Otolaryngology Coding Alert

Question: A patient presents to the emergency department (ED) with a bruised nose and epistaxis, which they report occurred while playing soccer. The otolaryngologist is called to the ED to consult on the patient. After stopping the bleeding with direct pressure and temporary placement of a cotton swab in the nostril, the ENT orders and interprets a three-view nasal X-ray, diagnoses a broken nose, and treats the nasal fracture without manipulation. How should I report this encounter?

North Carolina Subscriber

Answer: While your first instinct might be to report 21315 (Closed treatment of nasal bone fracture with manipulation; without stabilization) for this fix, that would not be correct in this case. According to CPT^®, “For closed treatment of nasal bone fracture without manipulation or stabilization, use appropriate [evaluation and management] E/M code.”

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Furthermore, in this scenario, you won’t be able to use 30901 (Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method) because “there was no cautery performed or packing left in place to remain after the encounter,” per CPT^® Assistant (Volume 30, Number 7, 2020).

So, on your claim, you would report:

• The appropriate-level ED E/M code from the 99282-99285 (Emergency department visit for the evaluation and management of a patient …) code set; possibly 99293 or 99294 (… which requires a medically appropriate history and/or examination and low/moderate level of medical decision making) depending on the documentation.
• 70160 (Radiologic examination, nasal bones, complete, minimum of 3 views) for the X-ray
• Modifier 26 (Professional component) appended to 70160 to indicate that you are only coding for your physician’s work of reading the X-ray, not the equipment used.
• S02.2XXA (Fracture of nasal bones, initial encounter for closed fracture)
• Y93.66 (Activity, soccer)