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Coding CT Abdomen and Pelvis Without and With Contrast on the Same Date of Service

Published on 

Wednesday, May 19, 2021

 | FAQ 
Question:

A patient came to the ER and a CT of the abdomen and pelvis without contrast (CPT code 74176) was performed. While the patient was still in the ER, the patient went back to CT a second time and a CT abdomen and pelvis with contrast was performed, in other words – two separate scans. Can CPT codes 74176 and 74177 be billed together on the same date of service, and if so, is a modifier needed? Or do we have to report only one CPT code 74178 (CT abdomen and pelvis with and without contrast)?

Answer

If the payer uses Medicare’s National Correct Coding Initiative (NCCI) edits, you can bill CPT codes 74176 and 74177 on the same date of service. A modifier is needed to indicate the scans were separate and distinct from each other, i.e., two separate scans. Depending on the payer, use modifier 59 or XU.

When a patient has only one visit to the CT department for CT abdomen and pelvis with and without contrast as a single study, you must bill CPT code 74178. In this scenario, it would be inappropriate to bill CPT codes 74176 and 74177 with a modifier as this would constitute unbundling.

Article Author: Jeffery Gordon, RN, MSN, CCA, COC
Jeffery Gordon, RN, MSN, CCA, COC, is the Manager of Outpatient Medical Review at Medical Management Plus, Inc. Jeff has over thirty-five years of experience in healthcare including Critical Care, Infection Control, Quality Assurance, Medical Necessity, Outpatient Coding, Medicare Claims data analysis and Medical Record review.

This material was compiled to share information.  MMP, Inc. is not offering legal advice. Every reasonable effort has been taken to ensure the information is accurate and useful.