Pulsed Irrigation Evacuation (PIE)
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This policy governs coverage of pulsed irrigation evacuation under the DHA TRICARE durable equipment benefit. The available document window contains only the policy manual table of contents and does not provide the applicable coverage criteria or operational requirements.
No material clinical or coverage changes in this revision.
Coverage Criteria
Coverage Criteria
PIE may be covered when all of the following are met.
PIE coverage
- Clinical condition: The patient has neurogenic bowel.
- Prior conservative treatment failure: The patient has failed conservative therapy with bowel retraining.
Examples include suppositories, digital stimulation, abdominal massage, and enemas.
PIE is excluded when any contraindication is present, including abdominal surgery within the past 12 months, renal insufficiency, acute diverticulitis, impaction outside the colon such as ileus, or suspected compromise of colonic integrity, including suspected perforation.
Coding
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