31500

Intubation, endotracheal, emergency procedure

CPT code 31500 describes an emergency endotracheal intubation. This critical procedure involves the insertion of a flexible plastic tube through the mouth (or occasionally the nose) and into the trachea to establish and maintain a patent airway. The primary goal is to ensure adequate ventilation and oxygenation in patients who are unable to breathe on their own or are at risk of losing their airway. Unlike elective intubations performed in a controlled environment as part of general anesthesia, 31500 is specifically reserved for acute, life-threatening situations. The clinician often uses a laryngoscope—either a standard direct blade or a video-assisted device—to visualize the larynx and vocal cords. Once the glottis is visualized, the endotracheal tube is carefully passed through the cords. Immediate confirmation of placement is mandatory, typically achieved through direct visualization, auscultation of breath sounds in both lungs, observation of symmetric chest rise, and the use of quantitative end-tidal CO2 monitoring or capnography. Once placement is confirmed, the cuff at the distal end of the tube is inflated to prevent air leaks and protect the lungs from aspiration. This procedure is frequently performed in the emergency department, intensive care unit, or during rapid response/code blue events on hospital wards. Because it is an emergency procedure, it requires rapid assessment of the airway, preparation of rescue equipment, and the potential use of rapid sequence induction (RSI) medications to facilitate successful tube placement while minimizing the risk of gastric content aspiration.

Clinical Indications

  • Acute respiratory failure with hypoxia or hypercapnia
  • Apnea or impending respiratory arrest
  • Cardiac arrest (unprotected airway during resuscitation)
  • Protection of the airway in patients with depressed mental status (Glasgow Coma Scale score of 8 or less)
  • Severe upper airway obstruction due to trauma, angioedema, or foreign body
  • Massive hemoptysis or hematemesis threatening the airway
  • Status epilepticus refractory to initial medical management
  • Inhalation injury with suspected thermal damage to the airway
  • Profound shock requiring mechanical ventilation to reduce work of breathing

Procedure Steps

  1. Preparation of equipment including laryngoscope, endotracheal tubes of various sizes, stylets, and suctioning apparatus.
  2. Pre-oxygenation of the patient using 100% oxygen via bag-valve-mask or high-flow nasal cannula to maximize apnea time.
  3. Positioning the patient in the 'sniffing position' (atlanto-occipital extension) unless contraindicated by suspected cervical spine injury.
  4. Administration of induction agents and paralytics if performing rapid sequence intubation (RSI).
  5. Insertion of the laryngoscope blade into the right side of the mouth, sweeping the tongue to the left.
  6. Visualization of the epiglottis and then the glottic opening (vocal cords).
  7. Passage of the endotracheal tube through the vocal cords under direct or video visualization.
  8. Removal of the stylet and laryngoscope blade.
  9. Inflation of the endotracheal tube cuff with air.
  10. Verification of tube placement using end-tidal CO2 detection, auscultation of breath sounds, and absence of gastric sounds.
  11. Securing the tube with a commercial holder or tape and ordering a chest X-ray for definitive position confirmation at the carina.

Coding Guidelines

  • Code 31500 is used specifically for emergency intubations. Do not use this code for elective intubations or those performed as a routine part of a surgical procedure under general anesthesia.
  • This code is not included in the 'global' surgical package when performed in an emergency context for a different clinical indication than the surgery.
  • Per NCCI edits, 31500 should not be reported with other laryngoscopy codes like 31505-31526 if they are performed at the same session.
  • If an E/M service (such as an Emergency Department visit 99281-99285) is performed in addition to the intubation, the E/M code should be appended with modifier 25 to show it was a significant, separately identifiable service.
  • If intubation is performed during a critical care session (99291, 99292), the time spent performing the intubation must be subtracted from the total critical care time, as 31500 is not a bundled component of critical care codes.
  • Do not report 31500 if a more comprehensive airway procedure, such as a tracheostomy (31600), is performed immediately following or instead of the intubation.

Associated ICD-10 Codes