CPT Code 94177 is used to code Computed tomography, abdomen, and pelvis; with contrast material if performed with contrast. Underneath are the description, coding guidelines, modifiers & clinical examples of CPT 74177.
74177 CPT Code Description
CPT 74177 Description: Computed tomography, abdomen, and pelvis; with contrast material.
A diagnostic radiology test to detect disease of the colon, bowel and other abdominal organs.
Computed tomography directs multiple thin X-ray beams at the body structure being studied and uses computer technology to produce thin cross-sectional images of various layers or slices of the body.
Knowledge of body layers, contrast and dimensions is very important to code this procedure. Procedure is useful for the evaluation of trauma, tumors, and foreign bodies, as CT can visualize soft tissues and bones.
Patients must remain immobile during the study and sedation may be necessary, as well as a contrast medium to enhance the image.
There are basically three codes for CT Abdominal and Pelvis:
CPT 74176 – if no contrast is used;
CPT 74177 – if performed with contrast
CPT 74178 – if performed first without contrast in one or both body regions followed by the injection of contrast and further sections in one or both body regions.
As per American Medical Association guidelines, Oral or Rectal contrast administration is not considered “with contrast” for this procedure. Contrast should be administrated intravascularly, intra-athecally or intra-articularly to qualify for this code.
Dissect the Medical document (radiology) to check:
If the procedure was performed with contrast material or not (whether to use CPT 74176 or CPT 74177).
If three dimensional reconstruction of CT images is performed, use CPT 76377 or CPT 76376 with CT Proc code.
Abdominal/Pelvic pain and trauma, diverticulosis
Suspected mass, fluid, malignancy
Abnormality of vascular structure of Abdominal area
Radiation therapy, Bowel disease
Modifier 26, TC, 76, 77 & 59
The most common modifiers that are being used for CPT 74177 are:
Modifier 26: Generally, Modifier 26 is appended to CPT 74177 code to indicate that the service provided was the reading and interpreting of the results of a diagnostic and/or laboratory service.
It means the doctor only did the reading and reporting of a CT image and not have performed the technical part of procedure.
Modifier TC: Modifier TC is defined as “Technical Component” and should be appended to a procedure code when the physician performs the test but does not do the interpretation.
It means the document is a CT image and have not been interpreted, so, only technical component should be billed for this service.
If both technical and professional components are performed by Doctor’s office, we have to bill the procedure globally, this means it is not appending any modifier.
Modifier 76: Modifier 76 is used if ‘Repeat procedure by same physician on same day‘. If a Doctor had to perform the procedure more than once because of more clarity or other specified reason, this modifier should be used.
Modifier 77: Modifier 77 is used if ‘Repeat procedure by different physician on same day‘. If another Doctor wants to perform the same procedure on same day which they deem necessary, this modifier should be used.
Modifier 59: Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances.
i.e. If the payer uses National Correct Coding Initiative (NCCI) edits, you can bill CPT codes CPT 74176 and CPT 74177 on the same date of service. A 59 modifier is needed to indicate the scans were separate and distinct from each other.
CMS has provided MUE indicator for that purpose for each code. The MUE indicator for CPT 74177 is 2 and therefor only two units are needed.
The Global component may be reimbursed to NP, CNS, PA, physician, radiation treatment centre, portable X-ray supplier, radiological laboratory, and physiological laboratory providers for services that are rendered in the office setting; and to the radiation treatment centre and hospital providers for services that are rendered in the outpatient hospital setting.
Professional Interpretation Component
The professional interpretation component may be reimbursed to NP, CNS, PA, and physician providers for services that are rendered in the office setting; and to physician providers for services that are rendered in the inpatient hospital or outpatient hospital setting.
The technical component may be reimbursed to NP, CNS, PA, physician, radiation treatment centre, portable X-ray supplier, radiological laboratory, and physiological laboratory providers for services that are rendered in the office setting; and to radiation treatment centre providers for services that are rendered in the outpatient hospital setting.
Prior authorization is required and must be submitted to the MedSolutions Radiology Prior Authorization Department.
The fee rate for CPT 74177 can be different as per each insurance but Medicare has provided fee rate for CPT 74177, most insurance will revolve around this rate.
Facility: Global 340$ – 26 (professional component) – 90$ TC (technical component) 250$
Non-Facility: Global 457$ – 26 (professional component) – 90$ TC (technical component) 250$
OPPS: Global 340$ – 26 (professional component) – 90$ TC (technical component) 368$
Computed tomography of the abdomen and pelvis describes a typical encounter for CPT 74177 as:
A 56-year-old man with a history of non-Hodgkin lymphoma presents with pain in abdominal area. There is some fluid in Abdominal area which is worth looking.
Based on that CT imaging with contrast was ordered by doctor.
Now the Medical report should contain the following:
(Description of procedure-Indications-Complete summary of procedure-Findings-assessment)
Now the 3D reconstructions of CT imaging was also performed and the assessment was given as ascites in Medical report. Now the coding should be:
CPT 74177 (CT imaging)
CPT 76377 (3D imaging)
R18.8 (ascites) ICD-10-CM
If the payer uses the National Correct Coding Initiative (NCCI) edits of Medicare, they can bill CPT 74176 and CPT 74177 on the same date of service. A modifier is needed to indicate that the scans were separate and distinct from each other, that is, two separate scans. Depending on the payer, use modifier 59 or XU.
CPT 74176 = CPT 72192 (CT Pelvis w/o contrast) + CPT 74150 (CT abdomen w/o contrast)
CPT 74177 = CPT 72193 (CT Pelvis w/contrast) + CPT 74160 (CT abdomen w/contrast)
CPT 74178 = CPT 72194 (CT Pelvis w/o & w/contrast) + CPT 74150 (CT abdomen w/o & w/contrast)