Otolaryngology Coding Alert

Question: The emergency department (ED) called our otolaryngologist into the hospital at night to treat a patient with a profuse nosebleed that the ENT had packed extensively earlier in the day. The ENT went to the hospital, removed the anterior pack and placed a posterior pack. He then admitted the patient to the hospital for the night. How should I code the ED encounter?

New Jersey Subscriber

Answer: You should code the epistaxis control in the ED with 30905 (Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial). The ENT had previously packed the anterior nose (30903, Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method). So treatment in the ED is still the initial posterior packing.

The epistaxis code includes the related E/M (99221-99223, Initial hospital care, per day, for the evaluation and management of a patient -). So you should not separately code the admission.

Don't overlook: Since June 2007, the Correct Coding Initiative (CCI) has bundled 30903 into 30905. The edit allows a modifier when appropriate to override the bundle. Because the packings in your case occurred at separate sessions, you should append 30905 with modifier 59 (Distinct procedural service). For the ICD-9 code, list 784.7 (Epistaxis).