Radiology Coding Alert

Know when to code separately for enteroclysis tube introduction.

Staying up-to-date on coding guidance from authoritative sources is key to ensuring your claims are submitted accurately and compliantly. More specifically, you’ll need to home in on some recent authoritative guidance from CPT^® Assistant to properly report for small bowel series procedures.

As you’ll see, making a proper distinction between two similar code sets requires a keen attention to detail.

Check out these important insights into small bowel series coding — beginning with some key guidance from CPT^® Assistant.

Discern Between Single, Double Contrast Studies

CPT^® Assistant (February 2021; Volume 31: Issue 2) offers some much-needed context and elaboration surrounding the reporting of 74250 (Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; single-contrast (eg, barium) study) and any related scout abdominal radiographs.

Refresher: Code 74250, also known as a small bowel series, “involves a complete fluoroscopic and radiographic evaluation of the small intestine,” explains Barry Rosenberg, MD, chief of radiology at United Memorial Medical Center in Batavia, New York. Following a KUB, the patient is administered liquid barium. Afterwards, the provider takes a series of fluoroscopic images to monitor the flow of barium through the small intestine.

CPT^® Assistant offers some crucial context on reporting these services when, instead of performing a series of fluoroscopic images, the provider only performs a single radiograph following the administration of contrast. In these cases, the circumstances and documentation do not support 74250 reporting. Instead, you will exclusively report 74018 (Radiologic examination, abdomen; 1 view).

To consider: Documentation of fluoroscopic imaging that tracks the progress of the barium through the small intestine is necessary in order to report 74250. Furthermore, if the provider documents a single radiograph without fluoroscopic imaging, you will not code separately for the administration of contrast since the route of administration is oral.

CPT^® Assistant goes on to explain that 74250 reporting is only warranted when the provider administers liquid barium and proceeds to take multiple serial images. They also offer some important context surrounding the portion of the 74250 code description that states “including multiple serial images and scout abdominal radiograph(s), when performed.” CPT^® Assistant elaborates that the “when performed” portion of the code description exclusively pertains to scout abdominal radiographs, not multiple serial images. In other words, multiple serial images are a requirement for 74250 reporting, but multiple abdominal radiographs are not. You may not code separately for the KUB performed prior to contrast administration, regardless of whether the provider performs more than one.

Expand Upon Key 74250, 74251 Differences

Now that you’ve the basics of 74250 reporting covered, you need to understand how to pinpoint the key differences and similarities within a 74251 (… double-contrast (eg, high-density barium and air via enteroclysis tube) study, including glucagon, when administered) report. Fortunately, you don’t need to dig into any authoritative guidelines to figure out what the respective differences are between each procedure. The code description explains that, while 74250 is offering single contrast in the form of liquid barium, 74251 goes one step further by infusing high-density barium and air via an enteroclysis tube as the second form of contrast. The air helps to both expand the intestine and allow the barium to better adhere to the lumen (lining) of the intestines.

Refresher: An enteroclysis tube is typically inserted via the mouth or nose of the patient and extended through the stomach and into the small intestine.

If the documentation supports a double contrast study via an enteroclysis tube, you won’t solely be reporting 74251 as you would with 74250. Instead, you’ve got to take into consideration coding for both the tube placement and the fluoroscopic guidance for said placement. You’ll report these services with the following codes:

• 44500 (Introduction of long gastrointestinal tube (eg, Miller-Abbott) (separate procedure))
• 74340 (Introduction of long gastrointestinal tube (eg, Miller-Abbott), including multiple fluoroscopies and images, radiological supervision and interpretation)

Coder’s note: You will append modifier 26 (Professional component) to 74250 and 74251. You will not append modifier 26 to 74340 since it’s an RS&I (radiological supervision and interpretation) service.