Wiki Correct Procedure code and use of 25 modifier


Nicholls, GA
Best answers
Good Morning!
We had a claim reject in our coding scrubber software stating a modifier was needed. I viewed the codes that were billed and the manager in the office forgot to add a 25 modifier to the E/M code that was billed with a procedure that has a 10-day global period. I went back and reviewed the documentation to see if a 25 modifier could be used based on the documentation. The physician billed a 99202 and 30903. This is the note without patient information. I would like for someone else's opinion on this. I personally don't think that the procedure documented warrants coding 30903, if anything, it would be 30901, but I am not sure how to explain this to the physician as he is older and set in his ways. I would greatly appreciate any assistance/guidance. Thank you in advance.

Chief Complaint: NOSEBLEED

This 71 years old male presents for evaluation of the following problem(s): Patient was sent here from the ER to take the packing out of his nose. Patient states that he started having a nosebleed yesterday morning and could not control it at home. He went to the ER and had the nosebleed controled with packing. He was then told to come see us today to have the packing removed from his nose. He is not currently bleeding at this time but states that his nose is running.

Duration: 1 day
Frequent nose picking: no
Recurrent nosebleeds: no
Current anticoagulation therapy: yes
History of bleeding diathesis: no
Previous ENT evaluation: no
Treatments attempted: Went to ER had nose packed

Review of Systems:
Constitutional: negative
Eyes: negative
Ears: negative
Nose: negative
Mouth/Throat: negative
Cardiovascular: negative
Respiratory: negative
Gastrointestinal: negative
Genitourinary: negative
Musculoskeletal: negative
Skin: negative
Breast: negative
Neurological: negative
Psychiatric: negative
Hematologic/Lymphatic: negative
Allergic/Immunologic: negative

Past Medical History:
Past Medical History:

Surgical / Procedural History:

Social History:
Alcohol: none

Family History:

Current Medications:
Current Medications:
Rx: COUMADIN 2MG 1 TAB daily - days, 30, Ref: 0
Rx: LISINOPRIL 40MG 1 TAB daily - days, 30, Ref: 0
Rx: AMPICILLIN 500MG four times daily 1 days, , Ref: 0
Medication Allergies:

General: Ill-appearing , with mild distress from having his nose packed but no respiratory distress
Skin: no rash or prominent lesions
Head: normocephalic, atraumatic
Ears: Ear canals clear, tympanic membranes clear, ossicles normal appearance.
Nose: A tampon is in his right nostril-It was removed and old blood and secretions aspirated
Mucosa: a gouged area is seen in the anterior area. It was anesthetized and treated with silver nitrate
Septum: deviated left
Secretions: clear with old blood
Turbinates: within normal limits
Mouth: Mucous membranes moist, no mucosal lesions.
Dentition: poor oral hygiene is evident.with multiple badly decayed teeth
Throat: Pharynx: No erythema. no blood
Tonsils: absent
Neck: Supple without lymphadenopathy. Thyroid is normal size without nodules or tenderness.

.DX: EPISTAXIS : 784.7

Explained in detail to pt. and daughter how to control bleeding should it reoccur

Follow-up: PRN
I would try to expalin the different between the charges:
30901 'Control nasal hemorrhage, anteriro, simple' provider applies electrical or chemical coagulation or packing materials to the anterior section of the nose.

30903 'Control nasal hemorrhage, anterior, complex' provider uses extensive electical coagulation or extensice packing in the anterior section of the nose.

The documentation you provided simply states treated with silver nitrate, I would have to say in order to qualify for the complex procedure there would have to be more elaboration as to the difficulties encountered and why the treatment was more complex. Example, had to treat numerous times, bleeding was excessive etc.

Hopefully the provider having a clear understanding of the two codes will help.
In this case what you have updated that the Epistaxis was treated already in ER. Today patient just came for F/U to remove packing. There is no current bleeding also, then why your Dr billed for same procedure that too high severity CPT code.

My question is, Can we bill controle of Epistaxis again when it was treated already. In this visit it seems to be the F/U.

Please clarify me this...


Natarajan Chellamuthu, CPC