Wiki Diagnostic Rad. Contrast Verbage

[JessicaKim.CPC@gmail.com]

Hi everyone,

I was wondering if anyone knew if MRI procedures ever give oral contrast or is it always IV administered?

For example, if the report says MRI of abdomen “pre-contrast” or “post contrast”, could we code 74150 or 74160 or would it HAVE to state “with “ or “without contrast”?

And how about “enhanced” and “non-enhanced contrast” for CTs?
Or those ok to code with and without or again, will it have to state “with” or “without contrast”?

I was getting a lot of different opinions so now I’m confused..

Thank you in advance!

 

[thomas7331]

Yes, some MRI procedures do use oral contrast.

If you are seeing 'pre-contrast' documented, that is in reference to imaging done before administration of contrast, so would be coded as 'without contrast' (if that is all that was done). You'd usually see this in a study that's being done both with and without contrast, so similarly, the 'post contrast' images would refer to those performed with the contrast. So the two together would represent a study done first without and then followed by with contrast - i.e. 74170 (not 74150 or 74160) in your example.

'Enhanced contrast' is a technical term used by the radiologists (see: Contrast Enhancement) - it can mean different things. I would not make any assumptions for coding purposes based on the presence of this term in the documentation.

The physician order for the study should clearly state whether or not a study is to be done with contrast or without contrast or both. I'd recommend getting clarification from the physician via a query if this isn't clear in the record.

 

[JessicaKim.CPC@gmail.com]

Yes, some MRI procedures do use oral contrast. If you are seeing 'pre-contrast' documented, that is in reference to imaging done before administration of contrast, so would be coded as 'without contrast'. So, 'post contrast' would apply to the imaging with contrast. So the two together would represent a study done first without and then followed by with contrast - i.e. 74170 (not 74150 or 74160).

'Enhanced contrast' is a technical term used by the radiologists (see: Contrast Enhancement) - it can mean different things. I would not make any assumptions for coding purposes based on the presence of this term in the documentation. The physician order for the study should clearly state whether or not a study is to be done with or without contrast, or both. I'd recommend getting clarification from the physician via a query if this isn't clear in the documentation.

Thank you so much for responding. So where I’m getting the confusion from is that I was told it has to specifically state “IV contrast”.

Whether it’s pre or post, and it doesn’t state whether it was oral or IV, I was told to downcode it to as without contrast.

Not sure if I’m making sense?

 

[thomas7331]

Thank you so much for responding. So where I’m getting the confusion from is that I was told it has to specifically state “IV contrast”.

Whether it’s pre or post, and it doesn’t state whether it was oral or IV, I was told to downcode it to as without contrast.

Not sure if I’m making sense?

I don't know why it would have to be documented as 'IV'. Contrast is contrast - there's no reason that I can think of that oral contrast would disqualify a study from being coded as done with contrast. And I have never read or heard anywhere that this is a requirement in imaging documentation.

I would ask the person who told you this to give you a rationale or reference as to why they think this should be the case.

 

[JessicaKim.CPC@gmail.com]

So from what I know oral contrast cannot be billed as “with contrast”.

So it has to specify if it’s IV so we can bill accordingly.

 

[zoinks071]

According to the chapter guidelines at the heading of the Radiology Chapter... "The phrase 'with contrast' used in the codes for procedures performed using contrast for imaging enhancement represents contrast material administered intravascularly, intra-articularly, or intrathecally." Additionally it states... "Oral and/or rectal contrast administration alone does not qualify as a study 'with contrast'." So there does appear to be a clear distinction drawn in CPT as far as the route of administration. I hope this helps.

 

[thomas7331]

According to the chapter guidelines at the heading of the Radiology Chapter... "The phrase 'with contrast' used in the codes for procedures performed using contrast for imaging enhancement represents contrast material administered intravascularly, intra-articularly, or intrathecally." Additionally it states... "Oral and/or rectal contrast administration alone does not qualify as a study 'with contrast'." So there does appear to be a clear distinction drawn in CPT as far as the route of administration. I hope this helps.

Good to know, thanks Ben. I did a search in CPT before I responded above but apparently overlooked this guidance, so I stand corrected.

I would think, though, that this is something that could be identified from the type of contrast that was used, regardless of whether or not the administration route was specifically documented. If there was any question about the route, I'd personally want to query rather than downcode to a code that didn't represent what was actually done. But I guess that's ultimately that's a decision each organization would need to make for themselves.

 

[JessicaKim.CPC@gmail.com]

Good to know, thanks Ben. I did a search in CPT before I responded above but apparently overlooked this guidance, so I stand corrected.

I would think, though, that this is something that could be identified from the type of contrast that was used, regardless of whether or not the administration route was specifically documented. If there was any question about the route, I'd personally want to query rather than downcode to a code that didn't represent what was actually done. But I guess that's ultimately that's a decision each organization would need to make for themselves.

You’re absolutely right! I will definitely ask during our next meeting.

Thank you both so much!!! It was very helpful!!

 

[thomas7331]

You’re absolutely right! I will definitely ask during our next meeting.

Thank you both so much!!! It was very helpful!!

You're welcome, glad to be able to help.

I just had another thought actually - in my experience, when contrast is required there should be an accompanying order to the dispensing pharmacy in the chart which would specify the route for administration. That's another documentation source you could potentially use to support coding and/or defend in an audit in case it were ever questioned.