Otolaryngology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: A patient comes into the office with severe epistaxis. The otolaryngologist finds a pumping vessel and immediately packs it, then sends the patient to the hospital to be admitted for surgery, which consists of further cauterization and a septoplasty. How should we code this service? Iowa Subscriber Answer: First of all, the initial control of bleeding (30903*, Control nasal hemorrhage, anterior, complex [extensive cautery and/or packing] any method) and the subsequent procedures are performed in different places of service, so two claim forms must be submitted. The initial packing should be billed 30903-59. Append modifier -59 (Distinct procedural service) to indicate that the procedure took place at a different time and in a different place (the office) on the same day as the septal surgery. Bill the surgery as: 30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft 30903-59. Although 30903 is not bundled with 30520 in the Correct Coding Initiative, some carriers may bundle these procedures if septoplasty caused the bleeding. However, the pumping epistaxis is unrelated to the septoplasty, which is why modifier -59 is also appended to the second 30903. Modifier -59 signals that the bleeding occurred before the septoplasty was begun, and as a result, both procedures should be separately payable. If the claim is denied nonetheless, you should appeal, assuming the otolaryngologist's documentation is in order.