Internal Medicine Coding Alert

Question: The internist stops a patient's nosebleed. Is this always a procedure?

South Dakota Subscriber

Answer: No, if a patient reports with a nosebleed and the physician stops the bleeding with basic methods, you'll typically opt for the appropriate-level E/M code.

E/M methods: Code minimal attempts at stoppage -- including ice or brief, direct pressure -- as an E/M service. CPT does not consider these types of treatments separately billable procedures, so an E/M is the way to capture the services the physician provides.

For example, a 62-year-old established patient reports to the internist with an active right-nostril nosebleed that has lasted for three hours. The internist performs a problem focused history and exam, then uses ice and pressure to treat the nosebleed.

Report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making ...) with 784.7 (Epistaxis) appended for the above encounter:

Procedure methods: Several factors can up the nosebleed fix to the procedure level. You should check with individual payers if you are unsure, but you might be able to report 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) if the notes indicate that to treat a nosebleed the internist performed one of the following:

• administered nasal spray to anesthetize/shrink nasal mucosa

• extensive packing

• performed chemical cautery with a silver nitrate stick.

Key terms: When deciding on a nosebleed repair code, look for phrases such as "packing," "hemostasis" (control of bleeding), "bovie," "silver nitrate," "electrocautery," and "chemical cauterization." These terms would likely indicate a procedure.

Suppose in the above active right-nostril nosebleed example the internist anesthetizes the nasal mucosa with Cetacaine and cauterizes the septum area with silver nitrate to stop the bleeding.

This is a simple anterior repair. On the claim, report 30901 with 784.7 appended.

Modifier 50 alert: If the internist performs 30901 on both nostrils, report 30901 with modifier 50 (Bilateral procedure) appended.