Tuesday, April 3, 2018

Epistaxis Control

In the kNOW” this month tackles the topic of controlling epistaxis.  There are a variety of reasons that a patient will present with a bloody nose and several methods can be used by physicians to stop the bleeding.  Let’s take a look.

A 4 yr. old patient comes to the ER with a small, bleeding laceration on the right external nares after trying to shove a small toy up his nose.  The physician must use a suture to stop the bleeding.  ICD-10-PCS code assignment would center around the root operation of Control.  Remember, the definition of Control is stopping or attempting to stop postoperative or other acute bleeding.  So Control fits this scenario, and the code would be 0W3Q7ZZ for control of bleeding from respiratory tract via a natural or artificial opening as presented in the 4th Qtr. 2017 Coding Clinic.  This supplants information provided in the 4th Qtr. 2014 Coding Clinic when the root operation was determined to be Repair, which was prior to the definition change of Control.  If we want to assign a CPT code instead, it would be 30901, control nasal hemorrhage, anterior, simple. 

In a different circumstance, an 84 yr. old patient presents with epistaxis due to hypertension.  The bleeding is unrelenting from the anterior of the nose, and the physician decides to use a nasal tampon to control it.  While this is still a method of control, in ICD-10-PCS we have a guideline (B3.7) that tells us that when a more definitive root operation is available to specify the method of control, then we should use it.  In this scenario, Packing is the appropriate root operation as indicated in the 4th Qtr. 2017 Coding Clinic.  ICD-10-PCS code 2Y41X52 is the code we should apply.  Again, the CPT code assignment would be 30901 for the simple control of the anterior nasal hemorrhage.  If the packing was extensive, the CPT code would change to 30903.

As we can see, the key to the procedure code assignment in ICD-10-PCS is the root operation performed.  Understanding the root operation definitions will help us make the correct code choice.  In CPT, knowing the area of the epistaxis (anterior, posterior) and the extensiveness of the treatment will guide us to the appropriate code.

Now you are in the kNOW!!

About the Author 

Dianna Foley, RHIA, CHPS, CCS  is OHIMA's Coding Education Coordinator. Dianna has been an HIM professional for 20 years. She progressed through the ranks of coder, department supervisor, and department director, to her current role as a coding consultant. 

She recently served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati subsequently achieving her RHIA, CHPS, and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and a a presenter at regional HIM meetings and the OHIMA Annual Meeting.

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