Otolaryngology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.   Question: When is 30901 (control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method) separately payable, as opposed to, for example, being bundled with concurrent endoscopy?

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      Answer: Simple control of epistaxis is typically included in more complex procedures such as nasal/sinus endoscopies. If the bleeding is in the same anatomic location as the sinus procedure, 30901 would be included in the appropriate endoscopy code, 31231-31294. For example, the otolaryngologist may use an endoscope to examine the nasal passages to determine the location and severity of the bleeding. If he treats the epistaxis by packing the anterior section of the nose as a result of this examination, only 31231 (nasal endoscopy) should be billed because 30901 is bundled with 31231 in the National Correct Coding Initiative.
 
The edit may be bypassed if the documentation shows the bleeding was at a different site. To bill separately for bleeding and sinus endoscopy, append modifier -59 (distinct procedural service) to 30901.
 
Normally, 30901 is also considered part of most E/M services. But in some cases, the nosebleed control may be separately payable. For example, if the otolaryngologist sees a new patient who complains of chronic nosebleeds, a separate and significant E/M service will more than likely be performed, and both can be billed.
 
In such cases, the E/M service should be billed with modifier -25 (significant, separately identifiable evalua-tion and management service by the same physician on the same day of the procedure or other service) appended. Reimbursement is more likely if the E/M is associated, appropriately, with another diagnosis code.
 
Note: More complicated epistaxis treatment codes are not bundled with 31231 and may be reported separately: 30903, control nasal hemorrhage, anterior, complex (extensive cautery and/or packing), any method; and 30905, control nasal hemorrhage, posterior, with posterior nasal packs and/or cauterization, any method; initial.