How To Use CPT Code 99511

CPT 99511 describes the home visit for fecal impaction management and enema administration. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 99511?

CPT 99511 can be used to describe the home visit services provided by a healthcare provider to manage treatment for and remove a patient’s fecal impaction. This code is used when the provider visits the patient’s home and either administers an enema or manually removes the impaction by breaking up the mass and removing it in pieces.

2. Official Description

The official description of CPT code 99511 is: ‘Home visit for fecal impaction management and enema administration.’

3. Procedure

1. The healthcare provider arrives at the patient’s home.
2. The patient has a fecal impaction, which is a mass of stool in the rectum that will not pass.
3. The provider talks with the patient about nutrition, typical bowel patterns, use of medications and other laxatives, other medical conditions, and bowel retraining strategies.
4. The provider either administers an enema or removes the impaction manually by inserting a finger into the rectum to break up the mass and remove it in pieces.

4. Qualifying circumstances

Patients eligible to receive CPT 99511 services are those who have a fecal impaction that requires management and removal. This condition may occur in patients with limited mobility, those taking certain medications, or those with damage to nerves that communicate with intestine muscles. The healthcare provider must visit the patient’s home to provide the services.

5. When to use CPT code 99511

CPT code 99511 should be used when a healthcare provider visits a patient’s home to manage treatment for and remove a fecal impaction. This code is appropriate when the provider administers an enema or manually removes the impaction during the home visit.

6. Documentation requirements

To support a claim for CPT 99511, the healthcare provider must document the following information:

• Patient’s condition and the need for fecal impaction management and enema administration
• Date and time of the home visit
• Discussion topics with the patient, including nutrition, bowel patterns, medication use, other medical conditions, and bowel retraining strategies
• Details of the procedure performed, whether it was an enema administration or manual removal of the impaction
• Any additional instructions or follow-up appointments scheduled
• Signature of the healthcare provider who performed the service

7. Billing guidelines

When billing for CPT 99511, ensure that the service is provided as a home visit for fecal impaction management and enema administration. There are no specific guidelines regarding reporting this code with other codes. However, it is important to accurately document and code all services provided during the home visit.

8. Historical information

CPT 99511 was added to the Current Procedural Terminology system on January 1, 2002. There have been no updates to the code since its addition.

9. Examples

1. A healthcare provider visiting a patient’s home to manage treatment for and remove a fecal impaction by administering an enema.
2. A provider performing a home visit to manually remove a fecal impaction for a patient who is unable to pass the stool.
3. A healthcare professional visiting a patient’s home to discuss nutrition, bowel patterns, and bowel retraining strategies, and then administering an enema to manage the fecal impaction.
4. A provider performing a home visit to manually remove a fecal impaction for a patient with limited mobility.
5. A healthcare provider visiting a patient’s home to administer an enema and provide education on medication use and other laxatives for fecal impaction management.
6. A provider performing a home visit to manually remove a fecal impaction for a patient with nerve damage affecting their bowel muscles.
7. A healthcare professional visiting a patient’s home to discuss nutrition, bowel patterns, and bowel retraining strategies, and then manually removing a fecal impaction.
8. A provider performing a home visit to manually remove a fecal impaction for a patient taking medications that contribute to the impaction.
9. A healthcare provider visiting a patient’s home to administer an enema and provide education on bowel retraining strategies for fecal impaction management.
10. A provider performing a home visit to manually remove a fecal impaction for a patient with other medical conditions affecting their bowel function.