tci ED Coding & Reimbursement Alert - 2006 Issue 6

Reader Questions: Fecal Disimpaction Code Harms ED Claims

" Question: We are wondering how to code for a fecal disimpaction encounter. The doctor performed the disimpaction on an elderly patient after administering a moderate sedative. ED notes suggest a level-four E/M service. How should we report the encounter, and is there a way to report the sedation separately from the E/M service? Minnesota Subscriber Answer: While there is a code for fecal disimpaction in CPT 2006, its definition specifies -under anesthesia,- which the AMA has said requires performance in a formal OR setting.    You are probably best served depending on the carrier to report...

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