ED Coding and Reimbursement Alert

Remember, the physician might stop nosebleed during E/M.

When a patient reports to the ED with a nosebleed, coders will be presented with several choices when reporting the repair.

The lowdown: Your provider could perform nosebleed (or epistaxis) repair that is represented by several different codes. Knowing which code to use in which situation is the crux of your coding challenge with these patients.

Read on for more on coding your provider’s nosebleed repair services.

Use These Codes for Repairs

The codes: In the ED setting, your nosebleed repairs will be reported with these codes:

An ED evaluation and management (E/M) service from the 99281 (Emergency department visit for the evaluation and management of a patient that may not require the presence of a physician or other qualified health care professional) through 99285 (Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination and high level of medical decision making) code set

• 30901 (Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method)
• 30903 (Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method)

How you employ these codes, and which ones you use, will depend on the specifics of the encounter. Here’s a look at the common nosebleed presentations for each type of code:

ED E/M: You’ll report an ED E/M when the nosebleed repair does not reach the level of 30901.

“A coder can separate 30901 from an E/M service by the approach of the procedure. If a patient goes to the emergency department with a nosebleed and the physician controls the bleeding by applying external pressure, and also uses a cotton swab with phenylephrine and removed right after, then this would be included in the E/M service,” explains Marco Unzueta, BSHIM, CPC, CCS, CIC, CDEO, CDEI, AAPC Approved Instructor, medical coding supervisor at El Paso Children’s Hospital in El Paso, Texas.

30901: Citing Coder’s Desk Reference, Unzueta says you’ll report 30901 when the physician applies electrical or chemical coagulation or packing materials to the anterior (front) section of the nose. Only limited electrical or chemical coagulation is used during 30901 procedures, he says.

30903: Again, citing Coder’s Desk Reference, 30903, the physician uses extensive electrical coagulation or extensive packing in the anterior (front) section of the nose.

“Complex is intended to mean deeper into the canal … or multiple applications of the coagulation method. It could also include additional layers of packing,” explains Linda Martien, COC, CPC, CPMA, CRC, of Medical Revenue Cycle Management Consulting.

If the nosebleed requires extensive packing or cauterization in both nostrils, you should append modifier 50 (Bilateral procedure) to the repair code to indicate that it was a bilateral procedure.

ED E/M-25 a Possibility

There are also a couple of other services you could potentially code for during a nosebleed repair encounter. If the provider performs a significant, separately identifiable ED E/M before the nosebleed repair, then you can report it using modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service). You’ll need to have proof in the record that the provider performed a significant, separately identifiable E/M before the repair, complete with separate medical decision making (MDM) and history and exam (as appropriate).

Exception: If you’re coding the nosebleed repair itself with an ED E/M, you cannot report another ED E/M for the work the provider does before the repair. In these cases, you’d roll all of the work of the encounter — E/M before the repair and the repair itself — together and choose an ED E/M based on that level of MDM.