Editor’s Note: Cutting through the red tape to make certain you get paid for every dollar you earn has become more difficult than ever, particularly in our current climate of health care reform and ICD-10 transition. The ACEP Coding and Nomenclature Committee has partnered with ACEP Now to provide you with practical, impactful tips to help you navigate through this coding and reimbursement maze.
Question: Are there different codes for managing nosebleeds?
Answer: Yes, there are. Epistaxis control is achieved through a variety of modalities. Anterior epistaxis control has two codes: 30901 (simple, 1.62 relative value units [RVU], Medicare $58.32) and 30903 (complex, 2.25 RVU, Medicare $81). These codes are for unilateral procedures.
When a patient has a bilateral nosebleed, some payers require billing the procedure twice (as two units) with a 50 modifier (bilateral procedure) if control procedures are performed on both sides, while other payers will allow it to be billed only once with a 50 modifier.
The difference between “simple” and “complex” is not well-defined. The only description CPT gives to differentiate the two codes is that 30901 is “limited” and 30903 is “extensive.”
Posterior epistaxis control only has one code for the initial management (30905, 3.01 RVU, Medicare $108.36) and one for subsequent care (30906, 3.88 RVU, Medicare $139.68) if the bleeding recurs. The 50 modifier is not used for posterior bleeding due to there being only one posterior nasal area.
Brought to you by the ACEP Coding and Nomenclature Committee.
Dr. Lempert is chief medical officer, coding policy, at TeamHealth, based in Knoxville, Tennessee.