Pediatric Coding Alert

Question: An established patient reports to the pediatrician after a ball hit her in the face during a soccer match. 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 level-four E/M. Can I report 30903 x 2, since the physician stopped bleeding in both nostrils?

Pediatric Coding Listserv Subscriber

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

• 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.

You'll also report several diagnoses:

• 784.7 (Epistaxis) appended to 30903

• 920 (Contusion of face, scalp, and neck except eye[s]) appended to 99214

• 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

• 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.

Note: Although including E codes on your claim is optional, they provide a more complete picture of the circumstances surrounding injury. ICD-9 2010 greatly expanded your E code choices so that you can better explain many situations.