Revenue Cycle Insider

Question: If a provider performs an enema as an outpatient procedure in the office, is there a specific procedure code?

Delaware Subscriber

Answer: The short answer: No.

A patient may seek an enema for therapeutic reasons, like to relieve conditions such as constipation or impacted feces; or to relieve or prevent more serious conditions. When a provider performs an enema in an outpatient setting, the service is included in the evaluation and management (E/M) code for that date of service.

Administration may be performed therapeutically to relieve intussusceptions or intestinal obstructions, such as constipation. When the physician performs an enema in the office for the removal of impacted feces, that procedure is included in the E/M code for a particular date of service. There is no separate procedure code. Usually, you’ll select an E/M code from 99202-99215 (Office or other outpatient visit for the evaluation and management …). As always, the code you select will depend on what you find in the provider’s documentation.

Make sure you show medical necessity by appending the correct diagnosis code — and any history that’s applicable. If a patient seeks an enema due to constipation, you can report the appropriate code, such as K59.00 (Constipation, unspecified), as the primary diagnosis for this scenario, followed by any additional diagnoses that may be appropriate per the physician’s documentation, such as K50.10 (Crohn’s disease of large intestine without complications).

Note: If your office doesn’t have the ability to bill payers for durable medical equipment (DME) and supplies, you can ask the patient ahead of time to purchase the necessary items and bring to the office. Another option is to inform the patient ahead of time that the cost will be charged as a noncovered item, separate from the visit.

Rachel Dorrell, MA, MS, CPC-A, CPPM, Development Editor, AAPC