When It Is Appropriate To Assign A Cpt Code Using Contrast Material With Radiology Services?

June 2016

Radiology Billing and Coding: Coding for CT Imaging of the Belly and Pelvis
By M. John Verhovshek, MA, CPC
Radiology Today
Vol. 17 No. six P. 6

The abdomen and pelvis frequently undergo CT imaging at the same fourth dimension, for instance to evaluate a patient following trauma or for conditions such equally appendicitis, diverticulitis, ulcerative colitis, and cancer.

The following three CPT codes describe same-session CT imaging of the abdomen and pelvis:
• 74176, Computed tomography, abdomen and pelvis; without contrast material;
• 74177, Computed tomography, abdomen and pelvis; with contrast material(s); and
• 74178, Computed tomography, belly and pelvis; without contrast material in one or both body regions, followed by dissimilarity material(s) and further sections in 1 or both body regions.

Report 74176 when both studies (abdomen and pelvis) are performed without contrast. Use 74177 if both studies are performed with contrast. Apply 74178 if one or both studies is/are performed without contrast, followed by farther sections using contrast material(due south); and, when ane study (of either the belly or pelvis) is performed without dissimilarity, and the second report is performed with contrast.

A note well-nigh contrast: Per American Medical Association guidelines, oral and/or rectal contrast assistants lone does not authorize as a study "with dissimilarity," which applies to those procedures performed using contrast material administered intravascularly, intra-articularly, or intrathecally.

CPT Banana ("Coding Brief: Computed Tomography of Abdomen and Pelvis," November 2011) describes a typical encounter for 74177 as, "A 66-year-quondam female with a history of not-Hodgkins lymphoma presents with flank and abdominal pain. Previous examination(southward) demonstrated abnormally enlarged intestinal and retroperitoneal lymph nodes. A CT scan of the belly and pelvis with intravenous contrast is ordered." Information technology details a typical run into for 74178 every bit, "A l-year-one-time male presents with vague flank pain and persistent hematuria on serial urinalyses. In that location is no history of trauma. A CT scan of the abdomen and pelvis with and without contrast is ordered."

Report a unmarried code (74176, 74177, 74178) per merits. In the unusual example that a patient undergoes more one combined report per day and the services are documented accordingly, you lot may report both combined studies, with modifier 59, Distinct procedural service, appended to the second code. CPT Assistant (Nov 2011) specifies, "Although it would exist rare, combination CT abdomen/pelvis studies may exist performed in the morning followed by combination CT abdomen/pelvis studies performed later on the same day. In that instance, the second combined code should be reported with modifier 59 to denote to the payer that this is non a duplicate bill, merely that separate and distinct combined studies were performed during different sessions by the same physician on the same patient on the same twenty-four hours."

Look to Different Codes for Imaging of Either the Abdomen or Pelvis Alone
CPT besides includes the post-obit codes for CT of the abdomen only, and for CT of the pelvis only:
• 74150, Computed tomography, abdomen; without contrast textile;
• 74160, Computed tomography, abdomen; with contrast fabric(s);
• 74170, Computed tomography, abdomen; without contrast cloth, followed by contrast textile(due south) and farther sections;
• 72192, Computed tomography, pelvis; without dissimilarity textile;
• 72193, Computed tomography, pelvis; with contrast textile(south); and
• 72194, Computed tomography, pelvis; without contrast material, followed by contrast material(s) and farther sections.

To help you to select the appropriate code when reporting CT of the abdomen and/or pelvis (with, without, or with and without contrast), the CPT codebook provides a quick-view coding tool.

Typically, you volition non study a combined study with a CT of the belly or pelvis alone. The National Right Coding Initiative (NCCI) includes edits to prevent reporting stand-alone CT abdomen (74150 to 74170) and CT pelvis (72192 to 72194) codes on the same day of service as the combination CT abdomen and pelvis codes 74176 to 74178. Withal, CPT Assistant (November 2011) allows for exceptions: "[Yard]odifier 59 [Distinct procedural service] should be appended to the stand up-lone codes, when appropriate, to designate to the payer that the procedure was performed during a separate patient encounter and not during the same session as the combined CT abdomen and pelvis studies.

"For case, CT abdomen and pelvis with dissimilarity studies are performed at 1 PM for rectal bleeding and to evaluate the patient for possible colitis. A hyperdensity is identified inside the cecum, which could stand for a foreign body vs agile extravasation. A noncontrast CT of the pelvis is performed at 3 PM to appraise for resolution. Considering at that place are NCCI edits in identify, modifier 59 should exist appended to the CT pelvis code to designate that a separate and distinct study was performed during a dissimilar session."

In other words, if a combined report and a same-24-hour interval private study are supported, you may study the individual study separately with modifier 59 appended. Documentation must verify the distinct nature and medical necessity for both procedures.

CPT Assistant concludes with a reminder that modifiers are payer specific and recommends that practices contact their local carriers and other third-political party payers for instructions on the utilise of modifiers.

— Chiliad. John Verhovshek, MA, CPC, is managing editor for AAPC, the nation's largest medical credentialing organization.

When It Is Appropriate To Assign A Cpt Code Using Contrast Material With Radiology Services?,

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