30901 which is for nosebleed control has received a lot of scrutiny. It's a high volume code which CMS defines in policy as a code that's used more than 100,000 times during that year. As per, Codes that fall under this area are required to be re-evaluated in order to determine whether a descriptor wording is causing inappropriate usage of the codes or if the values need to be adjusted for some reason.
During the scrutiny of the code and determining its values, CMS found that the code is typically billed with an E/M 25 service and addition to it. So in these instances, a patient would come in with a nosebleed that's actively bleeding, the physician would evaluate that nosebleed and determine based on that that nosebleed control was appropriate.
According to CMS medical billing guidelines, there would be separate documentation for each so it would clearly define the history exam and medical decision making that's involved with evaluating the nose and then actual procedure or chart note description of the procedure so that an auditor could virtually circle each one and be able to determine where one ended and one began.
The OIG will be targeting this area this year so it's very important to make sure that your E/M 25 documentation is rock solid. Otherwise, auditors will be requesting repayments on any areas that they find from that documentation are not supporting that E/M 25.
The OIG has identified this as a higher over payment area so you can be expecting that in addition to your Medicare carriers that private payers will be picking up on this trend as well.
The code was revalued. And during that re-evaluation, it was reduced about an 8% with the proposal initially. The pre-time was valued at 11 minutes and the intra-time at 10 minutes.
The RUC agreed with the otolaryngology associations that there was no compelling evidence that change the current work value. However, CMS agreed with this proposal and instead, as per CMS Healthcare guidelines, reduced it from 1.21 to 1.10.
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