Oncology & Hematology Coding Alert

Question: A patient experienced a nosebleed while in the office. The hematologist used packing in the patient's right nostril for 15 minutes and then used a silver nitrate stick to stop the bleed. May we report this service separately from the E/M? The physician also performed a level-4 established visit to evaluate the patient's thrombocytopenia.

Illinois Subscriber

Answer: In the case you describe, you may report 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing], any method) linked to 784.7 (Epistaxis). You may report the 30901 service in addition to 99214 (Office or other outpatient visit ...) linked to the appropriate thrombocytopenia code (such as 287.30, Primary thrombocytopenia, unspecified).

The intervention you describe, which succeeded with the first attempt, meets the requirements for the limited cautery and/or packing code.

If ice packs or pressure had been sufficient to control the bleed, experts advise incorporating the service into the E/M code. On the other hand, if the nosebleed had required complex care, the appropriate code would be 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method). Extensive repair may include preformed nasal packs that fill nearly the entire anterior nasal vestibule (nasal tampons), nasal packing with yards of Vaseline gauze, cautery of several areas, or multiple bleeding episodes with several attempts to control the hemorrhage.

ICD-10-CM: When your coding system changes to ICD-10-CM, 784.7 will become R04.0 (Epistaxis) and 287.30 will translate to D47.3 (Essential [hemorrhagic] thrombocythemia).