You Be the Coder:
Intubation for UPPP
Published on Wed Aug 01, 2001
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: A uvulopalatopharyngoplasty (UPPP) was performed. The anesthesiologist was unable to place oral intubation. Therefore, my doctor placed a flexible bronchoscope in the center of an endotracheal tube that went through the left nostril and down the throat, past the true vocal chords into the trachea. He then pushed the endoscope tube through the nasal cavity, down the throat into the larynx and trachea. The flexible bronchoscope was removed and general anesthetic was given through the nasotracheal tube. I know to code UPPP, but do I charge for nasotracheal intubation? If yes, what code should I use?
Montana Subscriber
Answer: According to global surgery guidelines in the Medicare Carriers Manual and the national Correct Coding Initiative (CCI), intraoperative services such as intubation are included in the global package of the procedure (in this case, the UPPP), says Cheryl Odquist, CPC, an otolaryngology coding and reimbursement specialist in San Diego, Calif.
In addition, the anesthesiologist has probably included the intubation in the anesthesia fee, of which it is typically considered a part. When an intubation is performed in the emergency department, however, it may sometimes be coded separately using 31500 (intubation, endotracheal, emergency procedure).
This information is available in the introduction to version 6.3 of the CCI, which states:
A majority of invasive procedures require the availability of vascular and/or airway access; accordingly, the work associated with obtaining this access is included in the pre-procedure services and returning a patient to the appropriate post-procedure state is included in the procedural services. Intravenous access, intra-arterial access, airway access (e.g., HCPCS/CPT codes 36000, 36140, 36400, 36410) are frequently necessary; therefore, CPT codes describing these services may not be separately reported when performed in conjunction with a more comprehensive procedure. Airway access is associated with general anesthesia, and no CPT code is available for elective intubation. The CPT code 31500 may not be reported for elective intubation in anticipation of performing a procedure, as this represents a code for providing the service of emergency intubation.
CCI also states, "when anesthesia is provided by the physician performing the primary service, the anesthesia services are included in the primary procedure (Health Care Financing Administration Global Surgery Policy)," in this case, the UPPP.
