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v1.0.0
ICD-10 Guide
ICD-10 CodesR04.0

R04.0

Epistaxis

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/11/2025

Code Description

ICD-10 R04.0 is a billable code used to indicate a diagnosis of epistaxis.

Key Diagnostic Point:

Epistaxis, commonly known as a nosebleed, is the medical term for bleeding from the nasal cavity. It can occur spontaneously or as a result of trauma, and it can vary in severity from minor to life-threatening. The bleeding may originate from the anterior or posterior nasal passages, with anterior epistaxis being more common. Symptoms include visible blood from the nostrils, blood in the throat, or swallowing blood. Patients may also experience associated symptoms such as nasal congestion, headache, or dizziness if the bleeding is significant. Common causes include dry air, nasal trauma, allergies, and underlying health conditions such as hypertension or clotting disorders. The diagnostic approach typically involves a thorough history and physical examination, including inspection of the nasal passages. Laboratory findings may include complete blood count (CBC) to assess for anemia or coagulation studies if a bleeding disorder is suspected. Understanding the underlying cause is crucial for effective management and prevention of recurrence.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Variety of potential underlying causes
  • Differentiation between anterior and posterior epistaxis
  • Need for thorough documentation of patient history
  • Potential for co-existing conditions affecting bleeding

Audit Risk Factors

  • Inadequate documentation of the cause of epistaxis
  • Failure to specify whether the epistaxis is anterior or posterior
  • Misclassification of epistaxis as a symptom of another condition
  • Lack of supporting clinical findings in the medical record

Specialty Focus

Medical Specialties

Internal Medicine

Documentation Requirements

Detailed patient history including medication use, history of hypertension, and any bleeding disorders.

Common Clinical Scenarios

Management of chronic epistaxis in patients with hypertension or anticoagulant therapy.

Billing Considerations

Consideration of systemic causes of epistaxis, such as liver disease or coagulopathy.

Emergency Medicine

Documentation Requirements

Acute care documentation including vital signs, initial assessment, and interventions performed.

Common Clinical Scenarios

Acute presentation of epistaxis requiring immediate intervention, such as cauterization or packing.

Billing Considerations

Rapid assessment of the severity of bleeding and potential airway compromise.

Coding Guidelines

Inclusion Criteria

Use R04.0 When
  • Follow official ICD
  • CM guidelines for coding symptoms and signs
  • Ensure specificity in documentation regarding the nature and cause of the epistaxis

Exclusion Criteria

Do NOT use R04.0 When
No specific exclusions found.

Related CPT Codes

30901CPT Code

Cauterization of nasal hemorrhage

Clinical Scenario

Used in cases of severe anterior epistaxis requiring intervention.

Documentation Requirements

Document the indication for cauterization and any prior treatments attempted.

Specialty Considerations

Emergency medicine may require rapid documentation due to the acute nature of the presentation.

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The transition to ICD-10 has allowed for more specific coding of epistaxis, improving the ability to capture the underlying causes and severity of the condition, which can impact treatment and reimbursement.

ICD-9 vs ICD-10

The transition to ICD-10 has allowed for more specific coding of epistaxis, improving the ability to capture the underlying causes and severity of the condition, which can impact treatment and reimbursement.

Reimbursement & Billing Impact

reimbursement.

Resources

Clinical References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Coding & Billing References

  • •
    ICD-10-CM Official Guidelines for Coding and Reporting

Frequently Asked Questions

What is the difference between R04.0 and R04.1?

R04.0 is used for epistaxis when the cause is known, typically anterior, while R04.1 is for other types of epistaxis when the cause is unspecified or different.