Coding for Epistaxis

Seth Brown, MD, MBA

Epistaxis coding tends to be a confusing area for a number of surgeons. The following summarizes coding for epistaxis in the office and operating room. All the office based epistaxis codes have a zero day global period.

For nasal cautery or packing not requiring endoscopic guidance use the following codes (these are unilateral codes and a 50 modifier can be applied):

30901- control of nasal hemorrhage, anterior, simple
30903- control of nasal hemorrhage, anterior, complex (extensive cautery or packing)

If an endoscope is used for visualization of the bleeding source, but is not needed for control of epistaxis, then 31231 (nasal endoscopy, diagnostic) can be billed. This is usually instead of, not in addition to, the above codes.

If control of epistaxis requires posterior packing or cautery, use the following codes:

30905 – control of nasal hemorrhage, posterior (for the primary procedure)
30906 – control of nasal hemorrhage, posterior (subsequent)

If a nasal endoscope is needed to control the bleeding then use the following code:

31238 – nasal endoscopy with control of nasal hemorrhage (this is a unilateral code)

For open ligation of arteries use the following codes (both are 90 day global periods):

30915 – ligation arteries, ethmoidal
30920 – ligation arteries, internal maxillary artery, transantral

If an endoscopic sphenopalatine artery ligation is performed, an unlisted code, 31299, should be used, as no code exists to specifically describe the work. When billing, use a comparison code, such as the open ligation code, 30920. This comparison of work makes the most sense.

As always, please review codes with your professional coders when unclear of the proper code and contact the ARS if assistance is needed.

Revised 11/08/2014
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