How To Use CPT Code 74220

CPT 74220 is a code for radiologic examination of the esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (e.g., barium) study. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 74220 procedures.

1. What is CPT 74220?

CPT 74220 is a medical billing code used for radiologic examinations of the esophagus, specifically for single-contrast studies using barium. This code is utilized when a healthcare provider performs a diagnostic exam, commonly known as a barium swallow or esophagram, to evaluate the structure and function of the esophagus.

2. 74220 CPT code description

The official description of CPT code 74220 is: “Radiologic examination, esophagus, including scout chest radiograph(s) and delayed image(s), when performed; single-contrast (e.g., barium) study.”

3. Procedure

1. The patient is positioned on an X-ray table.
2. Scout films of the chest may be taken prior to administering contrast.
3. The patient swallows a barium drink, which coats the esophageal lining.
4. X-rays and/or fluoroscopy are used to visualize the barium’s path down the esophagus in real-time.
5. The provider evaluates the function and appearance of the esophagus, as well as the swallowing process.
6. The patient may be repositioned during the exam.
7. Based on initial findings, additional delayed films may be taken hours after the initial imaging.
8. The provider completes a written report detailing their findings, including any narrowing, blockages, enlarged veins, and other anomalies of structure or function.

4. Qualifying circumstances

Patients who are experiencing symptoms such as difficulty swallowing, pain, or regurgitation may be eligible to receive CPT 74220 services. Additionally, patients with a history of esophageal disorders, such as gastroesophageal reflux disease (GERD), esophageal strictures, or esophageal varices, may also qualify for this procedure. Healthcare providers will determine the necessity of the procedure based on the patient’s medical history, symptoms, and physical examination findings.

5. When to use CPT code 74220

CPT code 74220 should be used when a healthcare provider performs a single-contrast radiologic examination of the esophagus to diagnose or evaluate esophageal disorders. This code is appropriate for cases where only barium sulfate is used as the contrast agent, without the addition of air or other contrast materials. The code should be used for billing purposes when submitting claims to insurance companies or other payers.

6. Documentation requirements

To support a claim for CPT 74220, healthcare providers must document the following information in the patient’s medical record:

• Indication for the procedure, including relevant symptoms and medical history
• Details of the procedure performed, including the use of scout chest radiographs and delayed images, if applicable
• Findings from the examination, such as abnormalities in the esophagus or swallowing process
• Interpretation and conclusions drawn from the examination
• A written report of the findings, signed by the interpreting provider

7. Billing guidelines

When billing for CPT 74220, it is important to follow payer-specific guidelines and rules. If only the physician’s interpretation of the radiology service is being reported, professional component modifier 26 should be appended to the radiology code. If only the technical component of the radiology service is being reported, modifier TC should be appended to the radiology code. However, some payer policies may exempt hospitals from appending modifier TC, as the hospital’s portion is inherently technical. Do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 74220 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2020, with the previous descriptor being “Radiologic examination; esophagus.”

9. Similar codes to CPT 74220

There are several similar codes to CPT 74220, which differentiate based on the type of contrast used and the specific procedure performed. These include:

• CPT 74221: A double-contrast study using high-density barium and an effervescent agent
• CPT 74240: A radiologic examination of the upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast study
• CPT 74246: A double-contrast study of the upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed
• CPT 74248: A radiologic examination of the small intestine, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast study

10. Examples

Here are 10 detailed examples of CPT code 74220 procedures:

1. A patient with a history of GERD experiencing difficulty swallowing undergoes a single-contrast barium swallow to evaluate the esophagus for strictures or other abnormalities.
2. A patient with unexplained chest pain undergoes a CPT 74220 procedure to rule out esophageal causes of the pain.
3. A patient with a history of esophageal varices undergoes a CPT 74220 procedure to monitor the progression of the condition.
4. A patient with suspected achalasia undergoes a CPT 74220 procedure to evaluate the function of the esophagus and lower esophageal sphincter.
5. A patient with a history of esophageal cancer undergoes a CPT 74220 procedure to monitor for recurrence or complications.
6. A patient with dysphagia and weight loss undergoes a CPT 74220 procedure to evaluate for esophageal obstruction or other structural abnormalities.
7. A patient with a history of Zenker’s diverticulum undergoes a CPT 74220 procedure to assess the size and location of the diverticulum.
8. A patient with suspected eosinophilic esophagitis undergoes a CPT 74220 procedure to evaluate the esophageal lining for characteristic changes.
9. A patient with a history of esophageal surgery undergoes a CPT 74220 procedure to assess the surgical site and monitor for complications.
10. A patient with persistent regurgitation undergoes a CPT 74220 procedure to evaluate the esophagus for structural or functional abnormalities.