Otolaryngology Coding Alert

Question: Our otolaryngologist treated a patient with posterior nasal bleeding. Later that day the epistaxis reoccurred at the same site, and the physician repeated cauterization and packing of the posterior nasal cavity to achieve hemostasis. How is this coded?

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Answer: In this case, the two services were performed on the same day, but at separate encounters. So, you’ll report the initial posterior epistaxis treatment with 30905 (Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial). For the subsequent treatment of the posterior nosebleed via cautery and/or packing submit 30906 (… subsequent). Note, CPT^® code 30906 has higher relative value units (RVUs) than 30905.

Watch out: The National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits bundles 30906 (column 2 code) with 30905 (column 1 code). So, if the physician treats posterior epistaxis twice on the same day, the payer will view the two services as bundled. However, the NCCI edits allow you to use a modifier — such as -XE (Separate encounter …) or -59 (Distinct procedural service) if the payer does not recognize the X{ESPU} modifiers — to override the bundle.

Putting it all together, you’ll report 30905 and 30906-XE or -59 for the treatments and R04.0 (Epistaxis) for the diagnosis. Make sure the chart notes clearly describe the circumstances, demonstrate a second separate encounter, and emphasize that the patient’s condition was not resolved, therefore, a second treatment was medically necessary.