I'm having trouble deciding which is the correct way to charge out this procedure. The patient has been coming in for over a year who is tracheotomy dependent. He comes in for a change and the physician decides to do a revision flap tracheotomy-which would lead me to 31830 series but he is also replacing the tube which would toss me back to 31614 series... i just don't know what to do as I haven't had any situations like this one. Thoughts on how to code this one?
Procedure:
Revision Flap Tracheotomy with Bronchoscopy and tracheotomy tube change
...a tracheotomy tube change was attempted. The #6 shiley trach tube was removed. A #7 tube was utilized and this was not possible. Therefore, a #6 was placed into the trachea through the tracheotomy site and was ventilated. At this point, I made the decision to go forward with a formal flap tracheotomy. The standard flap incisions were designed on the anterior neck. A dissection of the tracheotomy tract from the skin to the trachea was carefully carried out, with the excision of the entire scar band of the tracheotomy tract leaving a large open wound. The subcutaneous undermining of the skin flaps were performed circumferentially. Each flap was then carefully sewn to the trachea using 3-0 suture. A 4-0 suture was used to close the margins of the skin flaps. At this point, a #8 shiley tube was placed with no difficulty. A flexible bronchoscopy was performed evaluating the tracha and mainstream bronchi, and secondary bronchi, revealed no bleeding site of abnormality. At this stage, the procedure was termed.
Lost!
Procedure:
Revision Flap Tracheotomy with Bronchoscopy and tracheotomy tube change
...a tracheotomy tube change was attempted. The #6 shiley trach tube was removed. A #7 tube was utilized and this was not possible. Therefore, a #6 was placed into the trachea through the tracheotomy site and was ventilated. At this point, I made the decision to go forward with a formal flap tracheotomy. The standard flap incisions were designed on the anterior neck. A dissection of the tracheotomy tract from the skin to the trachea was carefully carried out, with the excision of the entire scar band of the tracheotomy tract leaving a large open wound. The subcutaneous undermining of the skin flaps were performed circumferentially. Each flap was then carefully sewn to the trachea using 3-0 suture. A 4-0 suture was used to close the margins of the skin flaps. At this point, a #8 shiley tube was placed with no difficulty. A flexible bronchoscopy was performed evaluating the tracha and mainstream bronchi, and secondary bronchi, revealed no bleeding site of abnormality. At this stage, the procedure was termed.
Lost!
