How To Use CPT Code 72194

CPT 72194 describes the procedure of computed tomography (CT) imaging of the pelvis without contrast material, followed by the administration of contrast material(s) and further sections. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 72194?

CPT 72194 can be used to describe the diagnostic procedure of CT imaging of the pelvis. This code specifically refers to the imaging performed without the use of contrast material initially, followed by the administration of contrast material(s) and further sections. It allows healthcare providers to obtain detailed cross-sectional images of the pelvis to aid in the diagnosis, management, and treatment of various diseases and conditions.

2. Official Description

The official description of CPT code 72194 is: ‘Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections.’ It is important to note that this code should not be used for a combined CT abdomen and pelvis study, which has separate codes (74176-74178). Additionally, 3D rendering has its own specific codes (76376, 76377), and computed tomographic colonography has separate codes for diagnostic (74261-74262) and screening (74263) purposes. It is also advised not to report codes 72192-72194 in conjunction with codes 74261-74263.

3. Procedure

1. The healthcare provider positions the patient in a supine position on the scanner table.
2. An intravenous (IV) line is inserted into the patient for the administration of contrast material.
3. The provider supervises the administration of the IV contrast and obtains scout films or preliminary images.
4. The actual pelvic image acquisition is performed using a CT scanner, initially without injecting contrast material.
5. After the initial images are obtained, the provider administers contrast material via injection to enhance the image quality.
6. Additional sections are taken to capture more detailed images of the pelvis.
7. The acquired images are displayed on a monitor screen for the provider to review, analyze, and interpret.
8. A comprehensive report of the findings is prepared by the provider.

4. Qualifying circumstances

CPT 72194 is typically used for patients who require diagnostic imaging of the pelvis without contrast material, followed by the administration of contrast material(s) and further sections. It is important to note that the use of contrast material is necessary to enhance the visibility of internal structures or organs. The provider must ensure that the contrast material is intravascular, intraarticular, or intrathecal to qualify for this specific code. Oral or rectal contrast administration should not be considered when assigning this code.

5. When to use CPT code 72194

CPT code 72194 should be used when a healthcare provider performs CT imaging of the pelvis without contrast material initially, followed by the administration of contrast material(s) and further sections. This code accurately represents the specific procedure performed and ensures proper reimbursement for the service provided. It is important to review the patient’s medical records and the specific requirements of the procedure to determine if CPT code 72194 is appropriate.

6. Documentation requirements

To support a claim for CPT 72194, the healthcare provider must ensure proper documentation of the following:

• Indication for the CT imaging of the pelvis without contrast material
• Administration of contrast material(s) and the specific route used
• Date and time of the procedure
• Details of the sections taken and any additional images acquired
• Analysis and interpretation of the images by the provider
• Comprehensive report of the findings

7. Billing guidelines

When billing for CPT 72194, it is important to ensure accurate reporting and adherence to billing guidelines. The provider should append modifier 26 to the radiology code if reporting only the physician’s interpretation for the radiology service. If reporting only the technical component, modifier TC should be appended to the radiology code. However, it is essential to review payer policies as hospitals may be exempt from appending modifier TC. It is also crucial to consider payer guidelines for reporting contrast administration and any separately reportable supply codes. Careful attention should be given to the correct coding of the service to avoid any potential billing errors or denials.

8. Historical information

CPT 72194 was added to the Current Procedural Terminology system on January 1, 1990, with the description ‘Computerized axial tomography, pelvis; without contrast material, followed by contrast material(s) and further sections.’ The code underwent a change on January 1, 2003, with a revised description that remains in effect today.

9. Examples

1. A radiologist performs CT imaging of the pelvis without contrast material, followed by the administration of contrast material(s) and further sections to evaluate a patient with suspected pelvic inflammatory disease.
2. A urologist orders CT imaging of the pelvis without contrast material, followed by the administration of contrast material(s) and further sections to assess a patient with recurrent kidney stones.
3. An oncologist utilizes CT imaging of the pelvis without contrast material, followed by the administration of contrast material(s) and further sections to stage a patient with suspected pelvic malignancy.
4. A gynecologist performs CT imaging of the pelvis without contrast material, followed by the administration of contrast material(s) and further sections to evaluate a patient with abnormal uterine bleeding.
5. An orthopedic surgeon orders CT imaging of the pelvis without contrast material, followed by the administration of contrast material(s) and further sections to assess a patient with suspected pelvic fractures.