New & Revised Radiology CPT codes for 2020

In 2020, their are many changes for Upper GI procedures in radiology facility. Again, their are some deletion, revision and addition of CPT codes in radiology facility for 2020

To start with, let us first know about the upper gastrointestinal procedures. Mainly these exams are done to diagnosis the gastroesophageal refulx (GERD or Acid reflux) or hiatal hernia disorders. The main symptom for these disorders is dysphagia (difficulty swallowing).

Upper GI series codes ranges from 74240-74249. Also, we have CPT codes 74250, 74270 and 74280 for study of small and large intestine (colon).

In the next year 2020 update, the CPT code 74240 will be revised. The new description for code 74240 will include scout abdominal radiographs. Below in the 2019 code description for code 74240.

74240 Radiologic examination, gastrointestinal tract, upper; with or without delayed images, without KUB

The other codes 74241,74245, 74247 and 74249 will be deleted in 2020. Yes, we will have only limited codes now for single and double contrast exams for upper GI series.

Double contrast means Air contrast.

74241 Radiologic examination, gastrointestinal tract, upper; with or without delayed images, with KUB

74245 with small intestine, includes multiple serial images

74247 Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with or without delayed images, with KUB

74249 with small intestine follow-through

Along with code 74240, we have revision of CPT code 74246 as well. Procedure code 74246 will be used for double contrast study.

74246 Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with or without delayed images, without KUB

We will be having a new add-on CPT code for small bowel follow-through +74248, which will be used along with CPT code 74240 & 74246.

For single contrast small bowel follow through study use CPT code 74240, +74248 and for double contrast small bowel follow through study use CPT code 74246, +74248.

The codes for small intestine exams with multiple serial images will also see revisions. Both 74250 and 74251 will include scout abdominal radiographs. You’ll use 74250 for a single-contrast study and 74251 for a double-contrast study.

Now let us check the changes for large intestine (colon) radiological exams. CPT code 74270 and 74280 will also be see revision in new updated codes in 2020. The new revised codes will include scout abdominal radiographs and delayed images. Use 74270 for a single-contrast study and 74280 for a double-contrast study

74270 Radiologic examination, colon; contrast (eg, barium) enema, with or without KUB

74280 air contrast with specific high density barium, with or without glucagon

In Radiology, abdominal x-ray exam we have one more revision for CPT code 74022. Currently, the code description for 2019 is stated below.

74022 Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest

In 2020, the descriptor will change to specify the code requires “2 or more views of the abdomen (eg, supine, erect, decubitus), and a single view chest.”

Sample Upper GI Radiology Reports

Report 1

Exam(s):RAD/DG SMALL BOWEL

CLINICAL DATA: Recent melena, history of Crohn’s disease

EXAM:

SMALL BOWEL SERIES

TECHNIQUE:

Following ingestion of thin barium, serial small bowel images were obtained including spot views of the terminal ileum.

FLUOROSCOPY TIME: Radiation Exposure Index (as provided by the fluoroscopic device): 16.41 mGy If the device does not provide the exposure index:

Fluoroscopy Time (in minutes and seconds): 0 minutes, 24 seconds

Number of Acquired Images: 9

FINDINGS:

The scout film revealed a normal bowel gas pattern. There are surgical clips in the right mid and upper abdomen. The bony structures are unremarkable.

The patient ingested the barium preparation without difficulty. Initially there was mild prominence of the mucosal folds of the jejunum but these were normal on subsequent images. Over the course of approximately 30 minutes barium passed to the right colon. The jejunum and ileum demonstrated a normal mucosal pattern. There was no tenderness to palpation. The terminal ileum was visualized and was normally distensible and exhibited normal peristalsis. No abnormal bowel loop separation was demonstrated.

IMPRESSION:

Normal small bowel follow through examination.

CPT code: 74250

Report 2

Exam(s): RAD/DG BARIUM SWALLOW

CLINICAL DATA: Long history of difficulty with swallowing and intermittent choking sensation ; progressive symptoms over the past 2 years; history of gastroc Paris is.

EXAM:

ESOPHOGRAM / BARIUM SWALLOW / BARIUM TABLET STUDY

TECHNIQUE:

Combined double contrast and single contrast examination performed using effervescent crystals, thick barium liquid, and thin barium liquid. The patient was observed with fluoroscopy swallowing a 13 mm barium sulphate tablet.

FLUOROSCOPY TIME: Radiation Exposure Index (as provided by the fluoroscopic device): 13.6 mGy

If the device does not provide the exposure index:

Fluoroscopy Time: 0 minutes, 45 seconds

Number of Acquired Images: 15

COMPARISON: None.

FINDINGS:

The patient ingested the thick barium without difficulty. However, there was low will penetration of the barium to the level of the vocal cords which did elicit a cough reflex. This is a common experience the patient reports. The remainder of the cervical esophagus was unremarkable. A small cricopharyngeus muscle impression was noted.

The thoracic esophagus distended well. Moderate tertiary contractions were demonstrated and some stasis of the barium in the mid and lower portion of the esophagus was noted. There was a small reducible hiatal hernia. No reflux was observed. In the prone position esophageal motility appeared intact. There was no evidence of a stricture nor of esophagitis.

The barium tablet passed to the distal esophagus and hung transiently but then passed into the stomach with additional sips of barium.

IMPRESSION:

Laryngeal penetration of the barium to the level of the vocal cords which elicits a cough reflex. This is a frequent chronic problem for the patient. Direct visualization of the hypopharynx and larynx is recommended. A modified barium swallow may be useful in an effort to judge which consistencies of food and fluids results in the least aspiration.