ED Coding and Reimbursement Alert

Question: A patient reports to the ED after sustaining injuries during a soccer match; she was hit in the face with a ball, her nose is bleeding, and her right eye is blackened. The physician is not able to stop the bleeding with ice or pressure, so she performs repeated and extensive cautery using a silver nitrate stick on both nostrils. The bleeding relents, and the physician orders an x-ray to ensure that the patient's nose is not broken. Results are negative. Notes indicate a level-four E/M. Can I report 30903 x 2, since the physician stopped bleeding in both nostrils? Tennessee Subscriber Answer: No, you'll report this under bilateral procedure guidelines. On the claim, report the following: • 30903 (Control nasal hemorrhage, anterior, complex [ extensive cautery and/or packing] and method) for the repair • modifier 50 (Bilateral procedure) appended to 30903 to show that the physician treated both [...]