Malfunction of tracheostomy stoma

This code signifies a functional impairment or complication related to a surgically created opening in the trachea. It encompasses issues where the stoma itself is not working as intended, leading to problems with breathing, secretion management, or device placement. This is distinct from an infection or mechanical obstruction of the tracheostomy tube.

Apply this code when documentation specifies a problem with the stoma itself, such as granulation tissue causing partial occlusion, stomal stenosis, or a stoma that is too large or too small to properly accommodate the tracheostomy tube. Supporting documentation should clearly indicate a functional issue with the stoma, not just the presence of a tracheostomy.

• Differentiate from complications of the tracheostomy tube (e.g., obstruction, displacement), which are coded elsewhere.
• Always sequence this code after the underlying reason for the tracheostomy, if applicable, or as a primary diagnosis if the malfunction is the chief complaint.
• Ensure documentation specifies "malfunction of stoma" or similar language indicating a problem with the opening itself, rather than the device within it.