Avoid Radiology Codes For Rectal Drug Supervision

ICD-9 564.0x should define constipation, but keep in mind to report comorbid conditions, too.

Not every enema is an imaging procedure. Occasionally the gastroenterologist will choose to administer an enema for treating constipation. The challenge that you face in such cases is whether you should cover the enema tubing in an E/M or bill it as a separate procedure. Take help of the following situation -- with the bonus tips -- to help you with accurate ICD-9 coding.

Scenario: Our nursing staff carried out an enema for an elderly gentleman because of severe constipation post an office visit with his physician. The patient already has history of encopresis as well as constipation. What code options do you have?

Avoid Imaging Services 74283, 74270

Seeing the word 'enema' can at times mislead you to consider 74283 (Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction [e.g., meconium ileus]), however, you must stop right there.

Why: You should not report medical CPT®74283 because this code wouldn't be appropriate for this particular scenario. Medical CPT® 74283 comes under the "Diagnostic Radiology (Diagnostic Imaging) Procedures of the Gastrointestinal Tract" section of your manual, and is classified as a radiology service. You would then use 74283 for imaging enhancement (e.g., barium enema), which has nothing to do with what we consider as a therapeutic enema in the physician's office.

Nor is 74270 (Radiologic examination, colon; contrast [example, barium enema, with or without KUB]) the appropriate medical CPT® code.

Source URL :- http://www.supercoder.com/coding-newsletters/my-gastroenterology-coding-alert/enema-administration-case-analysis-skip-radiology-codes-for-rectal-drug-supervision-108424-article

Incorporate Therapeutic Enema Into Your E/M

Enema administration may also be carried out therapeutically to relieve intussusceptions or intestinal obstructions. Once the provider injects liquid through the anal canal, fluid soaks and then loosens hardened waste matter lying in the patient's colon.

Enema carried out for removal of impacted feces is not reported distinctly and is included when an E/M code is reported.

Since this is the case with the given scenario, you would likely use any of the E/M established outpatient visit medical CPT codes 99213-99215 to describe the E/M and the rest of the procedure -- including the administration of enema.

There is also an additional code for E/M visits for prolonged service time that does not need direct patient face-to-face contact.

Someone might also consider that they can bill 99358 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care; first hour) or +99359 (Prolonged evaluation and management service before and/or after direct [face-to-face] patient care; each additional 30 minutes [List separately in addition to code for prolonged physician service]). Though, Medicare contractors will not pay (nor can providers bill the patient) for these prolonged services medical CPT codes. These are Medicare covered services and reimbursement is included in the payment for other billable E/M services.

Append correct dx: As for the appropriate ICD-9 code, you must report 564.00 (Unspecified constipation) as the primary diagnosis, and then 789.0x (Abdominal pain) as secondary diagnosis to define pain from the stomach or another of the patient's comorbid situations.