How Do I Code a 2-Sided Nosebleed?

January 19, 2010

Heads up: 2 nosebleed codes are not the answer.

Question: A patient reports to the ED after sustaining injuries during a soccer match; she was hit in the face with a ball, her nose is bleeding, and her right eye is blackened. The physician is not able to stop the bleeding with ice or pressure, so she performs repeated and extensive cautery using a silver nitrate stick on both nostrils. The bleeding relents, and the physician orders an x-ray to ensure that the patient’s nose is not broken.

Results are negative. Notes indicate a level-four E/M. Can I report 30903 x 2, since the physician stopped bleeding in both nostrils? No, you’ll report this under bilateral procedure guidelines. On the claim, report the following:

Answer: No, you’ll report this under bilateral procedure guidelines. On the claim, report the following:

• 30903 (Control nasal hemorrhage, anterior, complex [ extensive cautery and/or packing] and method) for the repair

• modifier 50 (Bilateral procedure) appended to 30903 to show that the physician treated both nostrils

• 99284 (Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: a detailed history; a detailed examination; and medical decision making of moderate complexity …) for the E/M

• modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) appended to 99284 to show that the E/M and repair were separate services

• 784.7 (Epistaxis) appended to 30903 and 99284 to represent the patient’s nosebleed

• E917.0 (Striking against or struck accidentally by objects or persons; in sports without subsequent fall) appended to 30903 and 99284 to represent the cause of the patient’s nosebleed.

• E007.5 (Activities involving other sports and athletics played as a team or group; soccer) appended to 30903 and 99284 to represent the circumstances surrounding the patient’s nosebleed.

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