Learn How to Report Endoscopic Nosebleed Control
Plus, know who can perform history element
Endoscopic Nosebleed Control
Question: A patient came into your office with a nosebleed. Your otolaryngologist provided epistaxis control using an endoscope. After that you reported 30901 and 31231. The patient's payer keeps bundling the nosebleed control into the endoscopy code. Should you appeal this?
Answer: The problem is with your coding, not the payer's policy. CPT includes a specific medical billing code for endoscopic epistaxis control: 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage). In this method, the otolaryngologist uses an endoscope for a diagnostic evaluation of the bleeding nose and after that places electrocautery instruments or lasers parallel to the endoscope to stop internal nose bleeding.
In contrast, medical billing code 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing], any method) accounts for just cautery and/or packing to control the nosebleed (such as 784.7, Epistaxis). While the otolaryngologist uses an endoscope for a diagnostic evaluation of the nose and the bleed, pulls out the endoscope, and then carries out the control of the nasal hemorrhage, you should take these codes as bundled. This follows Correct Coding Initiative (CCI) edits and CPT definition. As 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) is a "separate procedure," you must report the correct hemorrhage control code (30901-30906)
Tip: You must pay close attention to how the otolaryngologist's procedure note defines endoscopic use. Ask your physician to make it evident in the procedure note what the role the endoscope played in controlling the nosebleed. This information directly impacts the medical coding and billing reimbursement, as in case he used the endoscope to assist in the control of the hemorrhage, you must report 31238.
ICD-10: When your ICD-9 coding system changes in 2013, 784.7 will become R04.0 (Epistaxis).
Discover Who Can Perform History Element
Question: Your coworker thinks it is essential for an allergist to take a patient's history, but you think a nurse can perform this duty. Who's right?
Answer: Any employee can take the history. In fact, the E/M service documentation guidelines state that ancillary staff may record the review of systems (ROS) and/or past, family, and social history (PFSH). Even though nurses frequently record this information, a front-desk staff member may even carry out the function. The allergist or nurse practitioner, though, must complete the history of present illness (HPI).ยป
Be careful: The allergist must necessarily sign off on the patient's chart and must specify that he reviewed the history notes. Documentation must include a notation supplementing or confirming the information that others recorded. Make certain that the physician signs off on any incident-to services, like medical billing code 99211 (Office or other outpatient visit for the evaluation and management of an established patient ...), along with higher-level E/M services (such as 99212-99215).
Endoscopic Nosebleed Control
Question: A patient came into your office with a nosebleed. Your otolaryngologist provided epistaxis control using an endoscope. After that you reported 30901 and 31231. The patient's payer keeps bundling the nosebleed control into the endoscopy code. Should you appeal this?
Answer: The problem is with your coding, not the payer's policy. CPT includes a specific medical billing code for endoscopic epistaxis control: 31238 (Nasal/sinus endoscopy, surgical; with control of nasal hemorrhage). In this method, the otolaryngologist uses an endoscope for a diagnostic evaluation of the bleeding nose and after that places electrocautery instruments or lasers parallel to the endoscope to stop internal nose bleeding.
In contrast, medical billing code 30901 (Control nasal hemorrhage, anterior, simple [limited cautery and/or packing], any method) accounts for just cautery and/or packing to control the nosebleed (such as 784.7, Epistaxis). While the otolaryngologist uses an endoscope for a diagnostic evaluation of the nose and the bleed, pulls out the endoscope, and then carries out the control of the nasal hemorrhage, you should take these codes as bundled. This follows Correct Coding Initiative (CCI) edits and CPT definition. As 31231 (Nasal endoscopy, diagnostic, unilateral or bilateral [separate procedure]) is a "separate procedure," you must report the correct hemorrhage control code (30901-30906)
Tip: You must pay close attention to how the otolaryngologist's procedure note defines endoscopic use. Ask your physician to make it evident in the procedure note what the role the endoscope played in controlling the nosebleed. This information directly impacts the medical coding and billing reimbursement, as in case he used the endoscope to assist in the control of the hemorrhage, you must report 31238.
ICD-10: When your ICD-9 coding system changes in 2013, 784.7 will become R04.0 (Epistaxis).
Discover Who Can Perform History Element
Question: Your coworker thinks it is essential for an allergist to take a patient's history, but you think a nurse can perform this duty. Who's right?
Answer: Any employee can take the history. In fact, the E/M service documentation guidelines state that ancillary staff may record the review of systems (ROS) and/or past, family, and social history (PFSH). Even though nurses frequently record this information, a front-desk staff member may even carry out the function. The allergist or nurse practitioner, though, must complete the history of present illness (HPI).ยป
Be careful: The allergist must necessarily sign off on the patient's chart and must specify that he reviewed the history notes. Documentation must include a notation supplementing or confirming the information that others recorded. Make certain that the physician signs off on any incident-to services, like medical billing code 99211 (Office or other outpatient visit for the evaluation and management of an established patient ...), along with higher-level E/M services (such as 99212-99215).
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