Need some help with intubation coding. Our offices just started billing for a Pulmonary/Critical Care Clinic and we're learning as fast as we can!
We've hit a problem dealing with elective intubation. 31500 Intubation, endotracheal, emergency procedure, doesn't quite fit what our physician was doing. According to the physician's note, the patient is in acute respiratory failure and was already intubated (has COPD, emphysema, CHF, pleural effusions, CHF, current pneumonia. You name it, she's got it.) He noted 35 minutes CC time and considered an extubation trial. A few hours later they did do the extubation and patient had O2 sats drop and respiratory distress increase Then he reintubated her and noted another 30 minutes of CC time and the intubation procedure with the use of flexible bronchoscope.
We have scoured the internet and have had trouble finding anything regarding if elective intubations are bundled into the critical care services or if they should be separately billable or some sort of bronchoscopy code would apply or any other respiratory codes that may apply to this situation. Does anyone have any advice for us on how we can bill this out? Any advice would be appreciated. Thanks!
Below are the later notes for CC and intubation, not his prior CC visit.
Patient failed extubation w/ progressive O2 needs and respiratory distress. Patient was awake and alert and able to make discussion with myself and family. Discussed with patient and family including POA. Patient did want to be reintubated, at least for a period of time to see if she can improve from her pneumonia. 30 minutes CC time not including intubation.
Prep: airway clssificaiton (Mallampati) Class II, oxygenated prior to intubation with Ambu bad, head was positioned (in neutral position of neck with axial stabilization, Has a neck that is fused), monitoring during the procedure (blood pressure monitoring, cardiac monitor, pulse ox, induction Propofol.
Technique: flexible bronchoscopy used, view was Grade 1, orally intubated, #7 French tube cuffed placed, tube was secured using a tube holder.
Confirmation of position: with auscultation of bilateral breath sounds, with capnometry, with chest xray.
tolerated procedure well.