When we talk about medical billing, CPT codes are the first thing that comes to the mind of billers. These codes serve as a medium of communication between billers and the payers. Medical billing uses the language of CPT codes to explain to the payer the procedure the physician performed, so that the appropriate reimbursement rate can be collected for the services.
Today, in this blog, we will briefly discuss CPT code 74176, with its accurate uses and reimbursement guidelines. This will help you avoid mistakes while submitting claims that lead to denials. Now let’s get going!
CPT Code 74176 – Description
CPT code 74176 refers to a computed tomography (CT) scan of the abdomen and pelvis without contrast. The American Medical Association (AMA) maintains this code under the ‘Diagnostic Radiology (Diagnostic Imaging) Procedures of the Abdomen’ code range.
In this diagnostic imaging procedure, the provider performs a CT scan of the abdomen and pelvis without contrast material to diagnose the cause of abdominal or pelvic pain or to detect other abnormalities in the internal organs.
Scenarios Where CPT Code 74176 is Applicable
Who can bill this service with CPT code 74176 and how? The following scenarios will answer your query.
Kidney Stones
Kidney stones are one of the most common conditions affecting more than 1 in 10 men in the United States. So, let’s imagine a scenario where a 35-year-old male rushes to the clinic because he is having a sudden, sharp pain in the left side of his abdomen accompanied by nausea and blood in the urine. The physician immediately orders a CT scan to diagnose the underlying issue. The radiologist performs a CT scan of the patient’s abdomen and pelvic region without contrast to detect any kidney stones.
Hence, the radiologist can bill using CPT code 74176 because he performed an abdominal and pelvic CT scan without contrast to get detailed views of the internal structures and kidney stones (including their location, size, and number).
Abdominal Injury or Trauma
Following a car accident, a young adult comes to the hospital. Although he reports having slight stomach pain, there is no visible bleeding. The physician orders a non-contrast CT scan of the abdomen and pelvis as a precaution to check for any organ injury or internal bleeding. The radiologist who performs the CT scan without contrast can bill his services with CPT code 74176.
Abdominal Mass
Suppose a 70-year-old man comes to a physician with excruciating abdominal pain caused by constipation. He also reports that he is seeing blood in his urine and experiences a feeling of fullness, even after eating small meals.
The physician performs a physical examination, during which he feels a palpable mass, so he orders a CT scan of the abdomen and pelvic area. The radiologist conducts a CT without contrast to identify the exact location of the abdominal mass and reports it to the physician. Hence, the radiologist can bill his services with the CPT code 74176.
Applicable Modifiers for CPT Code 74176
Now, the question that arises is, can you apply modifiers with this code? YES! But which modifiers are applicable? This section addresses the question. The following are a few modifiers that can be appended to CPT code 74176.
Modifier 26
Are any physicians at your practice interpreting, assessing, and recording the findings from the abdominal or pelvic CT scan? Then you should apply modifier 26 with CPT code 74176 for reimbursement of those services. Modifier 26 specifies the professional component of an abdominal and pelvic CT scan without contrast. In other words, it indicates that the physician was only responsible for interpreting and reporting the images.
Modifier TC
Modifier TC is used to bill for the cost of the technical elements of the test. For example, the cost of the CT scanner, imaging supplies, staff, and other expenses related to the imaging procedure, but excludes the physician’s interpretation. Typically, facilities (a radiology lab in this case) append modifier TC to charge only for the technical component of the service.
CPT Code 74176 – Billing & Reimbursement Guidelines
The following are the billing and reimbursement guidelines for CPT code 74176.
Ensure the Correct Person Bills the Code
There is a common confusion about who can bill the CT scanning with the CPT code 74176. The person performing the CT scan can bill for their service with this code. It may be a radiologist, a hospital’s outpatient department, or an imaging center. The ordering physician cannot bill this code unless they perform the CT scan and interpret the results as well, which is rare.
Use the Accurate Code
When a CT scan of the abdomen and pelvis is done without contrast (in a single session), you will apply the CPT code 74176 for the imaging of both anatomical areas. You will no longer use separate codes for separate billing. For example, using CPT code 74150 for an abdominal CT scan without contrast and CPT code 72192 for a pelvic CT scan without contrast. These two codes no longer need to be billed separately because of the existence of CPT code 74176.
Attach Complete Documentation
Your paperwork is your defense against claim denials. You must submit your claim with the supporting documents to collect timely and accurate reimbursements against CPT code 74176. These documents must include the following essential information:
- Medical necessity of the CT scan
- The patient’s medical history
- The patient’s symptoms and their relevant ICD-10 codes
- The area scanned (both abdomen and pelvis)
- Any findings
Obtain Prior Authorization
Radiology procedures usually require pre-authorization from the payer before the service is performed. Failure to obtain this pre-approval can result in claim denials. Note that in the case of CT scans, many insurance payers mandate pre-authorization, especially for non-emergency situations in outpatient settings, to ensure the service is absolutely medically necessary.
Conclusion
In conclusion, CPT code 74176 is used when the radiologist performs a CT scan without contrast for both the abdomen and pelvis. If diagnostic imaging is limited to only one of the two regions, then specific CPT codes should be used. We informed you of the accurate use of this code, its billing and reimbursement guidelines, and applicable modifiers to save you from denials.
However, if all of it still seems challenging, you can acquire professional radiology billing services. These services can improve your billing and coding process, minimize claim errors, and increase practice revenue.
