Radiology Coding Alert

Question: We had a report that indicated the radiologist performed a CT of the patient’s abdomen and pelvis with oral and IV contrast. We originally submitted the claim with 74170 and 72194, but the claim was denied. I thought oral contrast doesn’t qualify for a study “with contrast.”

How should we correct the claim?

New Jersey Subscriber

Answer: To correct your claim, you’ll assign 74177 (Computed tomography, abdomen and pelvis; with contrast material(s)) to report the procedure. A key piece of data that helps the coding dominos fall into place is understanding the administration of contrast materials.

You are correct regarding oral contrast use. According to the AMA CPT^® guidelines prior to the Radiology codes, “Oral and/or rectal contrast administration alone does not qualify as a study ‘with contrast.’” In the report you’ve cited, the radiologist used oral and intravenous (IV) contrast — not just oral contrast — which means you should assign an appropriate “with contrast” code for the procedure instead of 74170 (Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections) and 72194 (Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections). These codes are designated for procedures where the radiologist performs a computed tomography (CT) scan of the body structure without contrast, then administers contrast material, and captures more images.

Your question describes the radiologist performing a CT scan of the patient’s abdomen and pelvis with contrast. Some coders may think they should assign 74160 (Computed tomography, abdomen; with contrast material(s)) and 72193 (Computed tomography, pelvis; with contrast material(s)) to report the two body structures separately, but the AMA CPT^® code set includes a combination code that reflects a CT scan of both areas with contrast.

In the Abdomen codes, there is a handy table that leads you to the correct code if a CT of the abdomen and a CT of the pelvis are performed during the same encounter. By cross-referencing 74160 and 72193, you’ll arrive at 74177.