Pediatric Coding Alert

Know what epistaxis is? Read on to find out.

In news that should shock absolutely no one, children often get nosebleeds. While most of these issues can be remedied with sympathy and tissues, a pediatrician will sometimes need to step in to stop the bleeding.

Coders need to be on alert for evidence of certain terms in order to choose the correct nosebleed repair code. To get the scoop on the ins and outs of nosebleed coding, we talked to Chip Hart, director of PCC’s Pediatric Solutions Consulting Group in Vermont and author of the blog “Confessions of a Pediatric Practice Consultant.”

Here’s what he had to say about coding for nosebleed repair:

Q: A patient reports to the physician with a nosebleed, and the physician stops the bleeding with standard methods (ice, pressure). Is this an evaluation and management (E/M) service?

A: “If simple procedures like ice and pressure succeed by themselves, E/M is appropriate. However, the descriptor for 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) includes the phrase ‘any method,’ and if the clinician can discern that the cause is a ruptured blood vessel, which is easily a clinical assessment and would require no diagnostics to verify, proper coding might include both the E/M and 30901 or 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method), depending upon presentation.

“Nasal sprays for constriction and/or use of cautery are signs that the clinician performed more than E/M.”

Q: What aspects of an encounter would lead the coder to choose 30901?

A: “Descriptors like ‘hemorrhage’ and/or ‘epistaxis,’ plus a procedure note describing the presentation, preparation, method/approach, and outcome is what I would expect.”

Q: Could you provide a clinical example in which the physician performs 30901?

“Chief Complaint:

Prolonged bleeding of R nostril (nearly 1hr.). Est. Px.

“Clinician actions:

Visualized bleeding source, silver nitrate attempted & failed to halt bleeding, applied tampon/dental-tonsilar packing. (Pressure applied for approximately 10 min) Removed packing and observed hemostasis achieved. Patient tolerated the procedure well.

“CPT^®/modifier[s]:

30901
9921X-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)

“ICD-10:

R04.0 (Epistaxis).”

Q: Would a pediatrician typically perform complex nosebleed repair (30903)?

A: “No, this is an uncommon code among primary care physicians. I would expect packing a difficult bleed to be referred to the ER [emergency room] or an ENT [otolaryngologist].”