ED Coding and Reimbursement Alert

Question: The ED physician cauterized and performed packing for an anterior nosebleed. He called in the ENT because the patient was still bleeding. The ENT saw a posterior bleed and placed a posterior pack in the patient’s nose. Should I report the posterior code?

Iowa Subscriber

Answer: If the emergency department physician performed cautery and the patient additionally required packing, you have likely met the requirement for code 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method).

A majority of anterior bleeds come from Kesselbachs’ plexus, an area where several blood supplies come together. This area is located on the septum, very close to the nares/tip of the nose. Posterior bleeds are usually from branches of the sphenopalatine artery and are much further back within the nasal cavity.

Treatment of a posterior bleed involves placing some type of mechanical tamponading device in the back of the nasal cavity. Commonly used devices are long nasal tampons, Vaseline gauze packing that is placed posteriorly, or epistat balloons. The physician would place all of these devices through the nares.

If the otolaryngologist treated the posterior bleed, then that physician would bill for the service, not the ED doctor. The emergency physician would report the ED E/M code.