Procedure code and description
74177 - Ct abd & pelv w/contrast - average fee payment - $320- $330
In 2011, the Procedure code editorial panel created three new codes for CT of abdominal and pelvis:
* Code 74176, CT, abdomen and pelvis; without contrast material
* Code 74177, CT, abdomen and pelvis; with contrast material(s)
* Code 74178, CT, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions
Coverage Indications, Limitations, and/or Medical Necessity
Indications
Evaluation of abdominal or pelvic pain.
Evaluation of known or suspected abdominal or pelvic masses or fluid collections, primary or metastatic malignancies, abdominal or pelvic inflammatory processes, and abnormalities of abdominal or pelvic vascular structures.
Evaluation of abdominal or pelvic trauma.
Clarification of findings from other imaging studies or laboratory abnormalities.
Evaluation of known or suspected congenital abnormalities of abdominal or pelvic organs.
Treatment planning for radiation therapy.
Limitations
Three dimension reconstruction of CT of Abdomen and Pelvis (CPT code 76376 or 76377) is not expected to be utilized routinely. CPT code 76376 or 76377 are not an appropriate part of every CT examination.
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
999x Not Applicable
Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
99999 Not Applicable
CPT/HCPCS Codes
Group 1 Codes:
72192 Ct pelvis w/o dye
72193 Ct pelvis w/dye
72194 Ct pelvis w/o & w/dye
74150 Ct abdomen w/o dye
74160 Ct abdomen w/dye
74170 Ct abdomen w/o & w/dye
74176 Ct abd & pelvis w/o contrast
74177 Ct abd & pelv w/contrast
74178 Ct abd & pelv 1/> regns
74178 CT Abdomen One or Both Body Regions without and with Contrast
Note: For radiation therapy planning use 77014.
For CT guided needle placement, biopsy or drainage use 77012.
For CT guided tissue ablation use 77013.
I. Complaints associated with abdominal or pelvic pain1-11 [One of the following]
A. Generalized Abdominal pain in men and also women not of childbearing age112-118 (CT of the abdomen and pelvis with contrast) one of the following:
1. If equivocal ultrasound or
2. Pain is accompanied with any one of the following:
a. Failure of conservative treatment for 4 weeks
b. Cancer history
c. Fever (101 degrees or greater)
d. Mass
e. GI bleeding
f. Moderate to severe abdominal tenderness
g. Guarding, rebound tenderness, or other peritoneal signs
h. WBC 10,000 or greater
B. Obstructive uropathy or hydronephrosis with negative ultrasound [One of the following]
1. Pain in flank, radiating toward the groin
2. Hematuria
C. Diverticulitis with left lower quadrant pain [One of the following]
1. Aural temperature >38.3°C or >100.9°F
2. Leukocytosis, WBC >11,500/cu.mm
3. Diverticulosis by prior imaging study
4. Rebound
D. Abscess [One of the following]
1. Acute non localized abdominal pain
a. Aural temperature >38.3°C or >100.9°F
b. Leukocytosis, WBC >11,500/cu.mm
c. Rebound
2. Follow up during or after treatment [One of the following]
a. Condition unimproved or worsening while on treatment
b. Routine follow-up study after treatment, including evaluation for removal of drain
E. Appendicitis (In children and pregnant women, ultrasound is the initial study except for follow up of known appendicitis with suspected complications. If this is not possible then CT of the abdomen and pelvis. MRI abdomen [74181, 74182, or 74183] in pregnant women)
1. Right lower quadrant pain [One of the following]
a. Aural temperature >38.3°C or >100.9°F
b. Leukocytosis, WBC >11,500/cu.mm
c. Rebound
F. Crohn’s disease and inflammatory bowel disease (suspected) [One of the following]
1. Suspected Crohn’s disease [One of the following]
a. Abdominal pain and diarrhea for more than 6 weeks
b. Aural temperature >38.3°C or >100.9°F
c. Perianal fistula or fissure
d. Enterovesical fistula
e. Enterovaginal fistula
f. Enterocutaneous fistula
g. Children with unexplained anemia, growth failure, and abdominal pain
2. Complications of known Crohn’s disease [One of the following]
a. Mass on abdominal, pelvic or rectal exam
b. Aural temperature >38.3°C or >100.9°F
c. Leukocytosis, WBC >11,500/cu.mm
d. Guarding
e. Rebound
f. Follow-up during or after treatment [One of the following]
i. Condition unimproved or worsening after drainage and IV antibiotics for at least two days
ii. Condition unimproved or worsening after IV Abx Rx >1 wk
iii. Routine follow-up study after treatment, including evaluation for removal of drain
g. Fistula
h. Small bowel obstruction
i. Perianal fistula
j. Stricture or stenosis
3. Any evidence of clinical deterioration while on steroids or immunosuppressives
G. Ulcerative colitis with bloody mucoid stools [One of the following]
1. Diarrhea
2. Pain
3. Tenesmus
H. CT of the abdomen and pelvic either with or without contrast (CPT® 74177 or CPT® 74176) can
CMS has updated the list of specified HCPCS codes within the three imaging families and five composite APCs to reflect HCPCS coding changes. Specifically, CMS added CPT code 74176 (Computed tomography, abdomen and pelvis; without contrast material), CPT code 74177 (Computed tomography, abdomen and pelvis; with contrast material(s)), and CPT code 74178 (Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions) to the CT and CTA family. These codes are new for CY 2011. CMS also added HCPCS codes C8931 (Magnetic resonance angiography with contrast, spinal canal and contents), C8932 (Magnetic resonance angiography without contrast, spinal canal and contents), C8933 (Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents), C8934 (Magnetic resonance angiography with contrast, upper extremity), C8935 (Magnetic resonance angiography without contrast, upper extremity), and C8936 (Magnetic resonance angiography without contrast followed by with contrast, upper extremity), to the MRI and MRA family.
UHC covered CT abd codes
72133 Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections
72191 Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing
72192 Computed tomography, pelvis; without contrast material
72193 Computed tomography, pelvis; with contrast material(s)
72194 Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections
73200 Computed tomography, upper extremity; without contrast material
73201 Computed tomography, upper extremity; with contrast material(s)
73202 Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections
73206 Computed Tomography angiography upper extremity with and without contrast material
73700 Computed tomography, lower extremity; without contrast material
73701 Computed tomography, lower extremity; with contrast material(s)
73702 Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections
73706 Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing
74150 Computed tomography, abdomen; without contrast material
74160 Computed tomography, abdomen; with contrast material(s)
74170 Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections
74174 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing
74175 Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing
74176 Computed tomography, abdomen and pelvis; without contrast material
74177 Computed tomography, abdomen and pelvis; with contrast material(s)
74178 Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions
74261 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material
74262 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast images, if performed
74263 Computed tomographic (CT) colonography, screening, including image postprocessing (Non-covered service)
75571 Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium
75572 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image post processing, assessment of cardiac function, and evaluation of venous structures, if performed)
75573 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image post processing, assessment of LV cardiac function, RV structure and function and evaluation of venous structures, if performed)
75574 Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image post processing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)
Effective for services furnished on or after January 1, 2009, multiple imaging procedures performed during a single session using the same imaging modality are paid by applying a composite APC payment methodology.
The services are paid with one composite APC payment each time a hospital bills for second and subsequent imaging procedures described by the HCPCS codes in one imaging family on a single date of service. The I/OCE logic determines the assignment of the composite APCs for payment. Prior to January 1, 2009, hospitals received a full APC payment for each imaging service on a claim, regardless of how many procedures were performed during a single session.
The composite APC payment methodology for multiple imaging services utilizes three imaging families (Ultrasound, CT and CTA, and MRI and MRA) and five composite APCs: APC 8004 (Ultrasound Composite); APC 8005 (CT and CTA without Contrast Composite); APC 8006 (CT and CTA with Contrast Composite); APC 8007 (MRI and MRA without Contrast Composite); and APC 8008 (MRI and MRA with Contrast Composite). When a procedure is performed with contrast during the same session as a procedure without contrast, and the two procedures are within the same family, the “with contrast” composite APC (either APC 8006 or 8008) is assigned.
CMS has updated the list of specified HCPCS codes within the three imaging families and five composite APCs to reflect HCPCS coding changes. Specifically, CMS added CPT code 74176 (Computed tomography, abdomen and pelvis; without contrast material), CPT code 74177 (Computed tomography, abdomen and pelvis; with contrast material(s)), and CPT code 74178 (Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions) to the CT and CTA family. These codes are new for CY 2011. CMS also added HCPCS codes C8931 (Magnetic resonance angiography with contrast, spinal canal and contents), C8932 (Magnetic resonance angiography without contrast, spinal canal and contents), C8933 (Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents), C8934 (Magnetic resonance angiography with contrast, upper extremity), C8935 (Magnetic resonance angiography without contrast, upper extremity), and C8936 (Magnetic resonance angiography without contrast followed by with contrast, upper extremity), to the MRI and MRA family. These codes were recognized for OPPS payment in the October 2010 OPPS Update (Transmittal 2050, Change Request 7117, dated September 17, 2010).
CY 2011 APC 8005 (CT and CTA without Contrast Composite)*
70450 Ct head/brain w/o dye
70480 Ct orbit/ear/fossa w/o dye
70486 Ct maxillofacial w/o dye
70490 Ct soft tissue neck w/o dye
71250 Ct thorax w/o dye
72125 Ct neck spine w/o dye
72128 Ct chest spine w/o dye
72131 Ct lumbar spine w/o dye
72192 Ct pelvis w/o dye
73200 Ct upper extremity w/o dye
73700 Ct lower extremity w/o dye
74150 Ct abdomen w/o dye
74261 Ct colonography, w/o dye
74176 Ct angio abd & pelv
ICD-10 Codes that Support Medical Necessity
ICD-10 CODE DESCRIPTION
A06.2 - A06.6 - Opens in a new window Amebic nondysenteric colitis - Amebic brain abscess
A06.81 - A06.89 - Opens in a new window Amebic cystitis - Other amebic infections
A18.10 - A18.18 - Opens in a new window Tuberculosis of genitourinary system, unspecified - Tuberculosis of other female genital organs
A18.31 - A18.39 - Opens in a new window Tuberculous peritonitis - Retroperitoneal tuberculosis
A18.7 Tuberculosis of adrenal glands
A18.83 Tuberculosis of digestive tract organs, not elsewhere classified
A18.85 Tuberculosis of spleen
A31.0 Pulmonary mycobacterial infection
A31.2 Disseminated mycobacterium avium-intracellulare complex (DMAC)
A34 Obstetrical tetanus
A39.1 Waterhouse-Friderichsen syndrome
A40.0 - A41.9 - Opens in a new window Sepsis due to streptococcus, group A - Sepsis, unspecified organism
A42.7 Actinomycotic sepsis
A50.04 Early congenital syphilitic pneumonia
A50.06 - A50.09 - Opens in a new window Early cutaneous congenital syphilis - Other early congenital syphilis, symptomatic
A51.49 Other secondary syphilitic conditions
A52.74 - A52.75 - Opens in a new window Syphilis of liver and other viscera - Syphilis of kidney and ureter
A56.11 Chlamydial female pelvic inflammatory disease
B15.0 - B19.9 - Opens in a new window Hepatitis A with hepatic coma - Unspecified viral hepatitis without hepatic coma
B25.1 - B25.2 - Opens in a new window Cytomegaloviral hepatitis - Cytomegaloviral pancreatitis
B37.7 Candidal sepsis
B65.0 - B65.9 - Opens in a new window Schistosomiasis due to Schistosoma haematobium [urinary schistosomiasis] - Schistosomiasis, unspecified
B67.0 Echinococcus granulosus infection of liver
B67.5 Echinococcus multilocularis infection of liver
B67.8 - B67.99 - Opens in a new window Echinococcosis, unspecified, of liver - Other echinococcosis
C00.0 - C43.9 - Opens in a new window Malignant neoplasm of external upper lip - Malignant melanoma of skin, unspecified
C4A.0 - C4A.9 - Opens in a new window Merkel cell carcinoma of lip - Merkel cell carcinoma, unspecified
C44.00 - C49.9 - Opens in a new window Unspecified malignant neoplasm of skin of lip - Malignant neoplasm of connective and soft tissue, unspecified
C50.011 - C75.9 - Opens in a new window Malignant neoplasm of nipple and areola, right female breast - Malignant neoplasm of endocrine gland, unspecified
C7A.00 - C7B.8 - Opens in a new window Malignant carcinoid tumor of unspecified site - Other secondary neuroendocrine tumors
C76.0 - C79.9 - Opens in a new window Malignant neoplasm of head, face and neck - Secondary malignant neoplasm of unspecified site
C80.0 - C84.79 - Opens in a new window Disseminated malignant neoplasm, unspecified - Anaplastic large cell lymphoma, ALK-negative, extranodal and solid organ sites
C84.A0 - C84.Z9 - Opens in a new window Cutaneous T-cell lymphoma, unspecified, unspecified site - Other mature T/NK-cell lymphomas, extranodal and solid organ sites
C84.90 - C84.99 - Opens in a new window Mature T/NK-cell lymphomas, unspecified, unspecified site - Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites
C85.10 - C86.6 - Opens in a new window Unspecified B-cell lymphoma, unspecified site - Primary cutaneous CD30-positive T-cell proliferations
C88.2 - C91.62 - Opens in a new window Heavy chain disease - Prolymphocytic leukemia of T-cell type, in relapse
C91.A0 - C91.Z2 - Opens in a new window Mature B-cell leukemia Burkitt-type not having achieved remission - Other lymphoid leukemia, in relapse
C91.90 - C91.92 - Opens in a new window Lymphoid leukemia, unspecified not having achieved remission - Lymphoid leukemia, unspecified, in relapse
C92.00 - C92.62 - Opens in a new window Acute myeloblastic leukemia, not having achieved remission - Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 - C92.Z2 - Opens in a new window Acute myeloid leukemia with multilineage dysplasia, not having achieved remission - Other myeloid leukemia, in relapse
C92.90 - C92.92 - Opens in a new window Myeloid leukemia, unspecified, not having achieved remission - Myeloid leukemia, unspecified in relapse
C93.00 - C93.32 - Opens in a new window Acute monoblastic/monocytic leukemia, not having achieved remission - Juvenile myelomonocytic leukemia, in relapse
C93.Z0 - C93.Z2 - Opens in a new window Other monocytic leukemia, not having achieved remission - Other monocytic leukemia, in relapse
C93.90 - C93.92 - Opens in a new window Monocytic leukemia, unspecified, not having achieved remission - Monocytic leukemia, unspecified in relapse
C94.00 - C94.32 - Opens in a new window Acute erythroid leukemia, not having achieved remission - Mast cell leukemia, in relapse
C94.80 - C96.4 - Opens in a new window Other specified leukemias not having achieved remission - Sarcoma of dendritic cells (accessory cells)
C96.A - C96.Z - Opens in a new window Histiocytic sarcoma - Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
C96.9 Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified
D00.1 - D01.9 - Opens in a new window Carcinoma in situ of esophagus - Carcinoma in situ of digestive organ, unspecified
D03.0 - D03.9 - Opens in a new window Melanoma in situ of lip - Melanoma in situ, unspecified
D06.0 - D09.19 - Opens in a new window Carcinoma in situ of endocervix - Carcinoma in situ of other urinary organs
D12.0 - D12.9 - Opens in a new window Benign neoplasm of cecum - Benign neoplasm of anus and anal canal
D13.1 - D13.9 - Opens in a new window Benign neoplasm of stomach - Benign neoplasm of ill-defined sites within the digestive system
D16.8 Benign neoplasm of pelvic bones, sacrum and coccyx
D17.5 Benign lipomatous neoplasm of intra-abdominal organs
D17.71 Benign lipomatous neoplasm of kidney
D18.03 Hemangioma of intra-abdominal structures
D18.1 Lymphangioma, any site
D19.1 Benign neoplasm of mesothelial tissue of peritoneum
D20.0 - D20.1 - Opens in a new window Benign neoplasm of soft tissue of retroperitoneum - Benign neoplasm of soft tissue of peritoneum
D21.20 - D21.22 - Opens in a new window Benign neoplasm of connective and other soft tissue of unspecified lower limb, including hip - Benign neoplasm of connective and other soft tissue of left lower limb, including hip
D21.4 - D21.5 - Opens in a new window Benign neoplasm of connective and other soft tissue of abdomen - Benign neoplasm of connective and other soft tissue of pelvis
D25.0 - D28.9 - Opens in a new window Submucous leiomyoma of uterus - Benign neoplasm of female genital organ, unspecified
D30.00 - D30.9 - Opens in a new window Benign neoplasm of unspecified kidney - Benign neoplasm of urinary organ, unspecified
D35.00 - D35.02 - Opens in a new window Benign neoplasm of unspecified adrenal gland - Benign neoplasm of left adrenal gland
D35.6 Benign neoplasm of aortic body and other paraganglia
D3A.00 - D3A.8 - Opens in a new window Benign carcinoid tumor of unspecified site - Other benign neuroendocrine tumors
D37.1 - D37.9 - Opens in a new window Neoplasm of uncertain behavior of stomach - Neoplasm of uncertain behavior of digestive organ, unspecified
D39.0 - D39.9 - Opens in a new window Neoplasm of uncertain behavior of uterus - Neoplasm of uncertain behavior of female genital organ, unspecified
D40.0 - D41.9 - Opens in a new window Neoplasm of uncertain behavior of prostate - Neoplasm of uncertain behavior of unspecified urinary organ
D44.10 - D44.12 - Opens in a new window Neoplasm of uncertain behavior of unspecified adrenal gland - Neoplasm of uncertain behavior of left adrenal gland
D44.6 - D44.7 - Opens in a new window Neoplasm of uncertain behavior of carotid body - Neoplasm of uncertain behavior of aortic body and other paraganglia
D45 Polycythemia vera
D48.3 - D48.4 - Opens in a new window Neoplasm of uncertain behavior of retroperitoneum - Neoplasm of uncertain behavior of peritoneum
D49.0 Neoplasm of unspecified behavior of digestive system
D57.02 Hb-SS disease with splenic sequestration
D57.212 Sickle-cell/Hb-C disease with splenic sequestration
D57.412 Sickle-cell thalassemia with splenic sequestration
D57.812 Other sickle-cell disorders with splenic sequestration
D73.1 - D73.2 - Opens in a new window Hypersplenism - Chronic congestive splenomegaly
D73.81 Neutropenic splenomegaly
D75.0 - D75.1 - Opens in a new window Familial erythrocytosis - Secondary polycythemia
D78.01 - D78.22 - Opens in a new window Intraoperative hemorrhage and hematoma of the spleen complicating a procedure on the spleen - Postprocedural hemorrhage of the spleen following other procedure
D86.0 - D86.2 - Opens in a new window Sarcoidosis of lung - Sarcoidosis of lung with sarcoidosis of lymph nodes
D86.84 Sarcoid pyelonephritis
D86.89 - D86.9 - Opens in a new window Sarcoidosis of other sites - Sarcoidosis, unspecified
E08.51 - E08.52 - Opens in a new window Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene - Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene
E09.51 - E09.52 - Opens in a new window Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene - Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.51 - E10.52 - Opens in a new window Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene - Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.51 - E11.52 - Opens in a new window Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene - Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E13.51 - E13.52 - Opens in a new window Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene - Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene
E16.3 - E16.8 - Opens in a new window Increased secretion of glucagon - Other specified disorders of pancreatic internal secretion
E24.0 Pituitary-dependent Cushing's disease
E24.2 - E27.9 - Opens in a new window Drug-induced Cushing's syndrome - Disorder of adrenal gland, unspecified
E28.2 Polycystic ovarian syndrome
E35 - E36.12 - Opens in a new window Disorders of endocrine glands in diseases classified elsewhere - Accidental puncture and laceration of an endocrine system organ or structure during other procedure
E74.00 - E74.09 - Opens in a new window Glycogen storage disease, unspecified - Other glycogen storage disease
E83.10 - E83.19 - Opens in a new window Disorder of iron metabolism, unspecified - Other disorders of iron metabolism
E84.0 - E85.9 - Opens in a new window Cystic fibrosis with pulmonary manifestations - Amyloidosis, unspecified
E89.6 Postprocedural adrenocortical (-medullary) hypofunction
Payment for Multiple Imaging Composite APCs
Effective for services furnished on or after January 1, 2009, multiple imaging procedures performed during a single session using the same imaging modality are paid by applying a composite APC payment methodology.
The services are paid with one composite APC payment each time a hospital bills for second and subsequentimaging procedures described by the HCPCS codes in one imaging family on a single date of service. The I/OCE logic determines the assignment of the composite APCs for payment. Prior to January 1, 2009, hospitals received a full APC payment for each imaging service on a claim, regardless of how many procedures were performed during a single session.
The composite APC payment methodology for multiple imaging services utilizes three imaging families (Ultrasound, CT and CTA, and MRI and MRA) and five composite APCs: APC 8004 (Ultrasound Composite); APC 8005 (CT and CTA without Contrast Composite); APC 8006 (CT and CTA with Contrast Composite); APC 8007 (MRI and MRA without Contrast Composite); and APC 8008 (MRI and MRA with Contrast Composite). When a procedure is performed with contrast during the same session as a procedure without contrast, and the two procedures are within the same family, the “with contrast” composite APC (either APC 8006 or 8008) is assigned.
CMS has updated the list of specified HCPCS codes within the three imaging families and five composite APCs to reflect HCPCS coding changes. Specifically, CMS added CPT code 74176 (Computed tomography, abdomen and pelvis; without contrast material), CPT code 74177 (Computed tomography, abdomen and pelvis; with contrast material(s)), and CPT code 74178 (Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions) to the CT and CTA family. These codes are new for CY 2011. CMS also added HCPCS codes C8931 (Magnetic resonance angiography with contrast, spinal canal and contents), C8932 (Magnetic resonance angiography without contrast, spinal canal and contents), C8933 (Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents), C8934 (Magnetic resonance angiography with contrast, upper extremity), C8935 (Magnetic resonance angiography without contrast, upper extremity), and C8936 (Magnetic resonance angiography without contrast followed by with contrast, upper extremity), to the MRI and MRA family. These codes were recognized for OPPS payment in the October 2010 OPPS Update (Transmittal 2050, Change Request 7117, dated September 17, 2010).
74178 CT Abdomen & Pelvis w/wo
74177 - Ct abd & pelv w/contrast - average fee payment - $320- $330
In 2011, the Procedure code editorial panel created three new codes for CT of abdominal and pelvis:
* Code 74176, CT, abdomen and pelvis; without contrast material
* Code 74177, CT, abdomen and pelvis; with contrast material(s)
* Code 74178, CT, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions
Coverage Indications, Limitations, and/or Medical Necessity
Indications
Evaluation of abdominal or pelvic pain.
Evaluation of known or suspected abdominal or pelvic masses or fluid collections, primary or metastatic malignancies, abdominal or pelvic inflammatory processes, and abnormalities of abdominal or pelvic vascular structures.
Evaluation of abdominal or pelvic trauma.
Clarification of findings from other imaging studies or laboratory abnormalities.
Evaluation of known or suspected congenital abnormalities of abdominal or pelvic organs.
Treatment planning for radiation therapy.
Limitations
Three dimension reconstruction of CT of Abdomen and Pelvis (CPT code 76376 or 76377) is not expected to be utilized routinely. CPT code 76376 or 76377 are not an appropriate part of every CT examination.
Bill Type Codes:
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
999x Not Applicable
Revenue Codes:
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.
99999 Not Applicable
CPT/HCPCS Codes
Group 1 Codes:
72192 Ct pelvis w/o dye
72193 Ct pelvis w/dye
72194 Ct pelvis w/o & w/dye
74150 Ct abdomen w/o dye
74160 Ct abdomen w/dye
74170 Ct abdomen w/o & w/dye
74176 Ct abd & pelvis w/o contrast
74177 Ct abd & pelv w/contrast
74178 Ct abd & pelv 1/> regns
74178 CT Abdomen One or Both Body Regions without and with Contrast
Note: For radiation therapy planning use 77014.
For CT guided needle placement, biopsy or drainage use 77012.
For CT guided tissue ablation use 77013.
I. Complaints associated with abdominal or pelvic pain1-11 [One of the following]
A. Generalized Abdominal pain in men and also women not of childbearing age112-118 (CT of the abdomen and pelvis with contrast) one of the following:
1. If equivocal ultrasound or
2. Pain is accompanied with any one of the following:
a. Failure of conservative treatment for 4 weeks
b. Cancer history
c. Fever (101 degrees or greater)
d. Mass
e. GI bleeding
f. Moderate to severe abdominal tenderness
g. Guarding, rebound tenderness, or other peritoneal signs
h. WBC 10,000 or greater
B. Obstructive uropathy or hydronephrosis with negative ultrasound [One of the following]
1. Pain in flank, radiating toward the groin
2. Hematuria
C. Diverticulitis with left lower quadrant pain [One of the following]
1. Aural temperature >38.3°C or >100.9°F
2. Leukocytosis, WBC >11,500/cu.mm
3. Diverticulosis by prior imaging study
4. Rebound
D. Abscess [One of the following]
1. Acute non localized abdominal pain
a. Aural temperature >38.3°C or >100.9°F
b. Leukocytosis, WBC >11,500/cu.mm
c. Rebound
2. Follow up during or after treatment [One of the following]
a. Condition unimproved or worsening while on treatment
b. Routine follow-up study after treatment, including evaluation for removal of drain
E. Appendicitis (In children and pregnant women, ultrasound is the initial study except for follow up of known appendicitis with suspected complications. If this is not possible then CT of the abdomen and pelvis. MRI abdomen [74181, 74182, or 74183] in pregnant women)
1. Right lower quadrant pain [One of the following]
a. Aural temperature >38.3°C or >100.9°F
b. Leukocytosis, WBC >11,500/cu.mm
c. Rebound
F. Crohn’s disease and inflammatory bowel disease (suspected) [One of the following]
1. Suspected Crohn’s disease [One of the following]
a. Abdominal pain and diarrhea for more than 6 weeks
b. Aural temperature >38.3°C or >100.9°F
c. Perianal fistula or fissure
d. Enterovesical fistula
e. Enterovaginal fistula
f. Enterocutaneous fistula
g. Children with unexplained anemia, growth failure, and abdominal pain
2. Complications of known Crohn’s disease [One of the following]
a. Mass on abdominal, pelvic or rectal exam
b. Aural temperature >38.3°C or >100.9°F
c. Leukocytosis, WBC >11,500/cu.mm
d. Guarding
e. Rebound
f. Follow-up during or after treatment [One of the following]
i. Condition unimproved or worsening after drainage and IV antibiotics for at least two days
ii. Condition unimproved or worsening after IV Abx Rx >1 wk
iii. Routine follow-up study after treatment, including evaluation for removal of drain
g. Fistula
h. Small bowel obstruction
i. Perianal fistula
j. Stricture or stenosis
3. Any evidence of clinical deterioration while on steroids or immunosuppressives
G. Ulcerative colitis with bloody mucoid stools [One of the following]
1. Diarrhea
2. Pain
3. Tenesmus
H. CT of the abdomen and pelvic either with or without contrast (CPT® 74177 or CPT® 74176) can
CMS has updated the list of specified HCPCS codes within the three imaging families and five composite APCs to reflect HCPCS coding changes. Specifically, CMS added CPT code 74176 (Computed tomography, abdomen and pelvis; without contrast material), CPT code 74177 (Computed tomography, abdomen and pelvis; with contrast material(s)), and CPT code 74178 (Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions) to the CT and CTA family. These codes are new for CY 2011. CMS also added HCPCS codes C8931 (Magnetic resonance angiography with contrast, spinal canal and contents), C8932 (Magnetic resonance angiography without contrast, spinal canal and contents), C8933 (Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents), C8934 (Magnetic resonance angiography with contrast, upper extremity), C8935 (Magnetic resonance angiography without contrast, upper extremity), and C8936 (Magnetic resonance angiography without contrast followed by with contrast, upper extremity), to the MRI and MRA family.
UHC covered CT abd codes
72133 Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections
72191 Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing
72192 Computed tomography, pelvis; without contrast material
72193 Computed tomography, pelvis; with contrast material(s)
72194 Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections
73200 Computed tomography, upper extremity; without contrast material
73201 Computed tomography, upper extremity; with contrast material(s)
73202 Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections
73206 Computed Tomography angiography upper extremity with and without contrast material
73700 Computed tomography, lower extremity; without contrast material
73701 Computed tomography, lower extremity; with contrast material(s)
73702 Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections
73706 Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing
74150 Computed tomography, abdomen; without contrast material
74160 Computed tomography, abdomen; with contrast material(s)
74170 Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections
74174 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing
74175 Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing
74176 Computed tomography, abdomen and pelvis; without contrast material
74177 Computed tomography, abdomen and pelvis; with contrast material(s)
74178 Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions
74261 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material
74262 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast images, if performed
74263 Computed tomographic (CT) colonography, screening, including image postprocessing (Non-covered service)
75571 Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium
75572 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image post processing, assessment of cardiac function, and evaluation of venous structures, if performed)
75573 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image post processing, assessment of LV cardiac function, RV structure and function and evaluation of venous structures, if performed)
75574 Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image post processing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)
Effective for services furnished on or after January 1, 2009, multiple imaging procedures performed during a single session using the same imaging modality are paid by applying a composite APC payment methodology.
The services are paid with one composite APC payment each time a hospital bills for second and subsequent imaging procedures described by the HCPCS codes in one imaging family on a single date of service. The I/OCE logic determines the assignment of the composite APCs for payment. Prior to January 1, 2009, hospitals received a full APC payment for each imaging service on a claim, regardless of how many procedures were performed during a single session.
The composite APC payment methodology for multiple imaging services utilizes three imaging families (Ultrasound, CT and CTA, and MRI and MRA) and five composite APCs: APC 8004 (Ultrasound Composite); APC 8005 (CT and CTA without Contrast Composite); APC 8006 (CT and CTA with Contrast Composite); APC 8007 (MRI and MRA without Contrast Composite); and APC 8008 (MRI and MRA with Contrast Composite). When a procedure is performed with contrast during the same session as a procedure without contrast, and the two procedures are within the same family, the “with contrast” composite APC (either APC 8006 or 8008) is assigned.
CMS has updated the list of specified HCPCS codes within the three imaging families and five composite APCs to reflect HCPCS coding changes. Specifically, CMS added CPT code 74176 (Computed tomography, abdomen and pelvis; without contrast material), CPT code 74177 (Computed tomography, abdomen and pelvis; with contrast material(s)), and CPT code 74178 (Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions) to the CT and CTA family. These codes are new for CY 2011. CMS also added HCPCS codes C8931 (Magnetic resonance angiography with contrast, spinal canal and contents), C8932 (Magnetic resonance angiography without contrast, spinal canal and contents), C8933 (Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents), C8934 (Magnetic resonance angiography with contrast, upper extremity), C8935 (Magnetic resonance angiography without contrast, upper extremity), and C8936 (Magnetic resonance angiography without contrast followed by with contrast, upper extremity), to the MRI and MRA family. These codes were recognized for OPPS payment in the October 2010 OPPS Update (Transmittal 2050, Change Request 7117, dated September 17, 2010).
CY 2011 APC 8005 (CT and CTA without Contrast Composite)*
70450 Ct head/brain w/o dye
70480 Ct orbit/ear/fossa w/o dye
70486 Ct maxillofacial w/o dye
70490 Ct soft tissue neck w/o dye
71250 Ct thorax w/o dye
72125 Ct neck spine w/o dye
72128 Ct chest spine w/o dye
72131 Ct lumbar spine w/o dye
72192 Ct pelvis w/o dye
73200 Ct upper extremity w/o dye
73700 Ct lower extremity w/o dye
74150 Ct abdomen w/o dye
74261 Ct colonography, w/o dye
74176 Ct angio abd & pelv
ICD-10 Codes that Support Medical Necessity
ICD-10 CODE DESCRIPTION
A06.2 - A06.6 - Opens in a new window Amebic nondysenteric colitis - Amebic brain abscess
A06.81 - A06.89 - Opens in a new window Amebic cystitis - Other amebic infections
A18.10 - A18.18 - Opens in a new window Tuberculosis of genitourinary system, unspecified - Tuberculosis of other female genital organs
A18.31 - A18.39 - Opens in a new window Tuberculous peritonitis - Retroperitoneal tuberculosis
A18.7 Tuberculosis of adrenal glands
A18.83 Tuberculosis of digestive tract organs, not elsewhere classified
A18.85 Tuberculosis of spleen
A31.0 Pulmonary mycobacterial infection
A31.2 Disseminated mycobacterium avium-intracellulare complex (DMAC)
A34 Obstetrical tetanus
A39.1 Waterhouse-Friderichsen syndrome
A40.0 - A41.9 - Opens in a new window Sepsis due to streptococcus, group A - Sepsis, unspecified organism
A42.7 Actinomycotic sepsis
A50.04 Early congenital syphilitic pneumonia
A50.06 - A50.09 - Opens in a new window Early cutaneous congenital syphilis - Other early congenital syphilis, symptomatic
A51.49 Other secondary syphilitic conditions
A52.74 - A52.75 - Opens in a new window Syphilis of liver and other viscera - Syphilis of kidney and ureter
A56.11 Chlamydial female pelvic inflammatory disease
B15.0 - B19.9 - Opens in a new window Hepatitis A with hepatic coma - Unspecified viral hepatitis without hepatic coma
B25.1 - B25.2 - Opens in a new window Cytomegaloviral hepatitis - Cytomegaloviral pancreatitis
B37.7 Candidal sepsis
B65.0 - B65.9 - Opens in a new window Schistosomiasis due to Schistosoma haematobium [urinary schistosomiasis] - Schistosomiasis, unspecified
B67.0 Echinococcus granulosus infection of liver
B67.5 Echinococcus multilocularis infection of liver
B67.8 - B67.99 - Opens in a new window Echinococcosis, unspecified, of liver - Other echinococcosis
C00.0 - C43.9 - Opens in a new window Malignant neoplasm of external upper lip - Malignant melanoma of skin, unspecified
C4A.0 - C4A.9 - Opens in a new window Merkel cell carcinoma of lip - Merkel cell carcinoma, unspecified
C44.00 - C49.9 - Opens in a new window Unspecified malignant neoplasm of skin of lip - Malignant neoplasm of connective and soft tissue, unspecified
C50.011 - C75.9 - Opens in a new window Malignant neoplasm of nipple and areola, right female breast - Malignant neoplasm of endocrine gland, unspecified
C7A.00 - C7B.8 - Opens in a new window Malignant carcinoid tumor of unspecified site - Other secondary neuroendocrine tumors
C76.0 - C79.9 - Opens in a new window Malignant neoplasm of head, face and neck - Secondary malignant neoplasm of unspecified site
C80.0 - C84.79 - Opens in a new window Disseminated malignant neoplasm, unspecified - Anaplastic large cell lymphoma, ALK-negative, extranodal and solid organ sites
C84.A0 - C84.Z9 - Opens in a new window Cutaneous T-cell lymphoma, unspecified, unspecified site - Other mature T/NK-cell lymphomas, extranodal and solid organ sites
C84.90 - C84.99 - Opens in a new window Mature T/NK-cell lymphomas, unspecified, unspecified site - Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites
C85.10 - C86.6 - Opens in a new window Unspecified B-cell lymphoma, unspecified site - Primary cutaneous CD30-positive T-cell proliferations
C88.2 - C91.62 - Opens in a new window Heavy chain disease - Prolymphocytic leukemia of T-cell type, in relapse
C91.A0 - C91.Z2 - Opens in a new window Mature B-cell leukemia Burkitt-type not having achieved remission - Other lymphoid leukemia, in relapse
C91.90 - C91.92 - Opens in a new window Lymphoid leukemia, unspecified not having achieved remission - Lymphoid leukemia, unspecified, in relapse
C92.00 - C92.62 - Opens in a new window Acute myeloblastic leukemia, not having achieved remission - Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 - C92.Z2 - Opens in a new window Acute myeloid leukemia with multilineage dysplasia, not having achieved remission - Other myeloid leukemia, in relapse
C92.90 - C92.92 - Opens in a new window Myeloid leukemia, unspecified, not having achieved remission - Myeloid leukemia, unspecified in relapse
C93.00 - C93.32 - Opens in a new window Acute monoblastic/monocytic leukemia, not having achieved remission - Juvenile myelomonocytic leukemia, in relapse
C93.Z0 - C93.Z2 - Opens in a new window Other monocytic leukemia, not having achieved remission - Other monocytic leukemia, in relapse
C93.90 - C93.92 - Opens in a new window Monocytic leukemia, unspecified, not having achieved remission - Monocytic leukemia, unspecified in relapse
C94.00 - C94.32 - Opens in a new window Acute erythroid leukemia, not having achieved remission - Mast cell leukemia, in relapse
C94.80 - C96.4 - Opens in a new window Other specified leukemias not having achieved remission - Sarcoma of dendritic cells (accessory cells)
C96.A - C96.Z - Opens in a new window Histiocytic sarcoma - Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
C96.9 Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified
D00.1 - D01.9 - Opens in a new window Carcinoma in situ of esophagus - Carcinoma in situ of digestive organ, unspecified
D03.0 - D03.9 - Opens in a new window Melanoma in situ of lip - Melanoma in situ, unspecified
D06.0 - D09.19 - Opens in a new window Carcinoma in situ of endocervix - Carcinoma in situ of other urinary organs
D12.0 - D12.9 - Opens in a new window Benign neoplasm of cecum - Benign neoplasm of anus and anal canal
D13.1 - D13.9 - Opens in a new window Benign neoplasm of stomach - Benign neoplasm of ill-defined sites within the digestive system
D16.8 Benign neoplasm of pelvic bones, sacrum and coccyx
D17.5 Benign lipomatous neoplasm of intra-abdominal organs
D17.71 Benign lipomatous neoplasm of kidney
D18.03 Hemangioma of intra-abdominal structures
D18.1 Lymphangioma, any site
D19.1 Benign neoplasm of mesothelial tissue of peritoneum
D20.0 - D20.1 - Opens in a new window Benign neoplasm of soft tissue of retroperitoneum - Benign neoplasm of soft tissue of peritoneum
D21.20 - D21.22 - Opens in a new window Benign neoplasm of connective and other soft tissue of unspecified lower limb, including hip - Benign neoplasm of connective and other soft tissue of left lower limb, including hip
D21.4 - D21.5 - Opens in a new window Benign neoplasm of connective and other soft tissue of abdomen - Benign neoplasm of connective and other soft tissue of pelvis
D25.0 - D28.9 - Opens in a new window Submucous leiomyoma of uterus - Benign neoplasm of female genital organ, unspecified
D30.00 - D30.9 - Opens in a new window Benign neoplasm of unspecified kidney - Benign neoplasm of urinary organ, unspecified
D35.00 - D35.02 - Opens in a new window Benign neoplasm of unspecified adrenal gland - Benign neoplasm of left adrenal gland
D35.6 Benign neoplasm of aortic body and other paraganglia
D3A.00 - D3A.8 - Opens in a new window Benign carcinoid tumor of unspecified site - Other benign neuroendocrine tumors
D37.1 - D37.9 - Opens in a new window Neoplasm of uncertain behavior of stomach - Neoplasm of uncertain behavior of digestive organ, unspecified
D39.0 - D39.9 - Opens in a new window Neoplasm of uncertain behavior of uterus - Neoplasm of uncertain behavior of female genital organ, unspecified
D40.0 - D41.9 - Opens in a new window Neoplasm of uncertain behavior of prostate - Neoplasm of uncertain behavior of unspecified urinary organ
D44.10 - D44.12 - Opens in a new window Neoplasm of uncertain behavior of unspecified adrenal gland - Neoplasm of uncertain behavior of left adrenal gland
D44.6 - D44.7 - Opens in a new window Neoplasm of uncertain behavior of carotid body - Neoplasm of uncertain behavior of aortic body and other paraganglia
D45 Polycythemia vera
D48.3 - D48.4 - Opens in a new window Neoplasm of uncertain behavior of retroperitoneum - Neoplasm of uncertain behavior of peritoneum
D49.0 Neoplasm of unspecified behavior of digestive system
D57.02 Hb-SS disease with splenic sequestration
D57.212 Sickle-cell/Hb-C disease with splenic sequestration
D57.412 Sickle-cell thalassemia with splenic sequestration
D57.812 Other sickle-cell disorders with splenic sequestration
D73.1 - D73.2 - Opens in a new window Hypersplenism - Chronic congestive splenomegaly
D73.81 Neutropenic splenomegaly
D75.0 - D75.1 - Opens in a new window Familial erythrocytosis - Secondary polycythemia
D78.01 - D78.22 - Opens in a new window Intraoperative hemorrhage and hematoma of the spleen complicating a procedure on the spleen - Postprocedural hemorrhage of the spleen following other procedure
D86.0 - D86.2 - Opens in a new window Sarcoidosis of lung - Sarcoidosis of lung with sarcoidosis of lymph nodes
D86.84 Sarcoid pyelonephritis
D86.89 - D86.9 - Opens in a new window Sarcoidosis of other sites - Sarcoidosis, unspecified
E08.51 - E08.52 - Opens in a new window Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene - Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene
E09.51 - E09.52 - Opens in a new window Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene - Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.51 - E10.52 - Opens in a new window Type 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene - Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.51 - E11.52 - Opens in a new window Type 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene - Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E13.51 - E13.52 - Opens in a new window Other specified diabetes mellitus with diabetic peripheral angiopathy without gangrene - Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene
E16.3 - E16.8 - Opens in a new window Increased secretion of glucagon - Other specified disorders of pancreatic internal secretion
E24.0 Pituitary-dependent Cushing's disease
E24.2 - E27.9 - Opens in a new window Drug-induced Cushing's syndrome - Disorder of adrenal gland, unspecified
E28.2 Polycystic ovarian syndrome
E35 - E36.12 - Opens in a new window Disorders of endocrine glands in diseases classified elsewhere - Accidental puncture and laceration of an endocrine system organ or structure during other procedure
E74.00 - E74.09 - Opens in a new window Glycogen storage disease, unspecified - Other glycogen storage disease
E83.10 - E83.19 - Opens in a new window Disorder of iron metabolism, unspecified - Other disorders of iron metabolism
E84.0 - E85.9 - Opens in a new window Cystic fibrosis with pulmonary manifestations - Amyloidosis, unspecified
E89.6 Postprocedural adrenocortical (-medullary) hypofunction
Payment for Multiple Imaging Composite APCs
Effective for services furnished on or after January 1, 2009, multiple imaging procedures performed during a single session using the same imaging modality are paid by applying a composite APC payment methodology.
The services are paid with one composite APC payment each time a hospital bills for second and subsequentimaging procedures described by the HCPCS codes in one imaging family on a single date of service. The I/OCE logic determines the assignment of the composite APCs for payment. Prior to January 1, 2009, hospitals received a full APC payment for each imaging service on a claim, regardless of how many procedures were performed during a single session.
The composite APC payment methodology for multiple imaging services utilizes three imaging families (Ultrasound, CT and CTA, and MRI and MRA) and five composite APCs: APC 8004 (Ultrasound Composite); APC 8005 (CT and CTA without Contrast Composite); APC 8006 (CT and CTA with Contrast Composite); APC 8007 (MRI and MRA without Contrast Composite); and APC 8008 (MRI and MRA with Contrast Composite). When a procedure is performed with contrast during the same session as a procedure without contrast, and the two procedures are within the same family, the “with contrast” composite APC (either APC 8006 or 8008) is assigned.
CMS has updated the list of specified HCPCS codes within the three imaging families and five composite APCs to reflect HCPCS coding changes. Specifically, CMS added CPT code 74176 (Computed tomography, abdomen and pelvis; without contrast material), CPT code 74177 (Computed tomography, abdomen and pelvis; with contrast material(s)), and CPT code 74178 (Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions) to the CT and CTA family. These codes are new for CY 2011. CMS also added HCPCS codes C8931 (Magnetic resonance angiography with contrast, spinal canal and contents), C8932 (Magnetic resonance angiography without contrast, spinal canal and contents), C8933 (Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents), C8934 (Magnetic resonance angiography with contrast, upper extremity), C8935 (Magnetic resonance angiography without contrast, upper extremity), and C8936 (Magnetic resonance angiography without contrast followed by with contrast, upper extremity), to the MRI and MRA family. These codes were recognized for OPPS payment in the October 2010 OPPS Update (Transmittal 2050, Change Request 7117, dated September 17, 2010).
74178 CT Abdomen & Pelvis w/wo
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