Inpatient Facility Coding & Compliance Alert

 Question: What does CPT® consider included in "contrast" in terms of billing, for procedures such as a CT abdomen study? Can we report the "with contrast" code whether we give IV, oral, rectal, gastrografin, or a combination of contrasts?
Arizona Subscriber

Answer: When a CPT® code descriptor for an abdominal or pelvic study references "with contrast," it refers to IV contrast material. Consider these two points from CPT®’s radiology guidelines pertaining to administration of contrast materials:

• Injection of intravascular contrast material is part of the "with contrast" CT, CT A, MRI, MRA procedure.
• Oral and/or rectal contrast administration alone does not qualify as a study with contrast.

Oral contrast is not billed separately and does not qualify as the "with" in "with contrast." When oral contrast is used, it is considered to be integral to the procedure.

Medicare coding guidelines agree with this position by stating that you cannot report a "with contrast" code for oral or rectal administration.

In your example, you should report 74150 (Computed tomography, abdomen; without contrast material).