The incision was made down to the strap muscles which were separated in the
    midline to expose the cricoid and the thyroid isthmus. The isthmus was divided
    with electrocautery, and an inferiorly based flap of second tracheal ring
    cartilage was created and sewn to the subcutaneous tissues with a 3-0 Vicryl.
    Then the indwelling oral tube was removed and replaced with a reinforced tube
    going directly into the trachea, and it was secured to the skin.

  3. Ken Lobo says:

    Thank u John! Short, concise and very educational. Helps coders and billers. AAPC needs to practice providing more of these kinds of education on the CPT codes.

  4. philip sahaayruban says:

    Hello John,
    I am AAPC member. Thank you for your valuable info on tracheotomy/-stomy,
    I have a separate question. If you could kindly answer, I would really appreciate.
    How do we determine whether or not we should code using HCPCS or CPT.
    For example : CBC count and removing Cerumen (from EAR)..both can be found in CPT and HCPCS
    Do they have to mention if the patient is Medicare or Medicaid?. Does that make difference?
    Thank you for your time. I am medical instructor teach health care and A and P classes. Learning more about Billing and coding.
    best regards, Philip

  5. philip sahaayruban says:

    am AAPC member. Thank you for your valuable info on tracheotomy/-stomy,
    I have a separate question. If you could kindly answer, I would really appreciate.
    How do we determine whether or not we should code using HCPCS or CPT.
    For example : CBC count and removing Cerumen (from EAR)..both can be found in CPT and HCPCS
    Do they have to mention if the patient is Medicare or Medicaid?. Does that make difference?
    Thank you for your time. I am medical instructor teach health care and A and P classes. Learning more about Billing and coding.
    best regards, Philip

  6. philip sahaayruban says:

    I am AAPC member. Thank you for your valuable info on tracheotomy/-stomy,
    I have a separate question. If you could kindly answer, I would really appreciate.
    How do we determine whether or not we should code using HCPCS or CPT.
    For example : CBC count and removing Cerumen (from EAR)..both can be found in CPT and HCPCS
    Do they have to mention if the patient is Medicare or Medicaid?. Does that make difference?
    Thank you for your time. I am medical instructor teach health care and A and P classes. Learning more about Billing and coding.
    best regards, Philip

  7. Brad Ericson says:

    Usually Medicare prefers the HCPCS code.

  8. sarah says:

    What would be the appropriate cpt code for repeat tracheostomy after initial tracheostomy had completely healed? Thank you.

Leave a Reply

Your email address will not be published. Required fields are marked *