How To Use CPT Code 74246

CPT 74246 describes the radiologic examination of the upper gastrointestinal tract using both air and high-density barium contrast, including scout abdominal radiographs and delayed images. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 74246?

CPT 74246 can be used to describe a radiologic examination of the upper gastrointestinal tract. This procedure involves the use of both air and high-density barium contrast to better evaluate the esophagus, stomach, and duodenum. The provider may also administer glucagon to reduce spasms of the gastrointestinal tract.

2. Official Description

The official description of CPT code 74246 is: ‘Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study, including glucagon, when administered.’

3. Procedure

1. The patient is positioned in an upright position with the X-ray table tilted upward.
2. The patient swallows high-density barium contrast to coat the esophagus, stomach, and intestine.
3. The provider uses fluoroscopy to visualize the gastrointestinal tract and introduces air contrast to expand the anatomy and improve visibility.
4. Glucagon may be administered to reduce intestinal spasm.
5. The provider may change the position of the table and the patient during the test to obtain different views.
6. The provider analyzes the images to check for tumors, obstructions, and ulcers and prepares a written report with the findings.

4. Qualifying circumstances

CPT 74246 is used for patients undergoing a radiologic examination of the upper gastrointestinal tract using both air and high-density barium contrast. This procedure is typically performed to evaluate the esophagus, stomach, and duodenum for tumors, obstructions, and ulcers. The provider may administer glucagon to reduce intestinal spasm during the examination.

5. When to use CPT code 74246

CPT code 74246 should be used when a radiologic examination of the upper gastrointestinal tract is performed using both air and high-density barium contrast. This code is appropriate when the provider conducts a double-contrast study, including the administration of glucagon if necessary. It is important to note that CPT code 74246 should not be reported in conjunction with codes 74220, 74221, or 74240.

6. Documentation requirements

To support a claim for CPT code 74246, the provider must document the following information:

• Patient’s medical history and reason for the radiologic examination
• Specific details of the procedure, including the use of both air and high-density barium contrast
• Date and time of the examination
• Any additional medications administered, such as glucagon
• Findings and impressions from the examination
• Provider’s signature

7. Billing guidelines

When billing for CPT code 74246, ensure that the radiologic examination of the upper gastrointestinal tract includes both air and high-density barium contrast. It is important to note that code 74246 should not be reported in conjunction with codes 74220, 74221, or 74240. If reporting only the physician’s interpretation, append modifier 26 to the radiology code. If reporting only the technical component, append modifier TC to the radiology code. However, be aware that payer policies may exempt hospitals from appending modifier TC. When reporting a global service, in which one provider renders both the professional and technical components, do not append a professional or technical modifier to the radiology code.

8. Historical information

CPT code 74246 was added to the Current Procedural Terminology system on January 1, 1990. There have been historical changes to the code, with the most recent update occurring on January 1, 2020. The updated description reflects the use of specific high-density barium, effervescent agent, and the inclusion of delayed images.

9. Examples

1. A patient undergoes a radiologic examination of the upper gastrointestinal tract using both air and high-density barium contrast to evaluate persistent abdominal pain.
2. A provider performs a double-contrast study of the esophagus, stomach, and duodenum in a patient with suspected ulcers.
3. A radiologist administers glucagon during a radiologic examination of the upper gastrointestinal tract to reduce intestinal spasm in a patient with a history of gastrointestinal motility disorders.
4. A patient undergoes a radiologic examination of the upper gastrointestinal tract using both air and high-density barium contrast to assess the effectiveness of previous treatment for esophageal strictures.
5. A provider performs a double-contrast study of the stomach and duodenum in a patient with unexplained weight loss and gastrointestinal bleeding.
6. A radiologist administers glucagon during a radiologic examination of the upper gastrointestinal tract to reduce intestinal spasm in a patient with suspected gastrointestinal obstruction.
7. A patient undergoes a radiologic examination of the upper gastrointestinal tract using both air and high-density barium contrast to evaluate dysphagia and difficulty swallowing.
8. A provider performs a double-contrast study of the esophagus, stomach, and duodenum in a patient with a family history of gastrointestinal cancers.