Pediatric Coding Alert

Question: A mother brought in her teenage son who had collided with another player in a soccer game. He had a bleeding nose that she couldn't stop from bleeding after two hours. The pediatrician applies a nitrogen stick to the bleeding site. Should I report an office visit code for the bleeding control?

Massachusetts Subscriber

Answer: Because the pediatrician used cauterization to control the bleeding, report 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method), which pays more (2.64 relative value units) than all established patient office visits except 99215 (3.43 RVUs). But if the physician used only pressure to control the nosebleed, and no kind of cauterization, you would code only the office visit. Link the nosebleed control to epistaxis (784.7).

If the pediatrician performs a significant and separate E/M service from the minor E/M included in 30901, such as evaluating associated head trauma, you may also report the office visit (99201-99215) appended with modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service).

On claims containing an E/M-25 service and 30901, you may want to also report 99058 (Service[s] provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service). Code 99058 is appropriate if the triage nurse considered the patient an emergency that required disrupting the physician's scheduled appointments.