Answer: Review of documentation is vital for coding the control of bleeding.
Forget about modifier -22 if bleeding complicates an E/M service. You can append modifier -22 only to surgical CPT codes. Usually, you use modifier -22 because of excessive bleeding that is a direct result of the procedure the physician is performing.
Circumstances definitely exist in which a critical care code is more appropriate than modifier -22 for the control of bleeding, e.g., when the physician is controlling bleeding for a patient who is critically ill and whose condition is potentially life-threatening if the bleeding continues.
CPT codes that represent the control of bleeding during a procedure typically represent endoscopic techniques for treating bleeding such as application of cautery with heater probe or bipolar or monopolar probe. You should use these control-of-bleeding codes only when a wound is actively bleeding. Otherwise, consider using modifier -22. You can't use control-of-bleeding codes if the physician induces the bleeding during a procedure.
Test Yourself and Reader Questions reviewed by Catherine Brink, CMM, CPC, president of Healthcare Resource Management Inc. in Spring Lake, N.J.