CPT Code 74176: CT Abdomen and Pelvis Without Contrast

What is CT abdomen and pelvis without contrast?

CPT code 74176 refers to a CT scan that captures detailed images of the abdomen and pelvis without using contrast material. This diagnostic imaging procedure is typically ordered when patients present with abdominal pain, trauma, suspected kidney stones, or bowel obstruction and when there’s a medical necessity for evaluating both the abdomen and pelvic areas in a single session.

The code represents a combined CT abdomen and pelvis study, allowing healthcare providers to perform the imaging procedure more efficiently using a bundled approach. Rather than billing separate specific codes for CT abdomen and CT pelvis, CPT code 74176 covers services provided for imaging both the abdominal and pelvic regions at once. This streamlining supports accurate billing and can simplify the reimbursement process.

Importantly, CPT code 74176 includes both the technical and professional components—meaning it accounts for the use of imaging equipment and the radiologist’s interpretation. This code should be used when the same physician or radiology practice is responsible for both components and when no contrast material is administered during the session.

Using CPT code 74176 appropriately ensures compliance in coding CT abdomen and pelvis procedures and contributes to a more efficient revenue cycle within the broader medical practice.

CPT code 74176 documentation requirements

Proper documentation is essential when reporting CPT code 74176 to ensure accurate billing and compliance with medical coding guidelines. For this CT abdomen and pelvis procedure, healthcare providers must clearly outline the clinical rationale and imaging details to support medical necessity.

Key elements to include in the documentation:

• Reason for imaging and clinical history such as abdominal pain, trauma, or suspected stones to justify the diagnostic imaging procedure.
• Dates of service, along with a signed order or intent to order for the CT from the ordering provider and documentation supporting the indication or medical necessity of the scan.
• Details of the scan, such as the CT imaging equipment used, indicate the anatomical regions imaged (i.e., both the abdomen and pelvis) and confirm that contrast material was not used during the procedure.
• Findings for the CT abdomen and CT pelvis, ensuring a thorough assessment of the abdominal and pelvic regions.
• Radiologist’s impression and recommendations, including a professional summary of results, including any suggestions for further evaluation.

It’s crucial to note that contrast material must not be administered during this scan. If contrast is used, CPT code 74177 (CT abdomen and pelvis with contrast) should be reported instead. Submitting the correct specific codes based on whether contrast material was used helps maintain clean claims and streamlines reimbursement.

CPT code 74176 billing guidelines

When billing for CPT code 74176, it’s important to follow proper billing guidelines to ensure compliance and prevent claim denials. This computed tomography service should be reported as a global service when the same provider performs both the technical and professional portions of the exam. If the imaging services are split between providers or facilities, use modifier -26 for the professional component and -TC for the technical component.

Avoid reporting separate codes for CT abdomen (74150) and CT pelvis (72192), as doing so is considered unbundling. Instead, CPT code 74176 should reflect the bundled nature of this imaging procedure, which includes both regions in a single session. This ensures accurate reporting and aligns with national CPT code 74176 billing guidelines.

If contrast material is administered during the scan, use CPT code 74177 (with contrast) or 74178 (with and without contrast) instead. In all cases, the code should be linked to an appropriate ICD-10 code that supports medical necessity based on the specific clinical indication. If the procedure qualifies as a distinct procedural service performed in addition to other unrelated imaging or procedures on the same day, consider the appropriate modifier used to reflect that.

Lastly, to support successful claim submission and maintain a healthy revenue cycle, it's important to meet payer-specific coverage criteria when billing CPT code 74176. Payers, including Medicare and other third-party payers, may require documented medical necessity for imaging, especially when ordered alongside other procedures on the same patient.

Other relevant CPT codes

To maintain compliance, always reference the following CPT codes correctly based on contrast usage:

• 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