Otolaryngology Coding Alert

Question: Our surgeon treated a post-op hemorrhage for bleeding in the ethmoid cavity following a septoplasty/ethmoidectomy procedure. The surgeon cauterized the bleeding using suction cautery. I reported 37799, but the payer denied it saying I should report a more specific code. Which code should I report?


Texas Subscriber
Answer: If the surgeon used a scope, you should report 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage) because it is a more specific code than 37799 (Unlisted procedure, vascular surgery).
 
Because the surgeon performed a septoplasty, the hemorrhage occurred during the global period of the surgery. Therefore, if the surgeon performed the hemorrhage control in the OR, you should append 78 (Return to the operating room for a related procedure during the postoperative period) to 31238.

If he performed the procedure in the office, you should instead append modifier 79 (Unrelated procedure or service by the same physician during the postoperative period), but keep in mind that Medicare only reimburses postoperative complications if you had to return the patient to the operating room. 

If the surgeon performs the postoperative hemorrhage control without using the scope, you should report either 30903 (Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method) or 30905 (Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial).