CPT Code 31500: Intubation, Endotracheal, Emergency Procedure

Learn CPT code 31500 for emergency endotracheal intubation. Understand billing, documentation, modifiers, and more in this guide.

Use Code

What is CPT code 31500?

CPT code 31500 refers to emergency endotracheal intubation, a procedure where a provider inserts a tube through the mouth into the patient’s trachea to establish or maintain an open airway. This code is commonly used during critical care services, such as respiratory failure or cardiac arrest, when rapid airway control is vital to preserve life. It falls under the Introduction Procedures on the Larynx section of the Current Procedural Terminology (CPT®) system maintained by the American Medical Association.

The intubation emergency CPT 31500 code is often reported by emergency physicians, anesthesiologists, intensivists, and respiratory providers in the inpatient setting, emergency departments, and ICUs. It is considered one of the separately billable procedures even when performed alongside critical care codes for thoracentesis tube thoracostomy and emergency endotracheal intubation. Proper documentation and modifier use are essential for compliant billing and coding for respiratory services.

What is endotracheal intubation?

Endotracheal intubation is a procedure where a provider inserts a flexible tube into the trachea to secure the airway. The tube is passed through the mouth or nose using direct or video laryngoscopy. This intervention supports ventilation, delivers oxygen, and protects the airway from aspiration.

It is used in cases of respiratory arrest, severe trauma, drug overdose, or during general anesthesia. Methods include:

Direct laryngoscopy
Video-assisted laryngoscopy
Rapid sequence intubation (RSI)
Use of bougies or introducers

Variants of intubation include elective intubation for surgery and emergency intubation for critical events. CPT 31500 is specific to emergency situations, not routine airway management in the OR.

CPT code 31500 documentation requirements

Proper documentation ensures that CPT 31500 is justified and supports reimbursement. Each aspect of the procedure must be detailed to validate its use as a separately billable procedure.

Urgent clinical indication

Document the reason for the procedure, such as hypoxia, apnea, trauma, or altered mental status. The presence of an emergent threat to airway patency must be clearly stated.

Technique used

Include the method and tools used: blade type, number of attempts, whether adjuncts like bougie or stylet were used, and any complications during insertion.

Confirmation of placement

Note how correct placement was verified—capnography, chest auscultation, visual confirmation, or imaging.

Time and provider

Record the exact time of intubation, provider's name and credentials, and the setting (e.g., inpatient setting or ER). This supports accurate billing and potential inclusion under critical care services.

CPT code 31500 billing guidelines

Billing for 31500 has specific requirements and exceptions. Below are key guidelines to ensure compliance and prevent denials.

Global surgical package does not apply

This code is not bundled under a global period. It is separately reportable, even when performed during an emergency procedure or resuscitation.

Cannot be billed with anesthesia induction codes

Avoid using code 31500 with anesthesia induction codes unless performed for resuscitation or airway compromise unrelated to elective surgery.

Only one provider may bill per session

Only the provider who successfully performs the intubation may bill for it. In cases of multiple attempts, only one unit is allowed unless clear documentation justifies a repeat.

Modifier use during E/M services

If evaluation and management services are performed on the same day, modifier 25 must be added to the E/M code to report both services appropriately.

Applicable modifiers for CPT code 31500

These modifiers ensure correct representation of the services performed, especially when CPT 31500 is part of a broader treatment plan involving other procedures.

Modifier 22 – Increased procedural services: Use when intubation is unusually difficult due to anatomical or clinical factors.
Modifier 25 – Significant, separately identifiable evaluation and management service performed on the same day.
Modifier 59 – Distinct procedural service: Indicates that intubation was separate from other procedures done that day.
Modifier 76 – Repeat procedure by the same provider: If reintubation was necessary and medically justified.
Modifier 77 – Repeat procedure by a different provider: If another physician performs a reintubation during the same encounter.
Modifier 78 – Unplanned return to the OR/procedure room for a related issue during the post-op period.
Modifier 79 – Unrelated procedure performed during the post-op period of a different surgery.

Note: CPT code 31500 is exempt from modifier 51, so it should not be reported using the multiple procedures code.

Related CPT codes

Here are some CPT codes that are commonly billed in conjunction with or as alternatives to CPT 31500, particularly for tube thoracostomy and emergency interventions:

32554 – Thoracentesis, needle aspiration of pleural space without imaging.
32556 – Thoracentesis with imaging guidance.
92950 – Cardiopulmonary resuscitation (CPR), often performed during the same session as emergency intubation.
94760 – Noninvasive oxygen saturation monitoring, sometimes documented with respiratory procedures.

These codes help capture related procedures as part of procedures part 2 coding for respiratory services.