Table of Contents

Basics of CPT code 30901, 30903, 30905, 30906

Nasal hemorrhage is also referred to as epistaxis. Epistaxis occurs when the nasal membrane lining is disturbed or irritated and causes abnormal bleeding.

Most (approximately 90%) cases of epistaxes are anterior, originating from Kiesselbach’s plexus. Anterior epistaxis is characterized by unilateral, steady, nonmassive bleeding. In contrast, posterior epistaxis generally arises from the posterior nasal cavity through branches of the sphenopalatine arteries.

The procedure code for nasal hemorrhage treatment is selected on the complexity of the exam.

For simple treatment of anterior nasal hemorrhage, report CPT code 30901. For complex anterior nasal hemorrhage treatment use CPT code 30903.

For simple posterior nasal hemorrhage treatment, report CPT code 30905. For complex simple posterior nasal hemorrhage, use CPT code 30906.

CPT code 30901,30903, 30905, 30906: Coding tips for Nasal Hemorrhage

Procedure description of CPT code 30901, 30903, 30905, 30906

Pledgets soaked in an anesthetic-vasconstrictor solution are inserted into the nasal cavity for 10-15 minutes to anesthetize and shrink the nasal mucosa. Following removal of the pledgets, the nasal cavity is examined. If the bleeding point can be identified, bleeding is controlled with pressure followed by chemical cautery using a silver nitrate stick applied to the bleeding point. Alternatively, electrocautery may be used.

Nasal hemorrhage is also referred to as epistaxis. The most common sites of bleeding are the anterior portion of the nasal septum at the plexus of vessels known as the Kiesselbach’s plexus or the ethmoidal vessels also located in the anterior region of the nasal cavity. Less common is bleeding from the sphenopalatine artery located posteriorly. Pledgets soaked in an anesthetic-vasoconstrictor solution are inserted into the nasal cavity for 10-15 minutes to anesthetize and shrink the nasal mucosa.

Following removal of the pledgets, the nasal cavity is examined. If the bleeding point can be identified, bleeding is controlled with pressure followed by chemical cautery using a silver nitrate stick applied to the bleeding point. Alternatively, electrocautery may be used. If pressure and electrocautery or chemical cautery fails, petroleum jelly gauze packing, a nasal tampon or sponge, or an epistaxis balloon may be used.

CPT code 30901 is reported for treatment of a simple anterior nasal hemorrhage by any method and CPT code 30903 for a complex anterior nasal hemorrhage. CPT Code 30905 is reported for treatment of an initial posterior nasal hemorrhage and CPT code 30906 for a subsequent posterior nasal hemorrhage.

30901 – Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method

30903 – Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method

30905 – Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial

30906 – Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; subsequent

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

For CPT code 31238, the physician uses an endoscope for a diagnostic evaluation of the bleeding nose. An endoscope has a rigid fiberoptic telescope that allows the physician both increased visualization and magnification of internal anatomy. Topical vasoconstrictive agents are applied to the nasal mucosa and nerve blocks with local anesthesia are performed. The endoscope is placed into the nose and a thorough inspection of the internal nasal structures is accomplished. Any bleeding sources are identified. Electrocautery instruments or lasers are placed parallel to the endoscope and are used to stop internal nasal bleeding.

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):

For CPT code 30915, When nasal packing fails to control nasal hemorrhage, the physician administers a local anesthetic and makes an incision along the side of the nose near the inner canthus of the eye to expose the ethmoid arteries. The periosteum (periorbitum) is elevated. The anterior ethmoid artery is identified in the suture line between the frontal and ethmoid bones. The posterior ethmoid artery is located entering the posterior medial wall near the orbital apex. A clip or suture completes the ligation. The incision is repaired with a layered closure.

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

Do and Don’t with Nasal Hemorrhage CPT codes

Control of bleeding is an integral component of endoscopic procedures and is not separately reportable. For example, control of nasal hemorrhage (CPT code 30901) is not separately reportable for control of bleeding due to a nasal/sinus endoscopic procedure.

Use Modifier 78 with HCPCS/CPT code, when any bleeding occurs in the postoperative period and patient return to the operating room for treatment. Modifier 78 indicates that the procedure was a complication of a prior procedure requiring treatment in the operating room. However, control of postoperative bleeding not requiring return to the operating room is not separately reportable.

For bilateral procedure, do use modifier 50 with CPT code 30903

List of Supply Code for CPT code 30901, 30903, 30905, 30906

SD134 tubing, suction, non-latex (6ft) with Yankauer tip (1)
SD214 tubing, suction, non-latex (2ft) with Frazier tip (1)
SG031 cottonoid
SG033 dressing, 12-7mm (Gelfoam)
SG055 gauze, sterile 4in x 4in
SH050 lidocaine 4% soln, topical (Xylocaine)
SJ010 basin, emesis
SJ037 oxymetazoline nasal spray (Afrin) (15ml uou)
SJ046 silver nitrate applicator
SL464 Atomizer tips (disposable)
SM001 atomizer tip shield (RhinoGuard)
SB027 gown, staff, impervious
SB034 mask, surgical, with face shield
SB039 shoe covers, surgical
SB044 underpad 2ft x 3ft (Chux)
SD009 canister, suction

SB034 mask, surgical, with face shield
SA048 pack, minimum multi-specialty visit
SB027 gown, staff, impervious
SB039 shoe covers, surgical
SB044 underpad 2ft x 3ft (Chux)
SC029 needle, 18-27g
SC051 syringe 10-12ml
SC055 syringe 3ml
SD009 canister, suction
SD071 epistaxis balloon
SD134 tubing, suction, non-latex (6ft) with Yankauer tip (1)
SD214 tubing, suction, non-latex (2ft) with Frazier tip (1)
SF012 cautery, bipolar cord
SF013 cautery, bipolar, pencil-handpiece
SG031 cottonoid
SG033 dressing, 12-7mm (Gelfoam)
SG055 gauze, sterile 4in x 4in
SG066 packing, gauze w-petrolatum, 0.5in (6yd uou)
SH047 lidocaine 1%-2% inj (Xylocaine)
SH050 lidocaine 4% soln, topical (Xylocaine)
SJ010 basin, emesis
SJ037 oxymetazoline nasal spray (Afrin) (15ml uou)
SL464 Atomizer tips (disposable)
SM001 atomizer tip shield (RhinoGuard)

Additional Code Information CPT code 30901 & 30903

PC/TC Indicator (26): 0 = Physician Service Codes

Multiple Procedures (51): 2 = Standard payment adjustment rules for multiple procedures apply

Bilateral Surgery (50): 1 = 150% payment adjustment for bilateral procedures applies

Physician Supervision: 09 = Concept does not apply

Assistant Surgeon (80,82): 1 = Statutory payment restriction for assistants at surgery applies to this procedure

Co-Surgeons (62): 0 = Co-surgeons not permitted for this procedure

Team Surgery (66): 0 = Team surgeons not permitted for this procedure

Diagnostic Imaging Family: 99 = Concept does not apply

Additional Code Information CPT code 30905 & 30906

PC/TC Indicator (26): 0 = Physician Service Codes

Multiple Procedures (51): 2 = Standard payment adjustment rules for multiple procedures apply

Bilateral Surgery (50): 2 = 150% payment adjustment does not apply

Physician Supervision: 09 = Concept does not apply

Assistant Surgeon (80,82): 1 = Statutory payment restriction for assistants at surgery applies to this procedure

Co-Surgeons (62): 0 = Co-surgeons not permitted for this procedure

Team Surgery (66): 0 = Team surgeons not permitted for this procedure

Diagnostic Imaging Family: 99 = Concept does not apply

References:

https://www.entnet.org//content/cpt-changes-2015-what-ents-need-know

http://www.hcpro.com/HOM-40010-1733/Respiratory-System-Hospital-CPT-Coding.html

CPT code 30901,30903, 30905, 30906: Coding tips for Nasal Hemorrhage