Radiology Coding Alert

Question: What does the radiologist mean when he refers to a triplecontrast CT?

Answer: Typically, a triple-contrast CT refers to scans of the abdomen and/or pelvis involving intravenous (IV), oral, and rectal contrast. You may see these particularly when a physician wants to see internal damage from a penetrating wound.

Watch the order of administration and scanning because this affects your coding. According to CPT's Radiology Guidelines, "oral and/or rectal contrast administration alone does not qualify as a study 'with contrast.'" Intravascularly administered contrast, on the other hand, does qualify for a "with contrast" code.

As a result, if the patient receives IV contrast before the scanning begins, then the IV contrast will still be present in the later scans with the added oral and rectal contrast. That means you should not report "without contrast" scans. All of the scans are "with contrast."

For example: The radiologist may scan the abdomen and pelvis with intravenous contrast, and then scan them again after administration of oral and rectal barium contrast. In this case, you should report new code 74177 (Computed tomography, abdomen and pelvis; with contrast material[s]).

Remember: Documentation should not refer only to a triple-contrast CT. The precise types of contrast and methods of administration should be documented. That will allow you to choose the proper code(s) and help you support your coding choices to payers and auditors.