When a patient presents with an active nosebleed, choosing the wrong code could lose you as much as $100.00 in reimbursement. Let’s look at an example:

An established patient presents after sustaining injuries playing soccer. A ball hits the patient’s face, which makes the nose bleed and gives him a black eye. You document a detailed history, exam and decision making is of moderate complexity. The patient is also complaining of a headache. You can’t stop the nose bleed with ice or pressure, so you perform extensive cautery using silver nitrate sticks on both nostrils, and repeat the procedure again. You order an x-ray to ensure the nose is not broken, the results come back negative. How should you code this?

• 99214 – detail history, exam and moderate decision making – diagnosis 784.0 – headache/facial pain – with modifier ‘25’
• 30903 ‘50’ (because you treated both nostrils) – control nasal hemorrhage, anterior complex, extensive cautery and/or packing – diagnosis 784.7 – epistaxis, E917.0 – striking against or accidentally by object or person in sports without subsequent fall and E007.5 – activity involving other sports and athletics played as a team or group soccer

Because you documentation is clearly defined on how your treated the nosebleed, using several attempts, reporting 30903 instead of 30901 (limited cautery and/or packing- defined as applied continuous pressure, inserted pledgets soaked with anesthetic-vasoconstrictor; administered nasal spray; chemical cautery, 1x only) you reimbursement would yield amount $100.00 more.

Make sure you choose the code that defines the services you performed.  Remember if you stop the nose bleed simply by using ice, you would only report the E/M code.