Did you know that the medical specialty of radiology has the third highest claim denial rate? According to a survey, the claim denial rate for radiology services is 20% whereas the average denial rate for all specialties combined is between 5% and 10%. And do you know what typically causes these denials? The real culprit is coding errors!
Many radiology claims are denied because of incorrect code selection or missing modifiers. That is why we have created this comprehensive guide on one such radiology procedural code, CPT code 74177, to help you navigate coding confusion.
So, are you ready to explore the depths of CPT code 74177? Let’s start!
CPT Code 74177 – Description
The Current Procedural Terminology (CPT) code 74177 is from the ‘Diagnostic Radiology (Diagnostic Imaging) Procedures of the Abdomen’ code range. It is used on claims to explain to the insurance payer that the healthcare provider performed a computed tomography (CT) scan of the pelvis and abdomen with a contrast dye.
The procedure represented by CPT code 74177 helps the provider view internal organs, blood vessels, and tissues, and identify any abnormalities that may be causing pelvic or abdominal pain.
Note that the physician may administer contrast material intravenously (inject it in the patient’s vein) and/or orally (ask the patient to drink the iodine/barium-based solution).
Medicare covers this abdominal and pelvis CT scanning with contrast material. The advised setting for this diagnostic procedure is a radiology department inside a hospital or an outpatient radiology center. The procedure typically takes 10 to 30 minutes.
Scenarios Where CPT Code 74177 is Applicable
Now, if you are new to radiology medical billing and wondering in what clinical situations you can report CPT code 74177 for charge capture and reimbursement, then read through the following examples. We have covered some real-world scenarios that necessitate abdominal and pelvis CT scanning with contrast material.
Diagnosing Infection
Abdominal CT scan is the preferred method for diagnosing appendicitis in adults because of its high accuracy. According to Radiopaedia, CT scan is highly sensitive, between 94% and 98%, and specific, up to 97%, when it comes to diagnosing acute appendicitis. It can even diagnose alternative reasons for abdominal pain.
So, for our first example, let’s consider that a 25-year-old woman visits her physician complaining of abdominal pain, nausea, and loss of appetite. She can even feel the slight onset of fever. After a physical examination, her physician suggests an abdominal and pelvis CT scan with contrast dye (CPT code 74177) to diagnose the problem. She is taken to the hospital’s radiology department, where she is injected with contrast dye and laid on the CT scanner bed for imaging.
The imaging results reveal increased appendiceal diameter, thickened walls, inflammation in the surrounding tissue, and an appendicolith (a calcified deposit within the appendix). Thus, she is diagnosed with appendicitis and prescribed antibiotics for treatment.
Diagnosing Inflammation
Abdominopelvic CT scanning with contrast is also used to diagnose inflammation. The procedure, represented by CPT code 74177, is frequently used to diagnose inflammatory bowel disease (IBD), which affects nearly 1.6 million people in the U.S.
So, assume that a 30-year-old man visits the hospital’s outpatient department (OPD) with symptoms like lower abdominal pain, chronic diarrhea, and fatigue. He is also a smoker and suffers from hypertension. Therefore, the physician suspects IBD. However, to confirm or rule out his hypothesis, the physician orders a CT scan of the abdomen and pelvis with contrast material.
The imaging results show inflamed and thickened bowel walls with strictures. Hence, the physician prescribes antibiotics and antidiarrheal medication for the treatment of IBD.
Diagnosing Masses and Malignancies
Stomach cancer or gastric cancer is rare compared to other types of cancer. Out of all the new cancers diagnosed in the U.S. each year, the share of stomach cancer is 1.5%. Also, men are more likely to develop stomach cancer compared to women.
So, for our next example, let’s take the case of a 45-year-old man who visits the hospital’s outpatient department complaining of abdominal pain, indigestion, nausea, and loss of appetite. The patient also appears to look very weak. The physician performs a physical exam and notices swelling in the belly. The patient’s medical records also show a family history of cancer. Therefore, suspecting that the patient may have developed stomach cancer, the physician orders a CT scan of the abdomen and pelvis with contrast dye (CPT code 74177).
The patient is taken to the radiology department for CT scanning. He is told to swallow a barium-based solution, which makes his stomach lining more visible. The imaging results show abnormal cell growth in the stomach lining. Hence, the physician suggests an upper endoscopy with biopsy at a later date to analyze whether the mass is benign (non-cancerous) or malignant (cancerous).
Diagnosing Vascular Abnormalities
Abdominal and pelvic computed tomography is also highly accurate in diagnosing abdominal aortic aneurysm (AAA), especially its size and extent. The contrast material helps the provider visualize blood vessels and detect any enlargements or bulges in a part of the abdominal aorta. These bulges form when the aorta wall becomes weak, typically because of old age, smoking, and certain medical conditions.
So, imagine that a 72-year-old man with a history of tobacco use visits the OPD with severe lower back pain and a pulsing sensation in his belly. He is having trouble standing and walking properly. The physician performs a brief physical exam during which he discovers rapid heartbeat and abnormal sounds in the abdomen. Hence, he orders the patient to undergo CT scan of the abdomen and pelvis with contrast (CPT code 74177). A contrast dye is administered intravenously, and the images show clear dilations in the abdominal aorta. For initial treatment, the patient is advised to make lifestyle changes (healthy diet and exercise).
Applicable Modifiers for CPT Code 74177
Modifiers are two-digit codes that explain the special circumstances in which a procedure was performed. They provide supplemental information to the insurance payer and may affect the reimbursement rate. So, you can also use the following modifiers with CPT code 74177 to collect accurate compensation for your services.
Modifier 26
Abdominopelvic CT scan with contrast material can be separated into professional and technical components. If you were only responsible for the professional part of the diagnostic radiology procedure, i.e., you only interpreted the imaging results and prepared a report, then append modifier 26 to CPT code 74177 to explain that to the insurance payer.
Modifier TC
However, if you are billing on behalf of the radiology department and only charging for the technical component, i.e., equipment use and the technician’s time and service, then append modifier TC to CPT code 74177.
Modifier 51
You can also append modifier 51 to CPT code 74177 if the same physician or technician performed multiple procedures on the same patient in the same session as the computed tomography of the pelvis and abdomen with contrast.
However, note that the reimbursement for the technical part of the service will be reduced by 50% (since the first procedure will be fully reimbursed), and the payment for the professional component will be reduced by 5%. Be mindful that in this case, CT scan of the abdomen and pelvis (CPT code 74177) will be the second or subsequent procedure.
CPT Code 74177 – Billing & Reimbursement Guidelines
Accurate coding is just one part of insurance billing and clean claim submissions. You must also take into account other factors like detailed documentation and payer policies when submitting claims for an abdomen and pelvis CT scan. The following billing best practices will help you reduce denials for your CPT code 74177 claims and collect fair and timely reimbursements.
Ensure the Correct Usage of CPT Code 74177
When selecting CPT code 74177 for radiology billing, you must make sure that the provider performed CT scanning on both the abdomen and pelvis. Plus, the procedure must have occurred with contrast dye for enhanced viewing of the internal structures, surrounding tissues, and blood vessels. If the contrast dye was not administered, you should report CPT code 74176 instead.
You must also not get confused between 74160 and 74177. CPT code 74160 only reports the CT scan of the abdomen with contrast, excluding the pelvis. So, during code selection, pay close attention to these details in each code’s description.
Provide Comprehensive Documentation
Do you know what serves as the setting stone for clean and compliant claim submission? Proving the medical necessity of your services! That’s right, and you can do that by submitting supporting documentation that highlights the medical necessity of the rendered service.
Now, in the case of CPT code 74177, insurance payers want to see why a CT scan of the abdomen and pelvis, that too with contrast material, was necessary for their beneficiary. So, you can do that by attaching:
- The patient’s complete medical record (including past diseases/disorders and present condition).
- Clinical notes
- Procedure report (including the structures – organs, tissues, and blood vessels – scanned, the type of contrast material used, imaging details, etc.).
- Imaging results, physician’s interpretation, and a detailed report with the physician’s signature on it.
- Suggested treatment plan or progress report
Pair with Appropriate ICD-10 Codes
Another way to prove the medical necessity of your services is to enter the correct ICD-10 diagnosis codes on the same claim form. These will help the payer understand the patient’s symptoms or condition that necessitated a medical intervention.
So, some suitable ICD-10 codes that can be paired with CPT code 74177 to justify its medical necessity include:
- R10.0 – Acute abdomen, severe abdominal pain with rigidity
- R10.84 – Generalized abdominal pain
- R10.9 – Abdominal pain, unspecified
- R11.2 – Nausea with vomiting, unspecified
- K35.80 – Acute appendicitis, unspecified
- K50.90 – Crohn’s disease, unspecified, without complications
Follow Payer-Specific Policies
Ranging from government insurance payers (Medicare and Medicaid) to commercial payers (e.g., United Healthcare, Aetna, Cigna, Humana, etc.), all have varying policies and guidelines for billing medical procedures, products, and services. The rules that may apply to one might be completely unacceptable for the other payer.
Therefore, we advise that before filing claims for CPT code 74177, you should review that specific payer’s policy manuals and guidelines to ensure compliance and avoid denials.
Summary
Did that feel like an information overload to you? Don’t worry, we know how to combat the infoglut. Let’s break down all that we learned in this guide on CPT code 74177 to leave you with clear takeaways. First, we explained that CPT code 74177 refers to a computed tomography scan of the abdomen and pelvis with a contrast material.
Second, we tried to understand the code’s application with the help of a few examples. For instance, we explored the use of abdominopelvic CT scanning with contrast in diagnosing appendicitis, inflammatory bowel disease, stomach tumors, and abdominal aortic aneurysm. We also covered some modifiers that can be appended to code 74177 for coding specificity. Lastly, we discussed some key billing tips that can increase your clean claim rate.
However, even with all this information on your fingertips, you may get hit with a claim denial. If that happens, turn to our proven radiology billing services. Our full suite includes everything, from error-free coding to timely denial management.
