Radiology Coding Alert

Question: Were a hospital-based radiology practice and have encountered a puzzling situation regarding how to code enhanced abdomen and pelvic CT scans. The hospital charges for contrast administration, and uses codes 74160 and 72192. We maintain that the study that is interpreted is contrasted, so therefore code 74160 and 72193. Are we correct? Should there be a special code developed for this type of study?

Diana Satrum
Purnell Radiology Inc., Albany, N.Y.

Answer: Coders should understand that a computerized axial tomography scan (CAT or CT scan) is an x-ray procedure that combines many x-ray images with the assistance of a computer to generate cross-sectional views and three-dimensional images of internal organs or body structures. Each of these pictures is like a slice of the body and is recorded on film. In order to increase the distinction between various organs or areas of the body, contrast material may be administered via intravenous injection, orally or rectally. Contrast enhancement also helps determine the type of pathology involvedfor instance, a tumor with vascular supply will become enhanced, whereas other types of tumors will not.

However, contrast is not always used.
One of the first things to look for when choosing the appropriate CPT code for CT scans is whether contrast was administered. Coders should note that only parenteral administration of contrast is considered appropriate for coding contrastoral and rectal administration is not considered contrast for coding purposes. There are distinct CPT codes for CT scans performed with parenteral contrast, without contrast, and without contrast followed by parenteral contrast.

If the contrast is administered prior to both the abdominal CT and the pelvic CT in the case cited, they would be coded with CPT codes 74160 (computerized axial tomography, abdomen; with contrast material[s]) and 72193 (computerized axial tomography, pelvis; with contrast material[s]).

In some cases, the pelvis CT may be performed first without contrast, followed by an abdominal CT performed after the administration of contrast material. This would result in the pelvis CT being coded 72192 (computerized axial tomography, pelvis; without contrast material) and the abdomen CT being coded 74160.

The radiologists documentation of the CT scans should indicate if and/or when the contrast was administered to enable accurate coding.