Defecography

Aetna covers fluoroscopic defecography (CPT 74270) as medically necessary only for patients with documented chronic constipation when anorectal manometry and rectal balloon expulsion are negative or inconclusive and there is clinical suspicion of anterior rectocele, enterocele, inappropriate puborectalis contraction, or pelvic organ prolapse. Defecography is not covered for routine constipation evaluation or for indications not listed, and MR defecography (CPT 72195–72197) is considered investigational/not covered for rectal prolapse, intussusception, outlet dysfunction/neurogenic bowel, spinal cord injury–related indications, and other excluded diagnoses.

"Constipation diagnosis codes K59."

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