Improve Your Common ED Airway Procedure Accuracy

Seconds count with airway tube insertions, however take a few minutes to learn these significant tips.

A recurrent presenting problem in the emergency department is a patient having trouble breathing owing to pulmonary disease, injury, or swelling of the throat tissues. You would normally report these encounters as high level ED visits or critical care due to the nature of the presenting problem; however you may also be able to report a procedure code in case it is correctly documented. Read on for advice on correctly documenting to support your airway services procedure medical coding.

1. Define Reason for Airway

The most general airway related procedure in the ED setting is endotracheal intubation where the patient has a compromised airway that requires stabilization.

Sample scenario: You should look for documentation describing tube placement similar to the following medical coding example:

A 24 year old female is brought in by her boyfriend from a picnic in a neighbouring park. Her face depicts signs of increasing swelling and she complains of having trouble breathing as if her throat is closing. She then reports a history of reactions to bee stings that have intensified in severity since she was a child. She is unclear that she was actually stung, but the boyfriend reports that there were bees present in the area and that they were seated near a large flower garden.

The emergency physician then orders an epinephrine injection, and as the patient had established increasing respiratory distress, places a tube down her throat to maintain her airway. After obtaining that limited history due to her breathing issues, an examination shows no other indication for the allergic reaction and he finds a likely sting site on the back of her neck. The patient reacts well to the epinephrine and then the swelling starts to subside after 40 minutes once she is admitted to the hospital. The physician afterwards documents 32 minutes of critical care time outside of distinctly billable procedures and then gives a diagnosis of anaphylaxis because of the bee sting.

On the claim, you would report the following for error-free medical coding:

99291 {Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes}

31500 {Intubation, endotracheal, emergency) for the tube placement}

989.5 {Toxic effect of other substances, chiefly non-medicinal as to source, venom}

E905.3 {Venomous animals and plants as the cause of poisoning and toxic reactions, hornets, wasps, and bees}

Medical Coding Tip: Apply the modifier 25 to 99291 to demonstrate that the intubation is distinct from the critical care services.

2. Critical Care? Scan for Time Details

You must keep in mind that in case the patient was reported as critical care, you should back out the time spent providing other procedures, for instance intubation, from your entire patient care time. A lot of payers require a statement in the documentation to that effect. Fortunately, most emergency physicians can place a tube rather rapidly.