Chapter 6: Abdomen (74000-74190)

In Radiology's "Abdomen" section, you'll find abdomen exams for different modalities, as well as a code specific to
peritoneogram: 74190 (Peritoneogram [e.g., after injection of air or contrast], radiological supervision and
interpretation).
Tip: For information on CTAs, see "Special Feature: Keep Sight of Anatomic Site to Select CTA Code" in Chapter 1. For
information on CT IVP, see "Separate Codes for IVP and CT IVP" in Chapter 3.
Abdominal X-Ray Documentation Needs View Type
Deciding which code you should report for a four-view abdominal X-ray depends on the types of views, rather than the
number. Depending on the radiologist's documentation, you will choose from the following codes:

74010 Radiologic examination, abdomen; anteroposterior and additional oblique and cone views
74020 ... complete, including decubitus and/or erect views
74022 ... complete acute abdomen series, including supine, erect and/or decubitus views, single view chest.

Bottom line: You need to see documentation of the view types anteroposterior, oblique, cone, decubitus, erect,
supine to accurately choose among these codes.
Don't Expect Special Code for These 'Delayed Images'
If the radiologist documents "IV bolus study of the abdomen and pelvis with delayed images" for CTs, you may wonder
what the term "delayed images" means.
Get started: This documentation reflects studies with contrast only you should not consider "delayed images" to be
without contrast.
That means you should report the study with 74177 (Computed tomography, abdomen and pelvis; with contrast
material[s]).
IV bolus: The documentation notes administration of "IV bolus." That indicates the patient received contrast
intravenously. CPT guidelines state that intravascular contrast qualifies for codes that specify "with contrast." (CPT
states oral and rectal contrast don't qualify for "with contrast" codes.)
Delayed images: "Delayed images" in this scenario often indicates the provider rescanned the patient after allowing
enough time for the contrast to enter the bladder. You should not report this differently than a typical abdomen/pelvis
CT.
Watch for: If the radiologist had documented also reading images taken before contrast administration, then you
should revise your coding: 74178 (Computed tomography, abdomen and pelvis; without contrast material in one or
both body regions, followed by contrast material(s) and further sections in one or both body regions).
Key Concepts:
Heed This Contrast Supply Coding Warning

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You have to kick your coding skills into high gear to avoid the unique pitfalls associated with patients receiving multiple
imaging exams on one day. Case in point: You have to know when to report an exam "with contrast."
Suppose a provider performs an abdominal CT and then immediately performs a pelvic CT on the same patient. She
administers 100 cc contrast intravenously before the abdominal CT but does not administer contrast before the pelvic
CT.
The 100 cc contrast administered prior to the abdominal CT counts toward a "with contrast" pelvic CT. The provider
doesn't have to inject contrast separately for each exam for you to report a "with contrast" abdomen and pelvis CT.
The patient still has contrast material used for image enhancement in her system, so the exam is "with contrast."
Don't miss: If you bear the cost of contrast, you should bill the actual contrast amount supplied.
Key Concepts:
Don't Report 3-D Code for Coronal
Scenario: Your facility purchased a new CT machine. You now perform a pelvic and abdominal CT without and with
contrast, and then perform a post-void X-ray. You also perform coronal reconstruction.
Answer: You should report the abdominal CTs using 74178 (Computed tomography, abdomen and pelvis; without
contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body
regions).
Ideal: Help auditors credit your radiologist for his work by suggesting he discuss the state of the abdominal structures
in one paragraph and the state of the pelvic structures in another.
The appropriate code for a single post-void abdominal X-ray is 74000 (Radiologic examination, abdomen; single
anteroposterior view). Correct Coding Initiative edits don't bundle this X-ray code with the CT codes, so you should be
able to report it separately. Just be sure the radiologist documents medical necessity for the exam.
Caution: You shouldn't report the coronal reconstruction which is 2-D separately. Codes 76376 and 76377 (3D
rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or
other tomographic modality with image postprocessing under control supervision ...) are for 3-D reconstruction only.
CT Colonography-Includes 3D Reconstruction
The CT colonography is reported with the use of following codes:

74261 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast
material
74262 ... with contrast material(s) including noncontrast images, if performed
74263 Computed tomographic (CT) colonography, screening, including image postprocessing.

CT colonography (virtual colonoscopy or CTC) is an enhanced abdominal CT scan in which computer reconstruction
allows radiologists to perform a detailed longitudinal 3D bowel examination for polyps, cancer, or other disease. This
procedure uses helical computed tomography of the abdomen and pelvis, along with 3D reconstruction, to visualize
the colon lumen. The test requires colonic preparation similar to that required for standard colonoscopy (instrument
colonoscopy) and air insufflation to achieve colonic distention.
Important: These codes are global codes, meaning they include both the technical (modifier TC, Technical
component) and physician reading fee (modifier 26, Professional component). Remember to append 26 if the
radiologist only interprets the CT and doesn't meet technical component requirements, such as owning the CT machine
and covering staffing costs.

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Also, note that the procedure includes 3D reconstruction. That means you should not report 3D reconstruction codes
76376-76377 with the CT colonography codes.
Strike Reimbursement for 74263
Medicare does not cover 74263, the screening CT colonography code. As per CMS, there is not enough evidence to
conclude that CT colonography is an appropriate colorectal cancer screening test. Hence, CT colonography for
colorectal cancer screening remains noncovered by Medicare. However, the American Cancer Society updated its
screening guidelines to recognize virtual colonoscopy as a cancer-screening tool, recommended every five years,
beginning at age 50, for both men and women at average risk for developing colorectal cancer. Some private payers
do allow patients with colorectal cancer screening coverage to opt for CT colonography.
Discover Diagnostic Indications
Typically a patient would have an exam if he has a personal or family history of colon polyps, diverticulosis, or colon
neoplasms.
Codes for these conditions include the following:

V10.05 Personal history of malignant neoplasm of large intestine

V12.72 Personal history of colonic polyps
V16.0 Family history of malignant neoplasm of gastrointestinal tract
V18.51 Family history, Colonic polyps
562.1x Diverticula of colon

Crucial: You should check your payer's policy to learn which conditions not just diagnoses you must meet for the
payer to consider CT colonographies medically necessary. Payers may cover diagnostic CT colonography as medically
necessary when a colonic lesion, structural abnormality, or technical difficulty prevents completion of conventional
colonoscopy.
Avoid the Dx Blunder with 74261 & 74262
You may run into trouble if you report 74261 and 74262 with V76.51 (Special screening for malignant neoplasms,
colon). Codes 74261 and 74262 refer to a diagnostic procedure, not a screening one. Second, because any
colonography with abnormal or suspicious findings requires a colonoscopy for diagnosis (such as a biopsy) or
treatment (such as a polypectomy), be on the watch for payers that will not pay for CT colonographies as an
alternative to a colonoscopy even though your radiologist may have performed this service for signs or symptoms of
a disease.
Best advice: Watch your insurance companies for criteria because they are very strict especially Medicare.
Report Renal CTA With 74175
If you've been confused about how to code renal CTAs, look no further than 74175 (Computed tomographic
angiography, abdomen, with contrast material[s], including noncontrast images, if performed, and image
postprocessing).
Here's why: The renal arteries branch off of the abdominal aorta below where the superior mesenteric branches off
and above the gonadal arteries. A renal scan typically covers the area between the supraceliac aorta and the iliac
bifurcation. This anatomical placement puts a renal scan in the abdomen (74175).
Tip: Physicians may order a renal CTA to look for renal artery stenosis. If the CTA confirms this diagnosis, report 440.1
(Atherosclerosis of renal artery).
Polish Your Pancreatitis Coding Skills

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To report magnetic resonance cholangiopancreatography (MRCP) for a patient with acute pancreatitis, for most
insurers, including Medicare, you should report 74181 (Magnetic resonance [e.g., proton] imaging, abdomen; without
contrast material[s]).
Some insurance companies may prefer S8037 (Magnetic resonance cholangiopancreatography [MRCP]). According to
the HCPCS manual, Blue Cross/Blue Shield and the Health Insurance Association of America use S codes to report
drugs, services, and supplies that have no national codes. Medicaid may also use these codes, but Medicare won't pay
them.
For acute pancreatitis, you should report 577.0 (Acute pancreatitis).

- Published on 2015-01-01

CPT 2014 American Medical Association. All rights reserved.