Primary Care Coding Alert

 CPT-approved nosebleed treatments involve certain methods, tools


 When a patient presents to your FP for nosebleed treatment, the severity of the patient's condition will likely affect your code choice for the encounter.

 Why? For less serious nosebleeds, your physician's actions won't meet CPT's definition for nosebleed treatment. In these situations, you-ll have to turn away from CPT's nasal hemorrhage treatment section and choose another code for the encounter.

Choose correctly by checking the FP's documentation to see if the encounter meets CPT parameters for nasal hemorrhage treatment.

Nosebleed Treatment Could Be an E/M Service

 You-ll end up coding a portion of your nosebleed presentations with an appropriate E/M code, says Joan Gilhooly, CPC, CHCC, president of Medical Business Resources LLC in Deer Park, Ill. When the FP stops the bleeding with standard methods, such as ice or pressure, you should report an E/M service (for instance 99201-99215, Office or other outpatient visit ...).

 Example: An established patient presents with mild left nasal bleeding. The physician performs a problem-focused history and exam while a medical assistant applies 10 minutes of direct pressure to the left nostril. After the pressure, a repeat assessment of the nostril shows the bleeding has stopped.

 In this instance, report 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: a problem-focused history; a problem-focused examination; and straightforward medical decision-making). Use ICD-9 code 784.7 (Epistaxis) with 99212 to represent the nosebleed.

Limited Packing Likely Means Simple Treatment

 When the nosebleed takes more involved methods to stop, such as simple cautery or nasal packing, you may report the service with 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing] any method).

 Report this code for nosebleed treatments that involve one attempt at cautery or packing placement in the nostril's anterior part that controls the bleeding on the initial attempt.

 You should use 30901 -if the physician took a silver nitrate stick to stop an anterior nosebleed or packed the nose with a cotton pledget,- says Jeffery F. Linzer Sr., MD, FAAP, FACEP, associate medical director for compliance and business affairs at EPG in Egleston, Ga.

 Consider this example: A 45-year-old male established patient reports that his right nostril started bleeding two hours ago and that putting pressure against the nostril failed to stop it.
 During the course of a level-three E/M service, the FP finds the patient is otherwise healthy and has no other bleeding. The physician examines the patient and discovers persistent ooze from the septum during a check of the right naris.

 The FP places cotton strips soaked in Pontocaine and epinephrine in the patient's right naris for 15 minutes. After the physician removes the strips, there is an obvious [...]