Radiology Coding Alert

'Unbundling' becomes a taboo term for abdominal and pelvic CTs.

If you've been scratching your head about the wording of new code 74178, you aren't alone. But the AMA has released more details that should help guide you to the proper code.

Anatomic Combination Is Key to 74176-74178

The creation of 74176-74178 is one of the big changes for coding in 2011, says Kelly C. Loya, CHC, CPC-I, CPhT, managing consultant with Sinaiko Healthcare Consulting Inc. The codes are as follows:

• 74176 -- Computed tomography, abdomen and pelvis; without contrast material
• 74177 -- ... with contrast material(s)
• 74178 -- ... without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions.

Rationale: Patients often have imaging of the abdomen and pelvis performed at the same setting, and the intent of the new CPT codes is to reflect this reality, according to the presentation by Richard Duszak, MD, FACR, FRBMA, RCC, at the AMA's 2011 CPT and RBRVS Symposium in Chicago.

Duszak stressed the importance of using the new codes and not unbundling the abdominal and pelvic services when they're performed at the same session. You should choose just one code for the entire session.

Helpful: CPT Changes 2011: An Insider's View provides examples of proper use of the codes and, in the procedure descriptions, indicates the radiologist evaluates the following in looking at the pelvic and abdominal CTs: "lower mediastinum, liver, spleen, gallbladder, adrenal glands, kidneys, ureters, bladder, retroperitoneal soft tissues, stomach, duodenum, small bowel, appendix, colon, pelvic genito-urinary/reproductive organs, all lymph node chains, major abdominal arterial and venous vasculature, and supporting musculature."

Summary: If you're reporting an abdominal CT alone or a pelvic CT alone, your coding won't change in 2011. You'll continue to choose either a pelvic code from 72192-72194 (Computed tomography, pelvis ...) or an abdominal code from 74150-74170 (Computedtomography, abdomen ...).

But if the abdominal and pelvic CTs are performed at the same session, you should choose the single code from 74176-74178 that represents the services provided. You should not additionally report a code from 72192-72194 (pelvis) or from 74150-74170 (abdomen).

Don't Miss 74178 Reporting Opportunities

The guidelines are especially helpful in deciphering how to use 74178, which would perhaps be more clearly worded as "without contrast material in one or both body regions, followed by contrast material(s) and further sections in the other body region or both body regions."

According to a chart provided by CPT, 74178 is appropriate when the patient has:

• An abdominal CT without contrast followed by a pelvic CT with contrast
• An abdominal CT without contrast AND a pelvic CT without contrast followed by a pelvic CT with contrast
• A pelvic CT without contrast followed by an abdominal CT with contrast
• A pelvic CT without contrast AND an abdominal CT without contrast followed by an abdominal CT with contrast
• Pelvic and abdominal CTs without contrast followed by pelvic and abdominal CTs with contrast.