| Clinical Indicators
Tracheostomy
| Procedure |
CPT |
FUD |
| Tracheostomy |
31600 |
0 |
Indications
1. History... one or more required
Upper airway obstruction with any of the following:
| a) |
stridor, |
| b) |
air hunger, |
| c) |
retractions, |
| d) |
obstructive sleep apnea with documented arterial
desaturation, |
| e) |
bilateral vocal fold paralysis, |
| f) |
previous neck surgery or throat trauma, or |
| g) |
previous irradiation to the neck
- Prolonged or expected prolonged intubation
- Inability of patient to manage secretions including:
a) aspiration
b) excessive broncho-pulmonary secretions
- Facilitation of ventilation support.
- Inability to intubate.
- Adjunct to manage head & neck surgery.
- Adjunct to manage significant head & neck trauma.
|
2. Physical Examination... required
| a) |
Respiration--describe. |
| b) |
Voice--describe. |
| c) |
Endotracheal tube--document if present and for how
long? |
| d) |
Larynx--describe, if possible. |
| e) |
Neck examination (always required). |
3. Tests... none required Postoperative
Observations
| 1. |
Breathing--satisfactory. Both sides of lung
ventilating. |
| 2. |
Bleeding from wound? |
| 3. |
Subcutaneous emphysema? |
| 4. |
Wound packing & sutures--document removal. |
| 5. |
Tracheostomy tube, tighten if loose, check cuff for proper
inflation. |
| 6. |
Chest X-Ray--document. Usually ordered after surgery tocheck
for pneumothorax or proper tube placement. |
Outcome Review
1. Document complications for departmental review. Associated ICD-9 Diagnostic Codes
| 141.0 |
M-Neoplasm, Tongue base |
| 145.9 |
M-Neoplasm, Mouth NOS |
| 146.0 |
M-Neoplasm, Tonsil |
| 146.9 |
M-Neoplasm, Oropharynx NOS |
| 161.0 |
M-Neoplasm, Glottis |
| 161.1 |
M-Neoplasm, Supraglottis |
| 161.8 |
M-Neoplasm, Larynx NEC |
| 212.1 |
B-Neoplasm, Larynx |
| 235.1 |
UB-Neoplasm, Oral cavity/pharynx |
| 239.1 |
Respiratory system neoplasm NOS |
| 478.5 |
Vocal cord disease NEC |
| 478.6 |
Edema of larynx |
| 478.74 |
Stenosis of larynx |
| 478.79 |
Disease of larynx NEC |
| 518.5 |
Post trauma pulmonary insufficiency |
| 518.8 |
Disease of lung |
| 518.81 |
Respiratory failure |
| 518.82 |
Other pulmonary insufficiency |
| 519.1 |
Trachea/bronchus disease NEC |
| 519.8 |
Respiratory system disease NEC |
| 786.09 |
Respiratory abnormality NEC |
| 799.1 |
Respiratory arrest |
| 802.20 |
Mandible Fx NOS, closed |
| 802.30 |
Mandible Fx NOS, open |
| 802.4 |
Fx malar/maxillary, closed |
| 802.5 |
Fx malar/maxillary, open |
Additional Information
Assistant Surgeon -- N
Supply Charges -- N
Prior Approval -- N Anesthesia Code(s)
00320
Patient Information
Although often performed as an emergency procedure in life-threatening
situations, tracheostomy may also be required for urgent and elective reasons.A
tracheostomy is an opening made in the trachea (windpipe) to allow
breathingwhen the larynx is obstructed or to permit long-term ventilation of
thelungs through a tube inserted into the neck opening. The main complicationis
bleeding, and this is often related to the speed required to performthis
operation in emergency situations. Other complications include escape of air
into the tissues of the neck (subcutaneous emphysema), which is treatable, and
postoperative scar formation in the lower neck.
Important Notice
The Clinical Indicators for Otolaryngology--Head and Neck Surgeryare
guidelines only. In no sense do they represent a standard of care.The
applicability of an indicator for a procedure, and/or of the processor outcome
criteria, must be determined by the responsible physician inlight of all the
circumstances presented by the individual patient. Adherenceto these guidelines
will not ensure successful treatment in every situation.The American Academy of
Otolaryngology-Head and Neck Surgery, Inc. emphasizesthat these clinical
indicators should not be deemed inclusive of all propertreatment decisions or
methods of care, nor exclusive of other treatmentdecisions or methods of care
reasonably directed to obtaining the sameresults.
© 2000 American Academy of Otolaryngology-Head and Neck Surgery. One
Prince Street, Alexandria, VA 22314.
|