CT abd CPT CODES 74176- 74178

Procedure code and description

74177 – Ct abd & pelv w/contrast – average fee payment – $320- $330

In 2011, the Procedure code editorial panel created three new codes for CT of abdominal and pelvis:

* Code 74176, CT, abdomen and pelvis; without contrast material

* Code 74177, CT, abdomen and pelvis; with contrast material(s)

* Code 74178, CT, 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

Coverage Indications, Limitations, and/or Medical Necessity

Indications

Evaluation of abdominal or pelvic pain.

Evaluation of known or suspected abdominal or pelvic masses or fluid collections, primary or metastatic malignancies, abdominal or pelvic inflammatory processes, and abnormalities of abdominal or pelvic vascular structures.

Evaluation of abdominal or pelvic trauma.

Clarification of findings from other imaging studies or laboratory abnormalities.

Evaluation of known or suspected congenital abnormalities of abdominal or pelvic organs.

Treatment planning for radiation therapy.

Limitations

Three dimension reconstruction of CT of Abdomen and Pelvis (CPT code 76376 or 76377) is not expected to be utilized routinely. CPT code 76376 or 76377 are not an appropriate part of every CT examination.

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
999xNot Applicable

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

99999Not Applicable

CPT/HCPCS Codes

Group 1 Codes:
72192Ct pelvis w/o dye
72193Ct pelvis w/dye
72194Ct pelvis w/o & w/dye
74150Ct abdomen w/o dye
74160Ct abdomen w/dye
74170Ct abdomen w/o & w/dye
74176Ct abd & pelvis w/o contrast
74177Ct abd & pelv w/contrast
74178Ct abd & pelv 1/> regns

74178 CT Abdomen One or Both Body Regions without and with Contrast

Note: For radiation therapy planning use 77014.

For CT guided needle placement, biopsy or drainage use 77012.

For CT guided tissue ablation use 77013.

I. Complaints associated with abdominal or pelvic pain1-11 [One of the following]

A. Generalized Abdominal pain in men and also women not of childbearing age112-118 (CT of the abdomen and pelvis with contrast) one of the following:
1. If equivocal ultrasound or
2. Pain is accompanied with any one of the following:
a. Failure of conservative treatment for 4 weeks
b. Cancer history
c. Fever (101 degrees or greater)
d. Mass
e. GI bleeding
f. Moderate to severe abdominal tenderness
g. Guarding, rebound tenderness, or other peritoneal signs
h. WBC 10,000 or greater
B. Obstructive uropathy or hydronephrosis with negative ultrasound [One of the following]
1. Pain in flank, radiating toward the groin
2. Hematuria
C. Diverticulitis with left lower quadrant pain [One of the following]
1. Aural temperature >38.3°C or >100.9°F
2. Leukocytosis, WBC >11,500/cu.mm
3. Diverticulosis by prior imaging study
4. Rebound
D. Abscess [One of the following]
1. Acute non localized abdominal pain
a. Aural temperature >38.3°C or >100.9°F
b. Leukocytosis, WBC >11,500/cu.mm
c. Rebound
2. Follow up during or after treatment [One of the following]
a. Condition unimproved or worsening while on treatment
b. Routine follow-up study after treatment, including evaluation for removal of drain

E. Appendicitis (In children and pregnant women, ultrasound is the initial study except for follow up of known appendicitis with suspected complications. If this is not possible then CT of the abdomen and pelvis. MRI abdomen [74181, 74182, or 74183] in pregnant women)
1. Right lower quadrant pain [One of the following]
a. Aural temperature >38.3°C or >100.9°F
b. Leukocytosis, WBC >11,500/cu.mm
c. Rebound

F. Crohn’s disease and inflammatory bowel disease (suspected) [One of the following]
1. Suspected Crohn’s disease [One of the following]
a. Abdominal pain and diarrhea for more than 6 weeks
b. Aural temperature >38.3°C or >100.9°F
c. Perianal fistula or fissure
d. Enterovesical fistula
e. Enterovaginal fistula
f. Enterocutaneous fistula
g. Children with unexplained anemia, growth failure, and abdominal pain
2. Complications of known Crohn’s disease [One of the following]
a. Mass on abdominal, pelvic or rectal exam
b. Aural temperature >38.3°C or >100.9°F
c. Leukocytosis, WBC >11,500/cu.mm
d. Guarding
e. Rebound
f. Follow-up during or after treatment [One of the following]
i. Condition unimproved or worsening after drainage and IV antibiotics for at least two days
ii. Condition unimproved or worsening after IV Abx Rx >1 wk
iii. Routine follow-up study after treatment, including evaluation for removal of drain
g. Fistula
h. Small bowel obstruction
i. Perianal fistula
j. Stricture or stenosis
3. Any evidence of clinical deterioration while on steroids or immunosuppressives
G. Ulcerative colitis with bloody mucoid stools [One of the following]
1. Diarrhea
2. Pain
3. Tenesmus
H. CT of the abdomen and pelvic either with or without contrast (CPT® 74177 or CPT® 74176) can

CMS has updated the list of specified HCPCS codes within the three imaging families and five composite APCs to reflect HCPCS coding changes. Specifically, CMS added CPT code 74176 (Computed tomography, abdomen and pelvis; without contrast material), CPT code 74177 (Computed tomography, abdomen and pelvis; with contrast material(s)), and CPT code 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) to the CT and CTA family. These codes are new for CY 2011. CMS also added HCPCS codes C8931 (Magnetic resonance angiography with contrast, spinal canal and contents), C8932 (Magnetic resonance angiography without contrast, spinal canal and contents), C8933 (Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents), C8934 (Magnetic resonance angiography with contrast, upper extremity), C8935 (Magnetic resonance angiography without contrast, upper extremity), and C8936 (Magnetic resonance angiography without contrast followed by with contrast, upper extremity), to the MRI and MRA family.

UHC covered CT abd codes

72133 Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections

72191 Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing

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

73200 Computed tomography, upper extremity; without contrast material

73201 Computed tomography, upper extremity; with contrast material(s)

73202 Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections

73206 Computed Tomography angiography upper extremity with and without contrast material

73700 Computed tomography, lower extremity; without contrast material

73701 Computed tomography, lower extremity; with contrast material(s)

73702 Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections

73706 Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing

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

74174 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing

74175 Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing

74176 Computed tomography, abdomen and pelvis; without contrast material

74177 Computed tomography, abdomen and pelvis; with contrast material(s)

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

74261 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material

74262 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast images, if performed

74263 Computed tomographic (CT) colonography, screening, including image postprocessing (Non-covered service)

75571 Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium

75572 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image post processing, assessment of cardiac function, and evaluation of venous structures, if performed)

75573 Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image post processing, assessment of LV cardiac function, RV structure and function and evaluation of venous structures, if performed)

75574 Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image post processing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)

Effective for services furnished on or after January 1, 2009, multiple imaging procedures performed during a single session using the same imaging modality are paid by applying a composite APC payment methodology.

The services are paid with one composite APC payment each time a hospital bills for second and subsequent imaging procedures described by the HCPCS codes in one imaging family on a single date of service. The I/OCE logic determines the assignment of the composite APCs for payment. Prior to January 1, 2009, hospitals received a full APC payment for each imaging service on a claim, regardless of how many procedures were performed during a single session.

The composite APC payment methodology for multiple imaging services utilizes three imaging families (Ultrasound, CT and CTA, and MRI and MRA) and five composite APCs: APC 8004 (Ultrasound Composite); APC 8005 (CT and CTA without Contrast Composite); APC 8006 (CT and CTA with Contrast Composite); APC 8007 (MRI and MRA without Contrast Composite); and APC 8008 (MRI and MRA with Contrast Composite). When a procedure is performed with contrast during the same session as a procedure without contrast, and the two procedures are within the same family, the “with contrast” composite APC (either APC 8006 or 8008) is assigned.

CY 2011 APC 8005 (CT and CTA without Contrast Composite)*

70450 Ct head/brain w/o dye
70480 Ct orbit/ear/fossa w/o dye
70486 Ct maxillofacial w/o dye
70490 Ct soft tissue neck w/o dye
71250 Ct thorax w/o dye
72125 Ct neck spine w/o dye
72128 Ct chest spine w/o dye
72131 Ct lumbar spine w/o dye
72192 Ct pelvis w/o dye
73200 Ct upper extremity w/o dye
73700 Ct lower extremity w/o dye
74150 Ct abdomen w/o dye
74261 Ct colonography, w/o dye
74176 Ct angio abd & pelv

ICD-10 Codes that Support Medical Necessity

ICD-10 CODEDESCRIPTION

A06.2 – A06.6 – Opens in a new windowAmebic nondysenteric colitis – Amebic brain abscess
A06.81 – A06.89 – Opens in a new windowAmebic cystitis – Other amebic infections
A18.10 – A18.18 – Opens in a new windowTuberculosis of genitourinary system, unspecified – Tuberculosis of other female genital organs
A18.31 – A18.39 – Opens in a new windowTuberculous peritonitis – Retroperitoneal tuberculosis
A18.7Tuberculosis of adrenal glands
A18.83Tuberculosis of digestive tract organs, not elsewhere classified
A18.85Tuberculosis of spleen
A31.0Pulmonary mycobacterial infection
A31.2Disseminated mycobacterium avium-intracellulare complex (DMAC)
A34Obstetrical tetanus
A39.1Waterhouse-Friderichsen syndrome
A40.0 – A41.9 – Opens in a new windowSepsis due to streptococcus, group A – Sepsis, unspecified organism
A42.7Actinomycotic sepsis
A50.04Early congenital syphilitic pneumonia
A50.06 – A50.09 – Opens in a new windowEarly cutaneous congenital syphilis – Other early congenital syphilis, symptomatic
A51.49Other secondary syphilitic conditions
A52.74 – A52.75 – Opens in a new windowSyphilis of liver and other viscera – Syphilis of kidney and ureter
A56.11Chlamydial female pelvic inflammatory disease
B15.0 – B19.9 – Opens in a new windowHepatitis A with hepatic coma – Unspecified viral hepatitis without hepatic coma
B25.1 – B25.2 – Opens in a new windowCytomegaloviral hepatitis – Cytomegaloviral pancreatitis
B37.7Candidal sepsis
B65.0 – B65.9 – Opens in a new windowSchistosomiasis due to Schistosoma haematobium [urinary schistosomiasis] – Schistosomiasis, unspecified
B67.0Echinococcus granulosus infection of liver
B67.5Echinococcus multilocularis infection of liver
B67.8 – B67.99 – Opens in a new windowEchinococcosis, unspecified, of liver – Other echinococcosis
C00.0 – C43.9 – Opens in a new windowMalignant neoplasm of external upper lip – Malignant melanoma of skin, unspecified
C4A.0 – C4A.9 – Opens in a new windowMerkel cell carcinoma of lip – Merkel cell carcinoma, unspecified
C44.00 – C49.9 – Opens in a new windowUnspecified malignant neoplasm of skin of lip – Malignant neoplasm of connective and soft tissue, unspecified
C50.011 – C75.9 – Opens in a new windowMalignant neoplasm of nipple and areola, right female breast – Malignant neoplasm of endocrine gland, unspecified
C7A.00 – C7B.8 – Opens in a new windowMalignant carcinoid tumor of unspecified site – Other secondary neuroendocrine tumors
C76.0 – C79.9 – Opens in a new windowMalignant neoplasm of head, face and neck – Secondary malignant neoplasm of unspecified site
C80.0 – C84.79 – Opens in a new windowDisseminated malignant neoplasm, unspecified – Anaplastic large cell lymphoma, ALK-negative, extranodal and solid organ sites
C84.A0 – C84.Z9 – Opens in a new windowCutaneous T-cell lymphoma, unspecified, unspecified site – Other mature T/NK-cell lymphomas, extranodal and solid organ sites
C84.90 – C84.99 – Opens in a new windowMature T/NK-cell lymphomas, unspecified, unspecified site – Mature T/NK-cell lymphomas, unspecified, extranodal and solid organ sites
C85.10 – C86.6 – Opens in a new windowUnspecified B-cell lymphoma, unspecified site – Primary cutaneous CD30-positive T-cell proliferations
C88.2 – C91.62 – Opens in a new windowHeavy chain disease – Prolymphocytic leukemia of T-cell type, in relapse
C91.A0 – C91.Z2 – Opens in a new windowMature B-cell leukemia Burkitt-type not having achieved remission – Other lymphoid leukemia, in relapse
C91.90 – C91.92 – Opens in a new windowLymphoid leukemia, unspecified not having achieved remission – Lymphoid leukemia, unspecified, in relapse
C92.00 – C92.62 – Opens in a new windowAcute myeloblastic leukemia, not having achieved remission – Acute myeloid leukemia with 11q23-abnormality in relapse
C92.A0 – C92.Z2 – Opens in a new windowAcute myeloid leukemia with multilineage dysplasia, not having achieved remission – Other myeloid leukemia, in relapse
C92.90 – C92.92 – Opens in a new windowMyeloid leukemia, unspecified, not having achieved remission – Myeloid leukemia, unspecified in relapse
C93.00 – C93.32 – Opens in a new windowAcute monoblastic/monocytic leukemia, not having achieved remission – Juvenile myelomonocytic leukemia, in relapse
C93.Z0 – C93.Z2 – Opens in a new windowOther monocytic leukemia, not having achieved remission – Other monocytic leukemia, in relapse
C93.90 – C93.92 – Opens in a new windowMonocytic leukemia, unspecified, not having achieved remission – Monocytic leukemia, unspecified in relapse
C94.00 – C94.32 – Opens in a new windowAcute erythroid leukemia, not having achieved remission – Mast cell leukemia, in relapse
C94.80 – C96.4 – Opens in a new windowOther specified leukemias not having achieved remission – Sarcoma of dendritic cells (accessory cells)
C96.A – C96.Z – Opens in a new windowHistiocytic sarcoma – Other specified malignant neoplasms of lymphoid, hematopoietic and related tissue
C96.9Malignant neoplasm of lymphoid, hematopoietic and related tissue, unspecified
D00.1 – D01.9 – Opens in a new windowCarcinoma in situ of esophagus – Carcinoma in situ of digestive organ, unspecified
D03.0 – D03.9 – Opens in a new windowMelanoma in situ of lip – Melanoma in situ, unspecified
D06.0 – D09.19 – Opens in a new windowCarcinoma in situ of endocervix – Carcinoma in situ of other urinary organs
D12.0 – D12.9 – Opens in a new windowBenign neoplasm of cecum – Benign neoplasm of anus and anal canal
D13.1 – D13.9 – Opens in a new windowBenign neoplasm of stomach – Benign neoplasm of ill-defined sites within the digestive system
D16.8Benign neoplasm of pelvic bones, sacrum and coccyx
D17.5Benign lipomatous neoplasm of intra-abdominal organs
D17.71Benign lipomatous neoplasm of kidney
D18.03Hemangioma of intra-abdominal structures
D18.1Lymphangioma, any site
D19.1Benign neoplasm of mesothelial tissue of peritoneum
D20.0 – D20.1 – Opens in a new windowBenign neoplasm of soft tissue of retroperitoneum – Benign neoplasm of soft tissue of peritoneum
D21.20 – D21.22 – Opens in a new windowBenign neoplasm of connective and other soft tissue of unspecified lower limb, including hip – Benign neoplasm of connective and other soft tissue of left lower limb, including hip
D21.4 – D21.5 – Opens in a new windowBenign neoplasm of connective and other soft tissue of abdomen – Benign neoplasm of connective and other soft tissue of pelvis
D25.0 – D28.9 – Opens in a new windowSubmucous leiomyoma of uterus – Benign neoplasm of female genital organ, unspecified
D30.00 – D30.9 – Opens in a new windowBenign neoplasm of unspecified kidney – Benign neoplasm of urinary organ, unspecified
D35.00 – D35.02 – Opens in a new windowBenign neoplasm of unspecified adrenal gland – Benign neoplasm of left adrenal gland
D35.6Benign neoplasm of aortic body and other paraganglia
D3A.00 – D3A.8 – Opens in a new windowBenign carcinoid tumor of unspecified site – Other benign neuroendocrine tumors
D37.1 – D37.9 – Opens in a new windowNeoplasm of uncertain behavior of stomach – Neoplasm of uncertain behavior of digestive organ, unspecified
D39.0 – D39.9 – Opens in a new windowNeoplasm of uncertain behavior of uterus – Neoplasm of uncertain behavior of female genital organ, unspecified
D40.0 – D41.9 – Opens in a new windowNeoplasm of uncertain behavior of prostate – Neoplasm of uncertain behavior of unspecified urinary organ
D44.10 – D44.12 – Opens in a new windowNeoplasm of uncertain behavior of unspecified adrenal gland – Neoplasm of uncertain behavior of left adrenal gland
D44.6 – D44.7 – Opens in a new windowNeoplasm of uncertain behavior of carotid body – Neoplasm of uncertain behavior of aortic body and other paraganglia
D45Polycythemia vera
D48.3 – D48.4 – Opens in a new windowNeoplasm of uncertain behavior of retroperitoneum – Neoplasm of uncertain behavior of peritoneum
D49.0Neoplasm of unspecified behavior of digestive system
D57.02Hb-SS disease with splenic sequestration
D57.212Sickle-cell/Hb-C disease with splenic sequestration
D57.412Sickle-cell thalassemia with splenic sequestration
D57.812Other sickle-cell disorders with splenic sequestration
D73.1 – D73.2 – Opens in a new windowHypersplenism – Chronic congestive splenomegaly
D73.81Neutropenic splenomegaly
D75.0 – D75.1 – Opens in a new windowFamilial erythrocytosis – Secondary polycythemia
D78.01 – D78.22 – Opens in a new windowIntraoperative hemorrhage and hematoma of the spleen complicating a procedure on the spleen – Postprocedural hemorrhage of the spleen following other procedure
D86.0 – D86.2 – Opens in a new windowSarcoidosis of lung – Sarcoidosis of lung with sarcoidosis of lymph nodes
D86.84Sarcoid pyelonephritis
D86.89 – D86.9 – Opens in a new windowSarcoidosis of other sites – Sarcoidosis, unspecified
E08.51 – E08.52 – Opens in a new windowDiabetes mellitus due to underlying condition with diabetic peripheral angiopathy without gangrene – Diabetes mellitus due to underlying condition with diabetic peripheral angiopathy with gangrene
E09.51 – E09.52 – Opens in a new windowDrug or chemical induced diabetes mellitus with diabetic peripheral angiopathy without gangrene – Drug or chemical induced diabetes mellitus with diabetic peripheral angiopathy with gangrene
E10.51 – E10.52 – Opens in a new windowType 1 diabetes mellitus with diabetic peripheral angiopathy without gangrene – Type 1 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E11.51 – E11.52 – Opens in a new windowType 2 diabetes mellitus with diabetic peripheral angiopathy without gangrene – Type 2 diabetes mellitus with diabetic peripheral angiopathy with gangrene
E13.51 – E13.52 – Opens in a new windowOther specified diabetes mellitus with diabetic peripheral angiopathy without gangrene – Other specified diabetes mellitus with diabetic peripheral angiopathy with gangrene
E16.3 – E16.8 – Opens in a new windowIncreased secretion of glucagon – Other specified disorders of pancreatic internal secretion
E24.0Pituitary-dependent Cushing’s disease
E24.2 – E27.9 – Opens in a new windowDrug-induced Cushing’s syndrome – Disorder of adrenal gland, unspecified
E28.2Polycystic ovarian syndrome
E35 – E36.12 – Opens in a new windowDisorders of endocrine glands in diseases classified elsewhere – Accidental puncture and laceration of an endocrine system organ or structure during other procedure
E74.00 – E74.09 – Opens in a new windowGlycogen storage disease, unspecified – Other glycogen storage disease
E83.10 – E83.19 – Opens in a new windowDisorder of iron metabolism, unspecified – Other disorders of iron metabolism
E84.0 – E85.9 – Opens in a new windowCystic fibrosis with pulmonary manifestations – Amyloidosis, unspecified
E89.6Postprocedural adrenocortical (-medullary) hypofunction

Payment for Multiple Imaging Composite APCs

Effective for services furnished on or after January 1, 2009, multiple imaging procedures performed during a single session using the same imaging modality are paid by applying a composite APC payment methodology.

The services are paid with one composite APC payment each time a hospital bills for second and subsequentimaging procedures described by the HCPCS codes in one imaging family on a single date of service. The I/OCE logic determines the assignment of the composite APCs for payment. Prior to January 1, 2009, hospitals received a full APC payment for each imaging service on a claim, regardless of how many procedures were performed during a single session.

74178 CT Abdomen & Pelvis w/wo

Source

CT abd CPT CODES 74176- 74178

Leave a Comment Cancel Reply