Gastroenterology Coding Alert

Question: My gastroenterologist ordered barium enema for a 4-year-old male patient with a history of encopresis and constipation. Thus, I’m billing the procedure for my radiologist. How should report the procedure if the radiologist writes the following text in her notes:

TECHNIQUE: A single frontal scout radiograph of the abdomen was performed. A rectal tube was inserted in usual sterile fashion, and retrograde instillation of barium contrast was followed via spot fluoroscopic images. A post-evacuation overhead radiograph of the abdomen was performed.

FINDINGS: The scout radiograph demonstrates a nonobstructive gastrointestinal pattern. There are no suspicious calcifications seen or evidence of gross free intraperitoneal air. The visualized lung bases and osseous structures are within normal limits.

The rectum and colon is of normal caliber throughout its course. There is no evidence of obstruction, as contrast is seen to flow without difficulty into the right colon and cecum. A small amount of contrast is seen to opacify small bowel loops on the post-evacuation image. There is also opacification of a normal-appearing appendix documented.

Iowa Subscriber

Answer: Report it as a commonly performed barium enema: 74270 (Radiologic examination, colon; contrast [e.g., barium] enema, with or without KUB).

Tip: Although you’ll usually see barium or barium and air enemas, some physicians instead may choose a water-soluble solution that includes iodine. For example, if the physician suspects perforation of the colon, he’ll choose a water-soluble contrast solution. Don’t limit your 74270 coding to barium; you bill use this code for a different kind of contrast agent that your gastroenterologist may use.

Additionally, you should bill 99212 (Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components:

• A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem[s] and the patient's and/or family's needs. Usually, the presenting problem[s] are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family.) to report the E/M service that your gastroenterologist performed.
  

For the ICD-10, you would report:

• R15.- — Fecal incontinence
• K59.00 — Constipation, unspecified.