How To Use CPT Code 74240

CPT 74240 is a radiologic examination code for the upper gastrointestinal tract using a single-contrast study; this article will cover its description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples.

1. What is CPT 74240?

CPT 74240 is a medical billing code used for radiologic examinations of the upper gastrointestinal (GI) tract, specifically using a single-contrast study. This code is utilized by medical coders and billers to accurately document and bill for this specific type of radiologic examination.

2. 74240 CPT code description

The official description of CPT code 74240 is: “Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; single-contrast (eg, barium) study.”

3. Procedure

1. The patient is positioned in an upright position with the X-ray table tilted upward.
2. The patient swallows a contrast agent, such as barium sulfate, to allow better visualization of the GI tract under fluoroscopy.
3. The provider may change the position of the table and patient during the test to observe the esophagus, stomach, and duodenum.
4. A limited, or coned-down, fluoroscopic scout film may be taken by the provider.
5. Based on initial findings, the provider may take additional delayed films hours after the initial imaging.
6. The provider analyzes the images for evidence of tumors, obstructions, and ulcers and writes a written report with the findings.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 74240 services are those who require a radiologic examination of their upper gastrointestinal tract. This may include patients experiencing symptoms such as difficulty swallowing, persistent abdominal pain, unexplained weight loss, or gastrointestinal bleeding. The examination may also be performed to diagnose or monitor conditions such as gastroesophageal reflux disease (GERD), ulcers, or tumors.

5. When to use CPT code 74240

It is appropriate to bill the 74240 CPT code when a provider performs a radiologic examination of the upper gastrointestinal tract using a single-contrast study. This code should be used for examinations that include scout abdominal radiographs and delayed images when performed. The code should not be used for double-contrast studies or examinations that do not involve the upper gastrointestinal tract.

6. Documentation requirements

To support a claim for CPT 74240, the following information should be documented:

• Indication for the examination, including relevant patient history and symptoms
• Details of the procedure, including the type of contrast used and any scout or delayed images taken
• Findings from the examination, such as the presence of tumors, obstructions, or ulcers
• A written report of the findings, including any relevant measurements or observations
• Any additional procedures or interventions performed during the examination

7. Billing guidelines

When billing for CPT code 74240, it is important to follow these guidelines:

• Append professional component modifier 26 to the radiology code if reporting only the physician’s interpretation for the radiology service.
• Append modifier TC to the radiology code if reporting only the technical component for the radiology service. Note that payer policy may exempt hospitals from appending modifier TC because 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.
• Do not report CPT 74240 in conjunction with CPT 74220, CPT 74221, or CPT 74246.

8. Historical information

CPT 74240 was added to the Current Procedural Terminology system on January 1, 1990. There have been updates to the code’s description since then, with the most recent change occurring on January 1, 2020.

9. Similar codes to CPT 74240

Five similar codes to CPT 74240 and how they differentiate are:

1. CPT 74220: This code is used for a radiologic examination of the esophagus, which does not include the entire upper gastrointestinal tract.
2. CPT 74221: This code is for a double-contrast study of the esophagus, as opposed to the single-contrast study in CPT 74240.
3. CPT 74246: This code is for a double-contrast study of the entire upper gastrointestinal tract, not just a single-contrast study.
4. CPT 74241: This code is for a radiologic examination of the upper gastrointestinal tract with small bowel follow-through, which is not included in CPT 74240.
5. CPT 74245: This code is for a radiologic examination of the upper gastrointestinal tract with a small bowel follow-through and a double-contrast study, which is more extensive than CPT 74240.

10. Examples

Here are 10 detailed examples of CPT code 74240 procedures:

1. A patient with persistent abdominal pain undergoes a single-contrast upper GI examination to evaluate for ulcers.
2. A patient with a history of gastroesophageal reflux disease (GERD) has a single-contrast upper GI examination to assess the severity of their condition.
3. A patient with unexplained weight loss undergoes a single-contrast upper GI examination to rule out the presence of tumors.
4. A patient with difficulty swallowing has a single-contrast upper GI examination to evaluate for esophageal strictures or obstructions.
5. A patient with a history of peptic ulcers undergoes a single-contrast upper GI examination to monitor their condition and assess for complications.
6. A patient with gastrointestinal bleeding has a single-contrast upper GI examination to identify the source of the bleeding.
7. A patient with a known esophageal tumor undergoes a single-contrast upper GI examination to assess the tumor’s size and location.
8. A patient with a history of gastric bypass surgery has a single-contrast upper GI examination to evaluate the integrity of the surgical site.
9. A patient with persistent nausea and vomiting undergoes a single-contrast upper GI examination to assess for gastric outlet obstruction.
10. A patient with a suspected hiatal hernia has a single-contrast upper GI examination to confirm the diagnosis and assess the severity of the hernia.