CPT Code 74176

(2022) CPT Code 74176 Description, Guidelines, Reimbursement, Modifiers & Examples

CPT code 74176 is used for diagnostic imaging procedures of the abdomen in diagnostic radiology (diagnostic imaging). The Diagnostic Radiology (Diagnostic Imaging) Abdomen Procedures CPT code 74176 is maintained by the American Medical Association (AMA) as a medical procedure code.

CPT Code 74176 Description

There are no known contraindications to abdominal and pelvic CT studies. However, as with any surgical operation, the relative benefits and risks of iodinated contrast-enhanced abdominal CT and pelvic CT should be carefully weighed. 

Appropriate precautions should be taken so as not to put patients at risk. Mobile units must adhere to the same Medicare coverage rules as CT scans performed on fixed equipment. They must also meet particular HHS health and safety regulations (HRSA). 

Similar to scans done on fixed devices, each patient’s scans must be found to be medically necessary. In addition, according to the state radiation control laws and regulations, the scans must be performed on CT scanning equipment approved as a stationary unit.

74176 cpt code

One of the most common uses for CT imaging of the abdomen and pelvis is to evaluate a patient after a trauma or diagnose diseases including appendicitis, diverticulitis, and ulcerative colitis. 

When assessing a patient following an injury or diagnosing an ailment such as appendicitis, diverticulitis, ulcerative colitis, or cancer, CT imaging of the abdomen and pelvis is frequently used.

When no contrast is used in either the abdominal or pelvic studies, the results are reported as CPT code 74176; The doctor will utilize computed tomography of the abdomen and pelvis without contrast material.

 If both studies are conducted using contrast, use 74177. ” 74178 should be used if the first study (of the abdomen or pelvis) is done without contrast and the second study (with contrast) is performed. This is true whether one or both investigations are done with or without contrast.

In cases where a procedure with contrast is performed concurrently with a process without contrast, the “with contrast” composite APC (APC 8006 or 8008) is used.

Oral and rectal contrast delivery alone does not meet the American Medical Association’s definition of study “with contrast,” which relates to intravascular, intra-articular, and intrathecal operations.

74176

We ask you to pre-authorize the “with contrast” codes to avoid unnecessary radiation exposure if you’re pre-authorizing the “with and without” ones. It’s usual for patients with impaired renal function, an allergy to contrast (CPT code 74176), or those having a kidney stone scan to use the “without” contrast codes.

A different CPT code must be used for CT Abdomen and Pelvis if conducted simultaneously. For example, when the process was completed, whether or not a contrast chemical was employed (whether to use CPT code 74176 or CPT 74177).

One of several imaging techniques is used to check for gastrointestinal tract problems. To make cross-sectional images of various levels or slices of the body, computer technology directs X-ray beams at the part of the body being researched.

The coding of this process necessitates extensive familiarity with the layers, contrast, and proportions of the human body. Imaging computed tomography (CT) is critical in diagnosing injuries, cancer, and foreign objects.

Patients may require sedation and a contrast medication to enhance the image, and they must stay immobile throughout the scan.

CPT Code 74176 Billing Guidelines

There is only one claim for each code (74176, 74177, 74178). Distinct procedural service modifier 59 can be assigned to both combined studies if one patient has more than one combination study performed on the same day. 

Based on the findings of the CPT Assistant, “If a patient has a combination CT abdomen/pelvis investigation in the morning, they may also have a combination CT abdomen/pelvis study later in the day. In this scenario, a modifier 59 should be used. 

It demonstrates that separate and unique combined investigations were performed on the same patient by the same physician at different times of day and not a duplicative bill.”

CPT 74178

For example, the CPT’s assistant “According to the November 2011 report, “A 65-year-old female with a history of non-Hodgkins lymphoma arrives with flank and abdominal pain.”

 During prior investigations, abnormally big lymph nodes were found in the abdomen and retroperitoneum. intravenous contrast CT scans are ordered for the abdomen and pelvic.”

A typical 74178 encounter is described: “Unspecific flank pain and persistent hematuria are detected through repeated urine tests in this 50-year-old guy. So it’s not like there was anything bad that happened before this.

 Both contrast-enhanced and contrast-free CT scans of the abdomen and pelvis are requested.”An abdominal CT with contrast study is done at 1 p.m. to check for rectal bleeding and possible colitis in the patient.

Foreign bodies or active extravasation may be to blame for the hyperdensity found in the cecum. 

A non-contrast CT scan of the pelvis is performed at 3 p.m. to see if the problem has been resolved. As a result of the NCCI revisions, the CT pelvis code should include the modifier 59 to indicate that a separate and unique investigation was done at another time.”

Another way of saying this is that the individual study can be reported independently with modifier 59 if both a combination trial and a same-day individual study are supported.

For both procedures, medical documentation is necessary to demonstrate their distinct nature and medical need.

It advises contacting their local carriers and other third-party payers for assistance in applying modifiers because payer-specific CPT code 74176 and 74177 can be charged on the same day of service as long as the payer follows Medicare’s National Correct Coding Initiative (NCCI).

 A modifier, such as two separate scans, is needed to indicate that the scans were unique from one another. If the payer chooses, the modifier 59 or XU can be used. 

A single CT abdomen and pelvis with and without contrast must be coded 74178 if the patient visits the CT department only once. Billing CPT code 74176 and 74175 with an additional modifier would be called unbundling in this scenario.

CPT Code 74176 Modifiers

One of the most commonly misunderstood modifiers is the 59. The most typical reason for using it in CPT code 74176 is to show that two or more procedures were conducted simultaneously but at distinct locations on the body.

Regrettably, it is frequently used to prevent a service from being grouped or combined with another on the same claim. It should never be used solely to avoid a packaged service or get around an insurance carrier’s edit system.

For CPT code 74176, 59 should only be used if no other, more relevant modifier exists to define the link between two procedure codes. Instead of the 59 modification, another modifier that better appropriately characterizes the billed services should be utilized.

When utilizing the 59 modifiers to indicate a different and independent service, documentation proving that the services were conducted separately should be kept in the patient’s medical file. 

Before reimbursing the full amount for the amended CPT code 74176, the insurance company may request to review the record to determine if the 59 modifiers are being used appropriately.

It’s worth noting that using the 59 modifier doesn’t necessitate using a different or separate diagnosis code for each billed service. As a result, employing different diagnosis codes for each of the services provided does not permit the application of the 59 modifiers.

Suppose a procedure or service is being performed on the same day as other services. The physician may be compelled to indicate that it is independent or unconnected to the other services. Some procedures and services fall under modifier 59 even though they aren’t commonly reported simultaneously. 

Modifier 59 should be substituted with another, well-established modifier where it is more appropriate. Fifty-nine should only be used if no other descriptive modifiers are available, and it is the most effective way to convey the conditions at hand.

The NCCI-related modifier -59 is frequently misunderstood. For example, if two or more surgeries are performed on a patient at separate anatomic sites or during different patient visits, the NCCI can use this data to illustrate that.

 It’s only appropriate to use it when no other modifier can sufficiently describe the relationship between two or more procedure codes example, CPT code 74176 might also bill for abdominal and pelvis studies. 

Use the 59 modifiers to emphasize that the two treatments are performed on separate nerves. Therefore, codes on the same nerve should not be coded with the 59 modifiers.

CPT 74175

Reimbursement

For this reason, CMS has provided an MUE indication for every code. For example, CPT 74176 has an MUE indicator of 2. Thus only two units are needed.

Example

The following is an example of a typical interaction between 74176 CPT code and computed tomography of the abdomen and pelvis: A 56-year-old non-Hodgkin lymphoma patient reports abdominal pain. 

An examination of the abdominal fluid is necessary. As a result, the doctor recommended a CT scan with contrast. 74176 CPT code and 74177 can be invoiced on the same day of treatment if the payer adopts Medicare’s National Correct Coding Initiative (NCCI) changes.

It is necessary to use a modifier to denote two separate scans, i.e., two scans. You’ll either see a modifier 59 or a XU if you’re paying by check.

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