How To Use CPT Code 74280

CPT 74280 describes the radiologic examination of the colon using a double-contrast technique with high-density barium and air. 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 74280?

CPT 74280 can be used to describe a radiologic examination of the colon using a double-contrast technique. This procedure involves infusing high-density barium and air through the rectum into the colon to enhance visibility. The service includes a scout film and delayed image, if performed, as well as abdominal X-ray exposures after the contrast is instilled. Glucagon may be administered prior to the procedure to prevent intestinal spasms.

2. Official Description

The official description of CPT code 74280 is: ‘Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high density barium and air) study, including glucagon, when administered.’

3. Procedure

1. The patient is appropriately prepared and usually sedated for the procedure.
2. The provider places the patient in the prone position and may administer glucagon intravenously to prevent intestinal spasms.
3. Scout films and delay images of the abdomen may be acquired before intubation and contrast administration.
4. The provider instills double-contrast, such as high-density barium and air, through the rectum into the colon using fluoroscopic guidance.
5. Multiple X-ray films are taken to image all the loops of the colon as the contrast flows through the bowel.
6. The provider observes the flow of barium via fluoroscopy and reviews the images to write a report.

4. Qualifying circumstances

CPT 74280 is performed to detect lesions and other disorders of the colon. It is typically done for patients who require a double-contrast study using high-density barium and air. The procedure may be performed by a radiologist or other qualified healthcare professional.

5. When to use CPT code 74280

CPT code 74280 should be used when a radiologic examination of the colon is performed using a double-contrast technique with high-density barium and air. It should not be reported in conjunction with CPT code 74270, which is used for a single-contrast barium enema without air contrast.

6. Documentation requirements

To support a claim for CPT 74280, the provider must document the following information:

• Patient’s preparation and sedation for the procedure
• Administration of glucagon, if performed
• Acquisition of scout films and delay images, if performed
• Details of the double-contrast technique using high-density barium and air
• Fluoroscopic guidance during the procedure
• Observation of barium flow and review of images
• Written report by the provider

7. Billing guidelines

When billing for CPT 74280, ensure that the procedure involves a double-contrast study using high-density barium and air. It should not be reported with CPT code 74270. 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, payer policy 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 74280 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2020, with the addition of specific high-density barium and the inclusion of glucagon administration.

9. Examples

1. A radiologist performing a double-contrast barium enema to detect colon lesions in a patient with a family history of colorectal cancer.
2. A gastroenterologist using a double-contrast technique to evaluate a patient with chronic diarrhea and suspected inflammatory bowel disease.
3. A general surgeon performing a double-contrast barium enema to assess the extent of diverticular disease in a patient with recurrent abdominal pain.
4. A colorectal surgeon using a double-contrast study to evaluate the effectiveness of a previous colon resection surgery in a patient with a history of colon cancer.
5. An oncologist ordering a double-contrast barium enema to monitor the response to chemotherapy in a patient with metastatic colon cancer.
6. A primary care physician referring a patient for a double-contrast barium enema as part of a routine colorectal cancer screening program.
7. A pediatrician ordering a double-contrast study to evaluate a child with chronic constipation and suspected Hirschsprung’s disease.
8. An emergency room physician performing a double-contrast barium enema to rule out a bowel obstruction in a patient with severe abdominal pain.
9. A geriatrician ordering a double-contrast study to assess the colon in an elderly patient with unexplained weight loss and anemia.
10. A nurse practitioner referring a patient for a double-contrast barium enema to investigate the cause of rectal bleeding.