Medicare Compliance & Reimbursement

If a patient reports to the ED with a nosebleed, and the physician stops the bleeding with basic methods, the coder usually chooses an E/M code,confirms LindaMartien, CPC, CPC-H, coding specialist at National Healing Inc. in Boca Raton, Fla.

These methods can include minimal attempts at stoppage, including ice or brief, direct pressure. The key to these encounters is that the physician did "not perform a billable procedure, so the E/M is the only way to capture the services the physician provides," Martien points out.

Also: Any treatment of an active nosebleed is likely going to trigger the assignment of a nosebleed repair code, relays Todd Thomas, CPC, CCS-P, president of ERcoder Inc. in Edmond, Ok.

"There are patients that present [to the ED] with a complaint of a nosebleed, but there is no active bleeding. In that situation, only the E/M would apply,"Thomas says.

Several factors can up the nosebleed fix to the level of procedure, according to Thomas. You might be able to report 30901 (Control nasal hemorrhage, anterior,simple [limited cautery and/or packing] any method) if the notes indicate that the ED physician performed one of the following to treat a nosebleed:

• applied continuous pressure

• inserted pledgets soaked with an anestheticvasoconstrictor solution into the nasal cavity

• administered nasal spray to anesthetize/shrink nasal mucosa

• performed chemical cautery with a silver nitrate stick.

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

Example: A patient presents to the ED with an active nosebleed. The physician 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 (Epistaxis) appended, Thomas says.

Remember: If the ED physician treats bleeding on both sides of the patient's nose, report the nosebleed repair code (30901, 30903) with modifier 50 (Bilateral procedure) appended.

ED physicians will also perform complex anterior nosebleed repairs, says Martien. You'll have to dig through the notes to identify complex repairs, but the extra work will pay off.

An easy $20: The average payout for 30903 (Control nasal hemorrhage, anterior, complex) is approximately $77 per claim (2.13 relative value units [RVUs] using the 2009 Medicare Physician Fee Schedule multiplied by Medicare's conversion rate of 36.0666). Code 30901 pays approximately $59 per claim (1.64 RVUs).