Retired - Correct Coding and Coverage – Peristeen® Transanal Irrigation (PAI) System
Joint DME MAC Publication
The Peristeen® transanal irrigation (PAI) system is a device used to empty the lower bowel and to prevent chronic constipation and fecal incontinence or simply as a method of bowel management. The system consists of an enema bag, a rectal catheter with an inflatable balloon and a hand pump. Effective for claims with dates of service on or after January 1, 2015 the correct code to bill is:
A4459 – MANUAL PUMP ENEMA SYSTEM, INCLUDES BALLOON, CATHETER AND ALL ACCESSORIES, REUSABLE, ANY TYPE
There is no Medicare benefit for this device; therefore, claims for code A4459 will be denied as non-covered (no Medicare benefit).
Code A4459 is an all-inclusive code at initial issue. Separate billing of any of the individual components is not allowed. The code is established as a single code to include all parts including the disposable supplies at initial issue. For refills of disposable supplies such as rectal catheters, HCPCS code A9270 (Noncovered item or service) should be used.
For questions about correct coding, contact the PDAC Contact Center at (877) 735-1326 during the hours of 8:30 a.m. to 4:00 p.m. CT, Monday through Friday, or e-mail the PDAC by completing the DME PDAC Contact Form.
|02/18/2015||Published on PDAC website|
|01/10/2019||Retired - information incorporated into applicable Local Coverage Determination or related Policy Article|