How To Use CPT Code 74261

CPT 74261 describes the diagnostic procedure known as computed tomographic (CT) colonography, which involves taking images of the colon without using contrast material. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 74261?

CPT 74261 is used to describe a diagnostic procedure called computed tomographic (CT) colonography. This procedure involves taking images of the colon using CT technology, without the use of contrast material. It is also known as a virtual colonoscopy, as it provides two and three-dimensional images of the colon, including the rectum and small intestine. Providers perform this procedure to diagnose lesions, polyps, and other disorders of the colon, as well as to determine the stage of colon cancer.

2. Official Description

The official description of CPT code 74261 is: ‘Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material.’

3. Procedure

1. The patient takes laxatives and suppositories to remove all stool from the colon before the procedure.
2. The patient is positioned in the supine position, and the provider may administer medication to reduce muscle movements in the colon and rectum.
3. A tube is inserted into the rectum, and the colon is inflated with carbon dioxide to enhance visualization.
4. The CT scanner takes two-dimensional images of the colon, and a computer generates a three-dimensional image that the provider can view on a computer screen.
5. The patient holds their breath while the images are taken, and additional images may be taken while the patient is in the prone position.

4. Qualifying circumstances

CPT 74261 is performed on patients who require diagnostic imaging of the colon without the use of contrast material. It is used to diagnose conditions such as lesions, polyps, and colon cancer. The procedure is typically performed on patients who have undergone a thorough bowel preparation to remove stool from the colon. Providers who perform this procedure must have the necessary training and expertise in interpreting CT images of the colon.

5. When to use CPT code 74261

CPT code 74261 should be used when a provider performs a diagnostic CT colonography without the use of contrast material. It is appropriate for patients who require imaging of the colon to diagnose conditions such as lesions, polyps, and colon cancer. If contrast material is used during the procedure, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT code 74261, the provider must document the following information:

• Indication for the procedure and the reason for performing a CT colonography
• Details of the bowel preparation performed by the patient
• Date and time of the procedure
• Specific findings observed during the procedure, including any lesions, polyps, or abnormalities
• Interpretation of the CT images by the provider
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 74261, ensure that the procedure was performed without the use of contrast material. If contrast material is used, a different CPT code should be reported. It is important to append the appropriate modifiers, such as modifier 26 for the professional component or modifier TC for the technical component, if applicable. However, payer policies may vary, and hospitals may be exempt from appending modifier TC. It is crucial to review payer guidelines and documentation requirements to ensure accurate billing and reimbursement.

8. Historical information

CPT code 74261 was added to the Current Procedural Terminology system on January 1, 2010. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes a CT colonography without the use of contrast material to evaluate the presence of polyps in the colon.
2. A provider performs a diagnostic CT colonography to assess the stage of colon cancer in a patient without using contrast material.
3. A virtual colonoscopy is performed on a patient to diagnose lesions in the colon, using CT technology without the use of contrast material.
4. A CT colonography is performed on a patient who has undergone a thorough bowel preparation to evaluate the presence of abnormalities in the colon.
5. A provider utilizes CT imaging without contrast material to diagnose a patient with suspected colon polyps.
6. A diagnostic CT colonography is performed on a patient to assess the presence of colon cancer, without the use of contrast material.
7. A virtual colonoscopy is performed on a patient to evaluate the presence of lesions in the colon, using CT technology without the use of contrast material.
8. A provider performs a CT colonography without contrast material to diagnose abnormalities in the colon of a patient.
9. A patient undergoes a diagnostic CT colonography without the use of contrast material to assess the presence of polyps in the colon.
10. A virtual colonoscopy is performed on a patient to evaluate the presence of lesions in the colon, using CT technology without the use of contrast material.