ED Coding and Reimbursement Alert

Question: A 17-year-old patient presented to the ED after being hit in the face with a soccer ball during a game. He was bleeding from both nares. The physician cleaned off the blood and examined the nares, finding several small areas of bleeding from the internal mucosa but no fractures. He placed nasal tampons, ordered an x-ray for confirmation, then replaced the nasal tampons when the patient returned from the x-ray. Before the patient achieved satisfactory hemostasis, the ED physician replaced the tampon, ultimately packing the entire nasal vestibule. Once bleeding stopped, the physician discharged the patient. Which codes should we report for this?

Codify Subscriber

Answer: In this situation, the physician performed complex epistaxis control bilaterally, so you'll report 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method) with a modifier 50 (Bilateral procedure) appended to it.

You won't report any separate codes for the tampon administrations or the packing because the complex nasal hemorrhage control code includes those as part of your payment.