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Official Description

Tracheostomy, emergency procedure; cricothyroid membrane

© Copyright 2026 American Medical Association. All rights reserved.

Common Language Description

The CPT® Code 31605 refers to an emergency tracheostomy procedure performed through the cricothyroid membrane. This procedure is typically indicated in urgent situations where immediate access to the airway is necessary, such as in cases of severe airway obstruction or respiratory distress. The cricothyroid membrane is a thin membrane located between the cricoid and thyroid cartilages in the neck, and accessing the airway through this membrane allows for rapid ventilation. The procedure is performed on patients aged two years or older, and it involves specific steps to ensure that the airway is established safely and effectively. The physician must carefully identify anatomical landmarks, administer local anesthesia, and make precise incisions to avoid damaging surrounding structures, particularly the vocal cords. This emergency intervention is critical in life-threatening situations where traditional intubation may not be feasible, providing a temporary airway until a more permanent solution can be established.

© Copyright 2026 Coding Ahead. All rights reserved.

1. Indications

The emergency cricothyroid membrane tracheostomy (CPT® Code 31605) is indicated in situations where immediate airway access is required due to severe respiratory distress or obstruction. This may include conditions such as:

  • Severe Airway Obstruction - Situations where the airway is blocked, preventing normal breathing.
  • Trauma - Injuries to the neck or face that compromise the airway.
  • Anaphylaxis - Severe allergic reactions that lead to swelling and obstruction of the airway.
  • Infection - Conditions such as epiglottitis that can cause rapid swelling of the throat.

2. Procedure

The procedure for an emergency cricothyroid membrane tracheostomy involves several critical steps to ensure the airway is established safely:

  • Step 1: Patient Positioning - The patient is positioned with the neck extended to provide optimal access to the cricothyroid membrane.
  • Step 2: Identification of Landmarks - The physician palpates the cricoid cartilage and identifies the anatomical landmarks necessary for the incision.
  • Step 3: Incision - A horizontal incision is made above the superior border of the cricoid cartilage to access the cricothyroid membrane.
  • Step 4: Exposure and Puncture - The cricothyroid membrane is exposed and punctured at the midline, with the blade directed inferiorly to avoid damaging the true vocal cords.
  • Step 5: Widening the Incision - The incision is widened to facilitate the insertion of a cannula.
  • Step 6: Cannula Insertion - A cannula is inserted through the incision to establish ventilation for the patient.

3. Post-Procedure

After the emergency cricothyroid membrane tracheostomy is performed, the patient requires careful monitoring to ensure adequate ventilation and to assess for any complications. The cannula must be secured to prevent displacement, and a tracheostomy collar may be applied to facilitate oxygen delivery. The healthcare team should observe for signs of airway obstruction, bleeding, or infection at the incision site. Additionally, plans for further airway management should be established, as this procedure is typically a temporary measure until a more permanent airway solution can be implemented.

Short Descr EMER TRACHEOSTOMY CTHYR MEM
Medium Descr TRACHEOSTOMY EMERGENCY CRICOTHYROID MEMBRANE
Long Descr Tracheostomy, emergency procedure; cricothyroid membrane
Status Code Active Code
Global Days 000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC) 0 - Physician Service Code
Multiple Procedures (51) 2 - Standard payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50) 0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 99 - Concept Does Not Apply
APC Status Indicator Procedure or Service, Multiple Reduction Applies
ASC Payment Indicator Non office-based surgical procedure added in CY 2008 or later; payment based on OPPS relative payment weight.
Type of Service (TOS) 2 - Surgery
Berenson-Eggers TOS (BETOS) P1G - Major procedure - Other
MUE 1
CCS Clinical Classification 34 - Tracheostomy, temporary and permanent
22 Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78 Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
80 Assistant surgeon: surgical assistant services may be identified by adding modifier 80 to the usual procedure number(s).
AQ Physician providing a service in an unlisted health professional shortage area (hpsa)
AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
GC This service has been performed in part by a resident under the direction of a teaching physician
GV Attending physician not employed or paid under arrangement by the patient's hospice provider
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2025-01-01 Changed Short Description changed.
Pre-1990 Added Code added.
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