Pulmonology Coding Alert

Question: One of the patients in our rehabilitation hospital developed a problem with his existing trache-otomy tube, which had been inserted four weeks ago in the hospital. The pulmonologist removed the original tube and replaced it with another. How should I code tube replacements?


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Answer: You should report the tracheotomy tube replacement with the subsequent hospital care codes (99231-99233, Subsequent hospital care, per day, for the evaluation and management of a patient ...), depending on the complexity of the patient's care. You may be tempted to use 31502 (Tracheotomy tube change prior to establishment of fistula tract), but the code's definition states that it is for tube changes prior to fistula tract establishment. Usually, the fistula tract is established within a few days of the original tube placement. Because you state that the initial insertion was four weeks prior to the replacement, this code would be inappropriate.