CPT codes play a critical role in every aspect of billing and coding. Inadequate or incorrect coding is harmful to the patient. This article will guide you in using CPT codes 74176 and 74178. There many technical and advanced aspects of CPT coding.This article will focus on the most frequently used aspects. If you are a coder, once you understand the basics, your job is set and you don’t need to worry about the rest.If you are a provider, a medical student, a medical CS resident, or any other professional, this article’s purpose is to educate you so you understand what your coders are doing. Significant gaps exist in the quality of education for medical school students, residents, and fellows, which affects what they can deliver in the exam room.
Understanding CPT Codes 74176 and 74178:
CPT code 74176 stands for CT scan of the abdomen/pelvis without contrast media [1]. This type of scan is often conducted in patients who complain of abdominal/pelvic pain [2] or to examine their abdomen/pelvis [2]. The details are as follows: the patient lies down on the scan table [2]; an x-ray beam and detector take a picture of the body part, and the picture is interpreted by the doctor to make a diagnosis.
However, 74178 denotes a CT of the abdomen and pelvis with contrast, meaning that the physician or other qualified health care professional has administered a substance, such as barium or other orally ingested encapsulated materials, into the patient’s digestive system to optimise CT-scan photoacquisition. If given orally, the contrast medium will reveal information regarding the motility of the gastrointestinal tract; more often, however, a physician or nurse will inject a contrast medium, such as iodine of varying concentrations, either to optimise the imaging of other soft tissues surrounding the bowel or to assess the functioning of the kidneys.
Procedure Description and Qualifying Circumstances:
The CPT code 74176 is for a CT scan of the abdomen and pelvis without contrast material performed with advanced noninvasive imaging technology. The patient is placed on a scanner table, and the machine rotates around the patient, collecting multiple cross-sectional images. These images are reconstructed to create an image of the abdomen and pelvis and detect abnormalities and disease.
When using CPT 74176, one must document qualifying circumstances, such as ‘Abdominal or pelvic pain, suspected injury or trauma, to evaluate suspected tumors or masses, to evaluate suspected organ function,’, to support the need for the procedure and to help ensure the correct reimbursement [2].
Billing Guidelines and Modifiers:
You must document the CT scan without contrast to be billed as CPT code 74176, and document that contrast was given for the scan to be billed under CPT code 74178. If you can’t document that contrast was given or describe the goal and specific enhancement areas, you can’t tick it off as CPT code 74178.
Modifiers are additional codes that provide supplemental information about the service. Modifier -26, for instance, signifies that only the professional portion of a procedure has been performed; modifier TC indicates that the technical component has been performed [2]. Use of the correct modifiers ensures proper payment for services rendered, which aids in avoiding claim denials and payment delays.
Frequently Asked Questions (FAQs):
Q1: What is the description of CPT code 74176?
A1: This diagnostic imaging service coded as 74176 is performed by a CT scanner, wherein a CT scan of the abdomen and pelvis, without contrast material, is captured. This allows one to evaluate and the diagnosis of the diseases of the abdomen and pelvis using clear pictures (radiographs) without the administration of contrast agents.
Q2: What is the description of CPT code 74178?
CPT code 74178 corresponds to CT of the abdomen and pelvis with contrast material (IV). The contrast material is a substance, for example iodine or gadolinium, and is used to enhance the visualisation of anatomy and physiology.
Q3: Are there any specific qualifying circumstances for these CT scans?
A3: Yes, possible eligibility criteria for CPT codes 74176 and 74178 include abdominal and/or pelvic pain, suspected injuries or injury, assessment of tumours or masses, and assessment of organ function [2].
Q4: What are the billing guidelines for these CPT codes?
A4: To ensure that you are reimbursed appropriately, you need to bill with a note indicating whether or not contrast material was used, and you need to be sure to append appropriate modifiers, when available, to delineate the professional versus technical portions when structured 2.
Conclusion:
These codes are necessary for CPT 74176 and 74178 are used to code a CT scan of the abdomen and pelvis. The following descriptions will explain the qualifying condition, billing requirements, proper use of modifiers, and benefits of using the right coding guidelines. As reimbursement policy changes, it is imperative for physicians and insurance companies to be aware of the coding guidelines and document one’s provision of care accurately. Healthcare providers must always prioritize patients’ conditions as their top-priority. However, it must also be noted that physicians must be vigilant in stay compliant to the law.
References:
[1] AAPC. CPT® Code 74176 - Diagnostic Radiology (Diagnostic Imaging... - AAPC. Retrieved from
[2] Coding Ahead. How To Use CPT Code 74176 - Coding Ahead. Retrieved from
http://www.cms1500claimbilling.com/2017/03/ct-abd-cpt-codes-74176-74178.html