Otolaryngology Coding Alert

Question: Our ENT provider performed simple anterior cautery on a patient’s right nostril and anterior complex packing on the left side. Which codes apply?

Answer: Submit the claim with the following codes:

• 30903 (Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method). This describes the procedure performed on the left nostril. You’ll list it first because it’s the higher-paying procedure.
• 30901 (Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method) with modifier XS (Separate structure…) or modifier 59 (Distinct procedural service) appended

Modifiers XS or 59 tell the insurer that the complex hemorrhage control occurred on a different side (structure) from the simple cautery. If the payer processes and pays with the modifiers for laterality properly, instead of modifier 59, you can use the appropriate LT (Left side) and RT (Right side) modifiers. But this option is only available with payers who do not bundle procedures when the separate sites are identified with body area modifiers as available in the CPT^® Appendix A. Otherwise, the LT and RT modifiers can be added as secondary modifiers to provide additional information.

Note: Whenever a payer recognizes the X[ESPU] modifiers, it is better to use these modifiers instead of the 59 modifier because you are showing the payer that you evaluated the documentation and you know why the distinct procedural service modifier is applicable and supported in the documentation.