Otolaryngology Coding Alert

Reviewed on May 15, 2015
Post-fistula procedures may call for unlisted-procedure code

CPT contains just a single code for tracheostomy tube change: 31502. But 31502 won't fit the bill for most trach tubes your otolaryngologist replaces.

For in-office tube changes, you probably can't report a separate service--but you may be able to claim the cost of supplies. And you can report tube changes in the OR, although it will mean more work for the coder. Timing Sets 31502 Apart You should report 31502 (Tracheotomy tube change prior to establishment of fistula tract) only when the otolaryngologist changes a tracheostomy tube before the fistula tract has become established, says Charles F. Koopmann Jr., MD, MHSA, professor and associate chair at the University of Michigan's department of otolaryngology in Ann Arbor. In other words, if the physician removes the indwelling tube and replaces it before the patient has had sufficient healing time to allow a fistula tract to form, you would claim 31502.

Rule of thumb: CPT does not provide specific guidelines on when the fistula tract becomes -established,- and you should rely on your physician's clinical judgment to determine this. As a general rule, however, the tract is usually established within seven to 10 postoperative days of the tracheostomy, Koopmann says. Changing the tube when the tract is immature is considerably more difficult than changing a tube after the tract has healed.

Learn more: For complete information on tracheostomy procedures, see page 81 of the November 2005 Otolaryngology Coding Alert.

90-Day Global Makes 31610 an Exception Unlike most tracheostomy codes--which have a zero-day global period--31610 (Tracheostomy, fenestration procedure with skin flaps) includes a 90-day global period. This means that you cannot bill for related services (including trach tube changes) within the 90-day global period of 31610 unless the ENT must return the patient to the operating room. In this case, you may report 31899 (Unlisted procedure, trachea, bronchi) appended with modifier 78 Unplanned return to the operating/procedure room by the same physician or Other Qualified Health Care Professional  following initial procedure for a related procedure during the postoperative period. See the information below for complete information on 31899.
Established Tract + Office Procedure = E/M Service For trach tube changes in the office, nursing home or bedside after the fistula tract has healed, you cannot report a separate procedure code. You may, however, consider the trach change as a factor when deciding on an appropriate-level E/M service for the encounter, says Melissa Pointer, CPC, billing manager for the department of otolaryngology at the University of Arkansas for Medical Sciences in Little Rock.

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