Computed tomography (CT) uses computer imaging and multiple, narrow beams of X-rays to produce thin, cross-sectional views or images of various body layers. These images allow visualization of soft tissue, as well as bones, making them useful for evaluating a wide range of conditions.

 CT imaging of the abdomen and pelvis frequently are performed together during the same encounter. The combined services are useful for evaluating a large number of conditions, including abdominal and pelvic pain; infections such as appendicitis or diverticulitis; inflammatory processes such as ulcerative colitis; and cancers of the colon, liver, kidneys, pancreas, and bladder. Combined CTs of the abdomen and pelvis also are performed to quickly identify internal injuries in cases of trauma.

During CT of the abdomen, the organs visualized include: the liver, spleen, kidneys, pancreas, the top half of the large intestine, the small intestine, and the superior aspect of the ureters. During a CT of the pelvis, the organs visualized include: the remainder of the large intestine, the small intestine, and ureters, as well as the bladder, uterus, and ovaries.

Combined Services Call for New CPT^® Codes

Prior to 2011, two CPT^® codes had to be selected to reflect the combined services when CTs of both the abdomen and pelvis were taken during the same encounter. Because of an increased frequency of these services performed during the same encounter, the American Medical Association (AMA) developed three new CPT^® codes for 2011 that reflect current practice.

Use these codes for a CT of the abdomen alone:

74150      Computed tomography, abdomen; without contrast material

74160      Computed tomography, abdomen; with contrast material(s)

74170      Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections 

Use these codes for a CT of the pelvis alone:

72192      Computed tomography, pelvis; without contrast material

72193      Computed tomography, pelvis; with contrast material(s)

72194      Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections

The following codes should be used only if both the abdominal and pelvic CT are performed during the same encounter.

74176      Computed tomography, abdomen and pelvis; without contrast material

74177      Computed tomography, abdomen and pelvis; with contrast material

74178      Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions

The AMA includes a table in CPT^® 2011 (see Table A) to help you determine the correct code.

Table A

Table A illustrates that CPT^® 74176 should be used only if both studies are done without contrast. Use CPT^® 74177 only if both studies are done with contrast.

Code 74178 should be used in two situations:

• One or both studies are done without contrast, followed by contrast material(s) and further sections.
• One study is done without contrast, while the other study is done with contrast.

Scenarios Help Show Correct Coding

Example one: A 34-year-old male presents with 48 hours of lower abdominal and pelvic pain. The patient also has a low-grade temperature. His physician orders a CT of the abdomen and pelvis without intravenous contrast. The radiologist supervises the process of providing the CT, and then interprets the images acquired. He also dictates a report of his findings. The radiologist should report 74176.

Example two: A 48-year-old female presents with flank pain and persistent gross hematuria. The patient’s urologist conducts a cystoscopy and is unable to identify the cause of the patient’s symptoms. He orders a CT of the abdomen and pelvis without and with intravenous contrast. The radiologist supervises the process of providing the CT, and then interprets the images acquired. He also dictates a report of his findings. The radiologist should report 74178.

Coding tips to remember:

• If both a CT of the abdomen and a CT of the pelvis are performed during the same session, use one of the new codes that describes that combination of services (74176, 74177, and 74178).
• Refer to the table provided in the CPT^® book to determine the correct code.
• Report 74176, 74177, or 74178 only once per session.
• Codes 74176, 74177, and 74178 can never be reported together with any of the codes for CT of the abdomen alone (74150, 74160, and 74170), or CT of the pelvis alone (72192, 72193, and 72194).

Nancy Higgins, CPC, CPC-I, CIRCC, CPMA, CEMC, has over 20 years of experience in the health care industry and is a manager in the Corporate Compliance department at Carolinas Healthcare System in Charlotte, N.C. Nancy is past president of the Charlotte, N.C. Local AAPC Chapter and was AAPC’s 2009 Coder of the Year. She can be reached at nancy.higginscpc@yahoo.com.

2 Responses to “Get the Latest on Abdomen and Pelvis CT Scan Codes”

1. Charlene Witherington Says:
   September 18th, 2011 at 5:00 pm

   The only downfall on combining the two, you get paid less.

2. Myrna N. Eng, CPC, CPC-H Says:
   November 17th, 2011 at 6:45 pm

   informative.

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