ED Coding and Reimbursement Alert

Question: A patient is seen in the emergency department at 6 a.m. for a nosebleed. Cautery was performed, and the patient was released. The patient returned at 10 p.m. for a nosebleed after using cocaine, and cautery was performed again. Can both visits be billed separately? Or does this apply to the provisions of only billing one visit on the same day?

Sue Fronczek
Medical Management Solutions Inc., Cherry Hill, N.J.

Answer: If you have a separate, identifiable evaluation and management (E/M) service for something other than caring for the nosebleed, you would also code an E/M with a code for cautery (30901-30906). Otherwise, the E/M service would likely be considered bundled to the service earlier in the day. The cautery would be billed for both visits. If the exact procedure was repeated, append modifiers -76 (repeat procedure by same physician) or -77 (repeat procedure by another physician). If a different code is used for the second treatment, use modifier -58 (staged or related procedure or service by the same physician during the postoperative period) to indicate that a more comprehensive treatment was rendered after a previous treatment was rendered and was not effective.

Getting paid for this by Medicare isnt guaranteed it is carrier specific. There should be an indication somewhere on the chart that you arent trying to double bill for the same procedure. Medicare states that if something changes if you do one level of care and and then it gets worse and you have to do another procedure they will take that into account, but there is no guarantee. As long as you append the modifier and provide Medicare with as much information as you can, that would be reasonable.