How To Use CPT Code 74251

CPT 74251 describes the radiologic examination of the small intestine using a double-contrast technique. 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 74251?

CPT 74251 can be used to describe a radiologic examination of the small intestine using a double-contrast technique. This code is used when a healthcare provider takes X-rays of the small intestine after infusing high-density barium and air through a tube inserted into the duodenum or small intestine. The service includes multiple serial images and scout abdominal radiographs, as well as the administration of glucagon if necessary.

2. Official Description

The official description of CPT code 74251 is: ‘Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; double-contrast (eg, high-density barium and air via enteroclysis tube) study, including glucagon, when administered.’

3. Procedure

1. The healthcare provider prepares the patient and usually administers sedation.
2. The patient is placed in the prone position.
3. The provider may acquire scout films of the abdomen before intubation and contrast administration.
4. Using fluoroscopic guidance, the provider inserts a tube through the patient’s nose or mouth, down the throat, and into the stomach and small bowel.
5. The provider administers double-contrast, such as high-density barium and air, through the tube.
6. Multiple X-ray films are taken to image all the loops of the small bowel as the contrast flows through.
7. The provider reviews the images and writes a report.

4. Qualifying circumstances

CPT 74251 is performed to detect lesions, disorders, or diseases in the small intestine, such as Crohn’s disease, narrowing or stricture of the intestine, and blockages. The procedure is typically done with the patient appropriately prepared and usually sedated. The provider may administer glucagon intravenously prior to the procedure to help prevent intestinal spasms.

5. When to use CPT code 74251

CPT code 74251 should be used when a healthcare provider performs a radiologic examination of the small intestine using a double-contrast technique. It is important to note that this code should not be reported in conjunction with CPT codes 74248 and 74250.

6. Documentation requirements

To support a claim for CPT 74251, the healthcare provider must document the following information:

• Patient’s preparation and sedation, if applicable
• Administration of glucagon, if necessary
• Date and time of the procedure
• Specific details of the procedure, including the use of double-contrast technique and the type of contrast administered
• Number and type of images obtained
• Any additional findings or observations
• Provider’s signature

7. Billing guidelines

When billing for CPT 74251, ensure that the procedure meets the criteria described in the official description. It is important to follow payer policies regarding the use of modifiers, such as modifier 26 for the professional component and modifier TC for the technical component. If reporting a global service, in which one provider renders both the professional and technical components, modifiers may not be necessary.

8. Historical information

CPT 74251 has undergone several changes throughout its history. The most recent change occurred on January 1, 2020, when the description was updated to include the use of an enteroclysis tube for contrast administration.

9. Examples

1. A healthcare provider performs a radiologic examination of the small intestine using a double-contrast technique to detect possible Crohn’s disease in a patient with chronic abdominal pain.
2. A patient with suspected intestinal blockage undergoes a radiologic examination of the small intestine using a double-contrast technique to identify the location and severity of the blockage.
3. A healthcare provider performs a radiologic examination of the small intestine using a double-contrast technique to evaluate the extent of narrowing or stricture in a patient with a history of gastrointestinal issues.
4. A patient with suspected Crohn’s disease undergoes a radiologic examination of the small intestine using a double-contrast technique to assess the presence and severity of inflammation.
5. A healthcare provider performs a radiologic examination of the small intestine using a double-contrast technique to evaluate the effectiveness of a previous surgical intervention in a patient with a history of small bowel resection.
6. A patient with unexplained weight loss undergoes a radiologic examination of the small intestine using a double-contrast technique to identify any abnormalities or lesions that may be causing the weight loss.
7. A healthcare provider performs a radiologic examination of the small intestine using a double-contrast technique to assess the presence and location of strictures in a patient with a known history of gastrointestinal obstruction.
8. A patient with chronic diarrhea undergoes a radiologic examination of the small intestine using a double-contrast technique to evaluate for possible malabsorption or other underlying causes.
9. A healthcare provider performs a radiologic examination of the small intestine using a double-contrast technique to assess the presence and severity of inflammation in a patient with suspected inflammatory bowel disease.
10. A patient with recurrent abdominal pain undergoes a radiologic examination of the small intestine using a double-contrast technique to identify any structural abnormalities or lesions that may be causing the pain.