ED Coding and Reimbursement Alert

Question: The ED physician performed a manual fecal disimpaction after administering IV MS and Diazepam. I was going to report 45915, but the -under anesthesia- part leaves me stumped. Should I bill this code, or are there other options I should consider?


South Carolina Subscriber


Answer: One approach you could use would be to append modifier 52 (Reduced services) to 45915 (Removal of fecal impaction or foreign body [separate procedure] under anesthesia), but the American Medical Association's (AMA) CPT department has stated that the -under anesthesia- term represents work performed in an operating room.

Instead, you may want to favor the more conservative option of rolling the work of
parenteral narcotics administration into the E/M code and capturing -high- risk in the risk table, thus allowing the E/M code you choose to reflect the physician's extra work.