CPT Code 74178: CT Abdomen and Pelvis With and Without Contrast

What is CPT code 74178?

CPT code 74178, as defined by the American Medical Association, describes 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. This specific code represents a combined CT abdomen and pelvis study that encompasses imaging of both anatomical regions during different sessions within the same examination.

The procedure provides comprehensive diagnostic imaging that covers the urinary tract, gastrointestinal system, reproductive organs, and other structures within both the abdomen and pelvis. Healthcare providers use this imaging modality when a specific clinical indication requires evaluation of conditions that may affect multiple organ systems or when the patient's symptoms suggest pathology that could involve either region.

CT abdomen and pelvis imaging serves multiple diagnostic purposes, particularly effective for evaluating pelvic pain, abdominal masses, trauma assessment, and staging of malignancies. The contrast enhancement phases allow for better differentiation of vascular structures, organ parenchyma, and pathological processes.

CPT code 74178 documentation requirements

In reporting CPT code 74178, documentation must clearly indicate why both abdomen and pelvis imaging with and without contrast material were clinically necessary for the same patient during the same session.

Essential documentation elements

The medical record must include the specific clinical indication that necessitates the combined study. This includes the patient's presenting symptoms, relevant medical history, physical examination findings, and the clinical question that requires imaging evaluation. Documentation should specify why separate CT abdomen or CT pelvis studies would be insufficient for proper diagnosis.

Medical necessity criteria

Medical necessity for CPT 74178 must be clearly established through documentation that demonstrates the clinical scenario requires a comprehensive evaluation of both body regions. The documentation should support why the combined study provides diagnostic information that cannot be obtained through alternative imaging methods or separate studies.

CPT code 74178 billing guidelines

Accurate billing for CPT 74178 requires understanding of coding guidelines, modifier usage, and compliance with the National Correct Coding Initiative (NCCI) edits. Healthcare providers must ensure proper reimbursement process by following established billing protocols and maintaining compliance with Medicare and other third-party payers' requirements.

These include the following:

• Providers must distinguish between CPT 74178 and other CT codes to ensure accurate billing and avoid potential claim denials or audit issues.
• The combined study represented by CPT 74178 should not be unbundled into separate abdomen and pelvis studies unless there is a distinct procedural service that warrants separate billing.
• When procedures are performed by the same physician on the same day, careful attention to the distinct nature of each service is essential.
• Proper use of modifiers is necessary when CPT 74178 is performed in conjunction with other procedures or when bilateral imaging is required.

Other relevant CPT codes

• CPT 74176: CT abdomen and pelvis without contrast material
• CPT 74177: CT abdomen and pelvis with contrast material
• CPT 74150: CT abdomen without contrast material
• CPT 74160: - CT abdomen with contrast material