Practice Management Alert

Question: When our physician stops a nosebleed, should we report a CPT^® evaluation and management (E/M) service code or a procedure code?

West Virginia Subscriber

Answer: It depends on the method(s) your physician employs to stop the patient’s nosebleed.

If the patient reports to the physician with complaints of a nosebleed and the provider stops the bleed with conventional methods such as ice or pressure, you should report an E/M code for the service.

E/M alert: The E/M code you choose for a nosebleed stop will depend on encounter specifics, and range from:

• 99201 (Office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: a problem focused history; a problem focused examination; straightforward medical decision making…) to 99205 (… a comprehensive history; a comprehensive examination; medical decision making of high complexity…) for new patients; and
• 99211 (Office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician or other qualified health care professional. Usually, the presenting problem[s] are minimal. Typically, 5 minutes are spent performing or supervising these services) to 99215 (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 comprehensive history; a comprehensive examination; medical decision making of high complexity…) for established patients.

If, however, the provider employs more aggressive means of stopping the bleed, such as cautery or packing, you’ll typically choose a simple nosebleed repair code 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method).

E/M-25 possibility: If you’re reporting 30901 for a nosebleed repair, your physician could have provided an E/M service that you can also code — provided you include the right modifier. After all, the physician cannot know how to stop the bleeding before performing some kind of evaluation; this evaluation often amounts to an E/M service.

Example: An established patient comes to the office with a nosebleed that he has not been able to control for “about three hours.” After performing a problem focused history and exam to look for signs of a bleeding diathesis, the provider finds blood oozing from the right inferior nasal turbinate. The provider places a compressed nasal sponge in the affected nare, expanding it with a few drops of oxymetazoline, to control the bleeding.

On the claim, you would report 30901 for the nosebleed repair. Then, report 99213 (… an expanded problem focused history; an expanded problem focused examination; medical decision making of low complexity…) for the E/M service with 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) appended to show that the provider performed a separately identifiable E/M service before stopping the nosebleed.