Gastroenterology Coding Alert

Question: Our physician administered an enema to address an obstruction. Is 74283 the right code?

Texas Subscriber

Answer: Probably not. Seeing the word “enema” can sometimes mislead you to consider 74283 (Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium ileus)), but you should stop right there.

Why: Don’t report 74283, because it falls under the “Diagnostic Radiology (Diagnostic Imaging) Procedures of the Gastrointestinal Tract” section of your code book and is classified as a radiology service. You would use 74283 for imaging enhancement (such as a barium enema), which has nothing to do with what we think of as a therapeutic enema in the physician’s office.

And although some coders instead turn to 74270 (Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study), this is also not the appropriate code for this situation, because it describes a radiology exam for viewing the intestine.

When the provider injects liquid through the anal canal, fluid soaks and loosens hardened waste matter lying in the patient’s colon.

Here’s how to code it: Enema for removal of impacted feces is not reported separately and is included in the evaluation and management (E/M) code for a particular date of service. Although this will typically come from the 99202-99215 range, you’ll select the specific code based on the documentation of the encounter.