It's included in the E/M.
Per CPT Assistant...
Question: Is it appropriate to report CPT code 45915, Removal of fecal impaction or foreign body (separate procedure) under anesthesia, when conscious sedation is used?
"CPT code 45915 is intended to be reported for fecal impaction or foreign body removals only when performed under general anesthesia. The CPT code descriptors that include the phrase "requiring anesthesia" or "under anesthesia" indicate that the work involved in that specific procedure requires the use of general anesthesia; therefore, it would not be appropriate to report code 45915 if general anesthesia is not provided. Fecal impaction or foreign body removal performed with other anesthetics is considered inclusive to the appropriate evaluation and management service code."
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