Pulmonology Coding Alert

Question: A patient is admitted to a rehabilitation hospital and develops a problem with an existing tracheotomy tube (the original trach tube was placed approximately two to four weeks ago while the patient was still in the acute care hospital). Our internist removes the original tube and replaces it with another. How should we code the tube replacement?

Pennsylvania Subscriber

Answer: Report the tracheotomy tube replacement with the subsequent hospital care codes (99231-99233), depending on the complexity of the patients care. Some pulmonology coders may be tempted to use 31502 (tracheotomy tube change prior to establishment of fistula tract), but the codes definition states that it is for tube changes prior to fistula tract establishment. Typically, the fistula tract is established within a few days of the original tube placement. Because the tracheotomy tube was replaced two to four weeks after its initial insertion, 31502 most likely would be inappropriate.

There is no extra reimbursement for changing a tube once the fistula tract is established. If the patient was in distress, this might qualify for critical care coding (99291-99293).