Part B Insider (Multispecialty) Coding Alert

Keep bilateral procedure guidelines in mind when you're dealing with bleeding conditions affecting both nostrils.

Question: An established patient reports to the family physician after sustaining injuries during a soccer match. A ball hit her in the face. Her nose is bleeding, and her right eye is blackened. The physician is not able to stop the bleeding with ice or pressure, so she performs repeated and extensive cautery using a silver nitrate stick on both nostrils. The bleeding relents, and the physician orders an x-ray to ensure that the patient's nose is not broken. Results are negative. Notes indicate a levelfour E/M. Can I report 30903 x 2, since the physician stopped bleeding in both nostrils?

Answer: No, you'll report this under bilateral procedure guidelines. On the claim, report the following:

• 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method) for the repair;

• modifier 50 (Bilateral procedure) appended to 30903 to show 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; and medical decision making of moderate complexity ...) for the E/M;

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99214 to show that the E/M and repair were separate services;

• 784.7 (Epistaxis) appended to 30903 and 99214 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 to represent the cause of the patient's nosebleed; and

• E007.5 (Activities involving other sports and athletics played as a team or group; soccer) appended to 30903 and 99214 to represent the circumstances surrounding the patient's nosebleed.