Summary & Overview
CPT 31820: Tracheostomy or Tracheocutaneous Fistula Closure
CPT code 31820 denotes the surgical closure of a tracheostomy or a tracheocutaneous fistula performed without plastic repair. This procedure addresses persistent openings between the trachea and the skin that have failed to heal after tracheostomy, restoring airway and integumentary integrity and reducing risks of chronic infection and air leak.
Nationally, CPT code 31820 is relevant across inpatient and outpatient surgical settings and affects reimbursement and utilization patterns for otolaryngology and thoracic surgery practices. Key payers commonly involved in coverage decisions include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will gain a concise clinical and billing overview of the procedure, the typical sites of service, and which major payers are engaged in coverage. The publication summarizes benchmarks and payment considerations, clarifies clinical context for coding and billing teams, and highlights areas where policy updates or payer-specific rules commonly influence claims processing. Data not available in the input for payor-specific rates, associated taxonomies, and ICD-10 diagnosis mapping are noted as unavailable within the source materials.
Billing Code Overview
CPT code 31820 describes the surgical closure of a tracheostomy or tracheocutaneous fistula. The procedure involves closing an opening in the trachea through the neck or repairing a persistent tracheocutaneous fistula where the tracheostomy site has failed to heal, performed without plastic repair.
Service type: Surgical procedure — otolaryngology/thoracic-head and neck surgery
Typical site of service: Operating room or ambulatory surgical center, with inpatient settings used when closure is part of a broader hospitalization or when patient comorbidity requires inpatient care.
Clinical & Coding Specifications
Clinical Context
A 45-year-old patient presents for elective surgical closure of a persistent tracheocutaneous fistula following prolonged decannulation after prior tracheostomy. The patient has a small, chronically patent skin opening at the lower anterior neck with intermittent air leak and localized scarring. Preoperative evaluation includes airway assessment, review of prior tracheostomy details, basic labs, and anesthesia clearance. In the operating room under general anesthesia with endotracheal tube or laryngeal mask airway, the surgeon excises the fistulous tract and performs layered closure of the tracheal and soft-tissue defect without plastic reconstructive techniques. Postoperative workflow includes short recovery room observation, pain control, wound care instructions, and follow-up visit within 1–2 weeks for wound check and suture removal. Typical site of service is an ambulatory surgery center or hospital outpatient surgery department. Service type is minor surgical closure of a tracheostomy/tracheocutaneous fistula without plastic repair.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure | Use when a distinct E/M is performed pre- or post-procedure and meets documentation requirements |
22 |