Otolaryngology Coding Alert

Question: What constitutes reporting CPT® code 30903 versus 31238?

Michigan Subscriber

Answer: In short, 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method) represents an open procedure and 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) denotes an endoscopic approach.

More explanation: Physicians may perform extensive methods to control complex anterior nasal bleeding, such as packing with Merocel, utilizing extensive nasal packing with Vaseline or antibiotics (filling most of the nasal vestibule), using petroleum ribbon gauze or nasal tampons, or cautery. The physician can also inject pharmacologic agents (such as epinephrine or lidocaine HCL) into the anterior septum for hemostatis. In these situations, you would report 30903.

Code 31238 applies when the physician inserts a rigid or flexible endoscope into the nasal cavity after anesthetic administration. The physician can then identify the area of bleeding and use an insulated bipolar cautery device or suction cautery to control the bleeding. Antibiotics are then applied and the scope is removed. All of the control of the hemorrhage work is done alongside the endoscope. The endoscope is not used just to locate the bleed, but also to assist in the control procedure.