Question: How should I code the following report?
x-ray codes 74000 and 74010
therapeutic enema code 74283
fluoroscopy codes 76000, 76003
ultrasonic guidance codes 76942 and 76986.
Each of these edits has a modifier indicator of "1," meaning that if the two services are truly separate, you may use the appropriate modifier to unbundle them.
Retrograde barium study through ileostomy:
Clinical Indication: Patient presents with diarrhea and abdominal pain. Recent trauma to the stoma.
Technique: A barium enema tip was placed into the colostomy. The barium enema balloon had been blown up and was used external to the ostomy as a seal while barium was retrogradely infused into the distal ileum. Fluoroscopic evaluation and spot films were obtained in varying projections.
Findings: Abdominal scout view showed a right lower quadrant ileostomy. Surgical clips present in right upper quadrant and in both right and left aspect of the abdomen.
Contrast agent flowed retrogradely into the ileum.
Impression: 1. There is no evidence of peristomal herniation of bowel loops. 2. There is an 11-cm segment of mildly dilated distal ileum.
Washington Subscriber
Answer: Although the study through the ileostomy is a variation on the basic enema, report 74270 (Radiologic examination, colon; barium enema, with or without KUB).
You shouldn't report the films separately, because the National Correct Coding Initiative ( NCCI Edits ) includes a number of services in 74270:
The procedure didn't reveal a new diagnosis, so report the signs and symptoms with 789.00 (Abdominal pain; unspecified site) and 787.91 (Diarrhea).