Coding for a single image of the small intestine following administration of enteric contrast

Q.

What is the appropriate CPT^® code to report for a single image of the small intestine following administration of enteric contrast (e.g., barium)? May CPT code 74250 be reported, or does reporting this code require multiple images? Moreover, does the “when performed” language apply to both the scout abdominal radiographs and the multiple serial images?

A.

CPT code 74018, Radiographic examination, abdomen, 1 view, should be reported for a study evaluating the abdomen with a single radiograph performed after administration of enteric contrast. No scout image is performed because this is a single-image study. Administration of contrast is not reported with code 74018 because the contrast is administered to the patient orally by clinical staff. 

CPT code 74250, Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; single-contrast (e.g., barium) study, is not appropriate to report for a single-image radiologic examination of the small intestine. Note that code 74250 requires multiple serial images. A scout film (one obtained without the use of a contrast medium) may initially be taken of the abdomen and is not separately reportable. The patient swallows a single-contrast material (barium), after which multiple serial images are obtained. In the code descriptor, the conditional phrase of “when performed” applies to “scout abdominal radiograph(s)” and not “multiple serial images.”

If you are a billing under (HOPPS) Hospital outpatient clinic- you can report the barium under revenue codes: 0255, 0270, or 0621.