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Outpatient Facility Coding Alert

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Coding for Nose Bleed

Published on Mon May 26, 2014

Question: A patient comes to a clinic after sustaining injuries during a soccer game. She had a black eye on the right side and her nose was bleeding from a direct hit from the ball. Upon her arrival the physician documented the detailed history, performed detailed examination, and made a medical decision of moderate complexity.

The otolaryngologist could not stop the bleeding with ice or pressure, so to stop the bleeding a repeated and extensive cautery was performed with silver nitrate sticks on both nostrils. The physician ordered an X-ray to ensure that the patient’s nose was not broken. The X-ray was negative. How should you code all these proceedings?

Oklahoma Subscriber

Answer: You should be sure of the type of nose bleed control your physician has done. For the situation given, you should code as explained below:
 
  • CPT® code 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method) for the complex repair and append modifier 50 (Bilateral procedure) to it, to indicate that the physician treated both nostrils.
  • 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: a detailed history; a detailed examination; medical decision making of moderate complexity) for the E/M. To  99214 you need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to show that the E/M and repair were separate services.
Also know the ICD- 9 codes to be appended:
  • 784.0 (Headache and facial pain) appended only to the E/M service, 99214-25
  • 784.7 (Epistaxis) appended to 30903 and 99214-25 to represent the patient’s nosebleed
  • E917.0 (Striking against or struck accidentally by objects or persons; in sports without subsequent fall) appended to 30903 and 99214-25 to represent the cause of the patient’s nosebleed
  • E007.5 (Activities involving other sports and athletics played as a team or group; soccer) appended to 30903 and 99214-25 to represent the circumstances surrounding the patient’s nosebleed. 

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