Radiology Coding Alert

Choosing the correct code to describe a diagnostic study of the upper gastrointestinal (UGI) tract presents a big challenge even to veteran radiology coders. "There are a number of possible codes that can be assigned," says Charla Prillaman, CPC, CHCO, senior coding consultant with Webster, Rogers & Co. in Florence, S.C., and the American Academy of Professional Coders (AAPC) 2000 Coder of the Year.

The source of the confusion can be found in the variables that determine which code to assign. CPT Codes provides two distinct series of codes for the studies: 74240-74245 and 74246-74249 (see box on page 26 for definitions). Both sets, Prillaman says, contain codes that describe contrast studies of the gastrointestinal tract anatomy from the patient's upper esophagus through the stomach and, in some cases, through the ileocecal valve. However, you must sort through specific elements to identify which code within the two sets of codes is most appropriate. "The radiologist's documentation is crucial when coding and billing UGI studies," she emphasizes. "The medical record must clearly state what was and/or was not done so that coders can map out the proper code."

The type(s) of contrast used during the study will help coders determine which of the two sets of codes to begin with, notes Patti Offner, RT, with Diagnostic Imaging Inc., in Philadelphia. During the study, the patient is asked to swallow about 16 ounces of positive-contrast solution, then the radiologist takes x-rays of the esophagus, stomach and duodenum. While both sets of codes describe procedures that provide images of the same anatomy, the type and combination of contrast agents determine which of the two types of codes should be reported.

Codes 74240-74245 are generally reported when one of two common contrast media is selected: barium sulfate or meglumine diatrizoate (Gastrografin). This is called a single-contrast barium study. However, sometimes the barium sulfate solution can harm the patient or provide insufficient information. In this case, the radiologist may choose to use meglumine diatrizoate, a water-soluble solution, as an alternative. Fluoroscopic visualization is performed, and documentary images are obtained.

Code series 74246-74249 is reported when effervescent granules and high-density barium are consumed. This type of study is called a "double-contrast" study because two contrast agents are employed. Radiologists may also refer to this as an "air-contrast study" in their notes because of the use of effervescent granules. Coders should be familiar with both terms to spot the type of study and choose the correct code series. When double-contrast studies are performed, the patient rapidly swallows carbonated powder, an effervescent agent that releases carbon dioxide into the lumen of the [...]