Do you know that among all medical specialties, radiology claims have the third-highest denial rate? Computed tomography (CT) scans, specifically abdominal and pelvic scans, are one of the most frequently performed imaging services. Which means their claims are also often denied.
CPT code 74177 is an essential billing code in radiology. However, many billers don’t know how to use this code correctly. That’s why our billing experts at NeuraBill have created this detailed guide on 74177. So, let’s start.
CPT Code 74177 – Description
CPT code 74177 is defined as:
“Computed tomography, abdomen and pelvis; with contrast material(s).”
The definition is self-explanatory, but let’s break this down in more detail.
Code 74177 reports a simple CT scan of the abdomen and pelvis with contrast material. During the study, both the abdomen and pelvis must be scanned. If imaging of only one area is required, other more relevant CPT codes should be used.
An important point to note is that for CPT code 74177 to be valid, the contrast must be administered intravenously. If a study requires contrast to be administered both intravenously and orally, 74177 can still be used. However, if the contrast is provided only through the mouth or via rectum, the study does not count as a “with contrast” scan and should be billed with CPT code 74176.
Additionally, in most cases, only a single combined study code (74176, 74177, 74178) is billed on a single claim. However, in rare cases, more than one combined study might be required. In this situation, the correct way of claim submission is to append modifier 59 or XE to the second instance.
If multiple CT scans are performed on the same date and time, you must mention the exact time at which each scan was performed. In addition to this, you must also add a note that the scans were performed in the “same session.” For example, 9:00 AM – CPT code 74176 and 9:30 AM – CPT code 74177, same session.
Appropriate Use Cases for CPT Code 74177
To make things clear, let’s look at a couple of real-world scenarios in which CPT code 74177 can be used.
Tuberculosis of the Bladder
Suppose a 45-year-old patient comes to the hospital. The patient explains to the physician that he has been experiencing burning pain while urinating and blood in the urine for several weeks. He also has a mild fever and slight weight loss. He also shares that he has taken some over-the-counter antibiotics commonly used in urinary tract infections. However, nothing seems to work.
These symptoms suggest that there might be an infection in the bladder, possibly tuberculosis of the bladder. However, to accurately diagnose and determine the extent of the infection’s spread to the urinary system, the physician orders a CT urography scan with contrast. The scan confirms the diagnosis. In the end, the medical billing department codes and submits the claim for reimbursement. In this case, CPT code 74177 is used along with the primary diagnosis code A18.12 for tuberculosis of the bladder.
Amebic Cystitis
Suppose a 38-year-old patient visits the emergency room with severe bladder pain and frequent, painful urination after returning from a tropical vacation. He also reports having loose stools and stomach cramps. These symptoms suggest a parasitic infection affecting the bladder, known as amebic cystitis.
However, to properly diagnose and check if the infection has affected other parts of the urinary tract, the physician orders a CT examination of the abdomen and pelvis with contrast. In this case, CPT code 74177 is used along with the primary diagnosis code A06.81 for amebic cystitis.
Modifiers to Append with CPT Code 74177
The following are some modifiers that you can use to describe the circumstances in which the CT scan, represented by CPT code 74177, was performed.
| Modifier | Description | Usage |
|---|---|---|
| 26 | Professional Component | Used when billing only for the physician’s interpretation and report. |
| 59 | Distinct Procedural Service | Indicates that the procedure is distinct and separate from other services performed on the same day. |
| CT | Equipment Non-compliance | 15% payment reduction. Used when equipment used to furnish certain services does not meet attributes of the National Electrical Manufacturers Association (NEMA) Standard XR–29–2013 |
| TC | Technical Component | Applied when billing only for the technical aspects, including equipment, supplies, and the technician’s services. |
| XE | Separate Encounter | Indicates that the service is distinct and separately reimbursable because it was performed during a separate encounter on the same service date. |
Reimbursement Guidelines for CPT Code 74177
The following are some guidelines and vital points that you should consider when filing claims for CPT code 74177:
Provide Comprehensive Documentation
Documentation is essential to prove the medical necessity of the procedure. Record the following details in the patient’s medical records:
- Patient’s name
- Date of service
- Written request from the physician who ordered the CT scan
- Notes explaining why the patient needs the scan and records of previous visits
- Official results written by the radiologist
- Proper signatures from qualified medical staff
- List of symptoms
- Laboratory data
Confirm Prior Authorization Requirements
Many insurance payers require prior authorization for CT scans. Failure to get pre-authorizations is among the biggest reasons for claim denials. However, the Centers for Medicare and Medicaid Services (CMS) does not require authorizations for CPT code 74177.
Still, you must always check the authorization requirements before submitting the claim.
Ensure ICD-10 Code Pairings
Justifying the medical necessity of the CT scans is vital for claim acceptance. The scans cannot be justified without appending valid ICD-10 diagnosis codes. Some ICD-10 codes that can be paired with CPT code 74177 include:
- A06.5: Amebic lung abscess
- A06.81: Amebic cystitis
- A18.11: Tuberculosis of the kidney and ureter
- A34: Obstetrical tetanus
- A39.1: Waterhouse-Friderichsen syndrome
- A41.3: Sepsis due to Hemophilus influenzae
- B17.2: Acute hepatitis E
You can check the complete list of valid ICD-10 codes in Medicare’s guide on abdominal and pelvic CT scans.
Check the Medicare Reimbursement Rate
The national average reimbursement amount for 74177 is $297.26 in non-facility settings.
The following is a more detailed breakdown of the cost structure:
- Professional Component:
- Facility price: $83.45
- Non-facility price: $83.45
- Technical Component:
- Facility price: Not applicable
- Non-facility price: $213.81
You can check the exact reimbursement rate for your MAC locality via the PFS Lookup Tool.
Meet the Additional Requirements
In addition to fulfilling the medical necessity requirement, the CT scan equipment must comply with the following:
- The equipment model must be FDA-approved.
- The model should be in its full market release phase.
Final Thoughts on CPT Code 74177
CPT code 74177 is a simple but frequently used procedural code for abdominal and pelvic CT scans. The scans must be conducted with a contrast dye that is administered intravenously. For proper reimbursement, you must justify the medical necessity and append appropriate ICD-10 codes, modifiers, and documentation.
However, this is a lot of information to remember, and 74177 billing can be confusing even for the most experienced billers. If you are facing frequent denials, you can always rely on our expert radiology billing services.
