Medical Billing
Be cautious of separate-procedure status of planned tracheostomy.
In case you're making assumptions about how should you report tracheostomy procedures, you could be costing your practice a lot of money. To make certain this won't happen to you; let our medical billing coding experts guide you through these four steps to ace tracheostomy coding.
Myth #1: A Planned Trach is No Dissimilar than an Emergency One.
CPT makes a major distinction between "planned" and "emergency" tracheostomy, and thus you must decide which of these conditions best defines the procedure when choosing CPT codes. So what's the difference?
In an emergency procedure, the patient is immediately endangered if the physician doesn't carry out the procedure. In other words, the airway is so compromised that the patient is already obstructed or may obstruct at any moment.
Use common sense: Simply because the ENT sees a patient and decides to carry out a tracheostomy that same day doesn't imply you have an emergency. Rather, an emergency tracheostomy must take place due to an immediate, life-threatening situation.
You must report such emergency procedures using one of two CPT codes:
- 31603 –(Tracheostomy, emergency procedure; transtracheal)
- 31605 – (…cricothyroid membrane)
These two procedures are different according to the location at which the surgeon carries out her incision.
Myth #2: All Trach Codes Have a Zero-Day Global Period.
In case the ENT uses skin flaps to make a more permanent stoma (opening) -- for instance for patients going through multiple sclerosis, amyotrophic lateral sclerosis (ALS) or further chronic conditions that cause breathing difficulties -- you must turn to 31610 (Tracheostomy, fenestration procedure with skin flaps).
Medical Billing & Coding Tip: At times physicians will use the terms "Bjork flap" or "inferior tracheal flap" to define skin flaps used in this kind of tracheostomy.
Global concerns: CPT Code 31610 is the lone tracheostomy procedure to include a 90-day global period. All added trach procedures have a zero-day global period.
Myth #3: Always Report Trach Code, Even if It's An Incidental Procedure.
As CPT describes all planned tracheostomies as "separate procedures," you must ensure that any trach the ENT offers is not essential to a more extensive procedure. In case the trach is incidental (that is, performed as a part of another procedure), you may not report it distinctly.
Example: In case the ENT carries out tracheostomy during laryngectomy (31360-31390) or large glossectomies (41140-41145), you may not report the tracheostomy separately. Reasonably, payment for the trach is included in the fee for the added extensive procedure, of which it is a part.
Myth #4: Patient's Age Doesn't Matter.
In case a planned tracheostomy occurs on a patient who is less than 24 months old, you should report CPT code 31601 (… under two years) rather than 31600,
Be aware: The "separate procedure" limitations apply to 31601 just as they do 31600. Consequently, for children under 2 years old, you must not report CPT code 31601 in case the tracheostomy is a part of an added extensive procedure.
Myth #2: All Trach Codes Have a Zero-Day Global Period.
In case the ENT uses skin flaps to make a more permanent stoma (opening) -- for instance for patients going through multiple sclerosis, amyotrophic lateral sclerosis (ALS) or further chronic conditions that cause breathing difficulties -- you must turn to 31610 (Tracheostomy, fenestration procedure with skin flaps).
Medical Billing & Coding Tip: At times physicians will use the terms "Bjork flap" or "inferior tracheal flap" to define skin flaps used in this kind of tracheostomy.
Global concerns: CPT Code 31610 is the lone tracheostomy procedure to include a 90-day global period. All added trach procedures have a zero-day global period.
Myth #3: Always Report Trach Code, Even if It's An Incidental Procedure.
As CPT describes all planned tracheostomies as "separate procedures," you must ensure that any trach the ENT offers is not essential to a more extensive procedure. In case the trach is incidental (that is, performed as a part of another procedure), you may not report it distinctly.
Example: In case the ENT carries out tracheostomy during laryngectomy (31360-31390) or large glossectomies (41140-41145), you may not report the tracheostomy separately. Reasonably, payment for the trach is included in the fee for the added extensive procedure, of which it is a part.
Myth #4: Patient's Age Doesn't Matter.
In case a planned tracheostomy occurs on a patient who is less than 24 months old, you should report CPT code 31601 (… under two years) rather than 31600,
Be aware: The "separate procedure" limitations apply to 31601 just as they do 31600. Consequently, for children under 2 years old, you must not report CPT code 31601 in case the tracheostomy is a part of an added extensive procedure.
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