Basics of CPT code 74178

Computed tomography directs multiple thin beams of x-rays at the body structure being studied and uses computer imaging to produce thin, cross-sectional views of various layers (or slices) of the body. It is useful for the evaluation of trauma, tumor, and foreign bodies as CT is able to visualize soft tissue as well as bones. Patients are required to remain motionless during the study and sedation may need to be administered, as well as a contrast medium for image enhancement. These codes report an exam of the abdomen and pelvis. Use CPT code 74176 if no contrast is used and CPT code 74177 if performed with contrast; and report CPT code 74178 if performed first without contrast in one or both body regions followed by the injection of contrast and further sections in one or both body regions.

Description of CPT code 74178

CT scans have become the primary diagnostic tool for many conditions and symptoms. CT scanning used as the primary diagnostic tool can be cost effective because it can eliminate the need for a series of other tests, is noninvasive and thus virtually eliminates complications, and does not require hospitalization. Below is the description of CPT code 74178, 74177 and 74176.

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

Do not report CPT code 74176-74178 in conjunction with 72192-72194, 74150-74170

Use CPT code 74176, 74177, or 74178 only once per CT abdomen and pelvis examination

Note: The phrase “with contrast” used in these codes describes procedures performed using contrast material administered intravascularly, intra-articularly or intrathecally. Oral and/or rectal contrast administration alone does not qualify as a study “with contrast.”1 When performed during the same session, a CT scan of the abdomen and pelvis with oral contrast but without intravenous contrast is reported with CPT code 74176.

The stand-alone codes for CT abdomen (74150-74170) and CT pelvis (72192-72194) are still available for use when the services are performed individually or in conjunction with other, non-abdominal or pelvic studies.

The choice of the appropriate CPT code depends on whether the studies are performed with or without the administration of contrast material in one or both anatomic areas and whether the studies are performed at the same or separate sessions.

When performed at the same session, the CT abdomen and pelvis combination codes 74176-74178 should be reported based on the use or nonuse of contrast material in one or both anatomic areas. For example, CPT code 74176 is reported when CT studies of both the abdomen and the pelvis are performed without the administration of contrast material; while code 74177 is used when both studies are performed only with contrast. Code 74178 is reported when two CT scans are performed, one with contrast and one without contrast, and both anatomic regions are studied in at least one of the two CT scans. The key difference between codes 74176, 74177, and 74178 is that only one CT scan of the abdomen and pelvis is performed for code 74176 (without contrast) and code 74177 (with contrast); whereas two scans are performed for code 74178, ie, one with contrast (abdomen or pelvis or both) and one without contrast (abdomen or pelvis or both).

Because the Centers for Medicare and Medicaid Services (CMS) established National Correct Coding Initiative (NCCI) edits for reporting stand-alone CT abdomen (74150-74170) and CT pelvis (72192-72194) codes on the same day of service as the combination CT abdomen and pelvis codes 74176-74178, modifier 59 should be appended to the stand-alone codes, when appropriate, to designate to the payer that the procedure was performed during a separate patient encounter and not during the same session as the combined CT abdomen and pelvis studies.

Related CT codes for CPT code 74178

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