ED Coding and Reimbursement Alert

Certain methods may signal a more complex treatment

When your ED physician treats a patient's nosebleed, you may be tempted to turn immediately to the nasal hemorrhage treatment CPT codes.

But rushing to use those codes may be premature, experts say. Before choosing a nosebleed treatment code, check the operative notes to see if the encounter meets CPT parameters for nasal hemorrhage treatment. Physician Could Perform E/M to Treat Nosebleed You-ll end up coding a portion of your nosebleed presentations in the ED with an appropriate E/M code, says Michael Granovsky, MD, CPC, president of MRSI, an ED coding and billing company in Woburn, Mass. If the physician is able to stop the bleeding with standard methods such as ice or pressure, you should report the service with an E/M code.

Example: A patient presents with mild left nasal bleeding. The physician performs an extended problem-focused history and exam, and applies 10 minutes of direct pressure to the left nostril. After the pressure, a repeat assessment shows that the bleeding has stopped.

In this instance, you should report 99283 (Emergency department visit for the evaluation and management of a patient, which requires these three key components: an expanded problem-focused history; an expanded problem-focused examination; and medical decision-making of moderate complexity) for the treatment, Granovsky says.

Also, attach 784.7 (Epistaxis) to 99283 to represent the patient's nosebleed. Limited Packing Indicates Simple Treatment When the nosebleed requires more substantial and invasive methods to be controlled, such as minimal cautery or nasal packing, you-ll be able to report the service with 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method). 

Report this code for nosebleed treatments that involve -one attempt at cautery or placement of packing in the anterior part of the nostril that controls the bleeding on the first try,- says Robert La Fleur, MD, FACEP, an emergency medicine physician and president of Medical Management Specialists in Grand Rapids, Mich.

Consider this example from La Fleur: A 7-year-old boy who picks at his nose is brought to the ED by his mother. The mother says the boy's right nostril started bleeding two hours ago, and she cannot stop it.

During the course of a level-two E/M service, the physician finds that the patient is otherwise healthy and has no other bleeding problems. The physician examines the patient and discovers persistent ooze from the septum during a check of the right naris.

The ED physician places cotton strips soaked in Pontocaine and Epinephrine in the patient's right naris for 15 minutes. There is an obvious bleeding site after the physician removes the strips, which he cauterizes with a silver nitrate stick.

This is an example of a simple anterior treatment, La Fleur says. On the claim, report the [...]