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What constitutes "dye"

  1. #1
    Flower City Coders
    Default What constitutes "dye"
    Medical Coding Books
    I have been an RN for 30 yrs but a coder for only a yr. I work for an insurance company and was asked to look at claims and associated radiology reports where the CPT codes for CT scans for our members showed a discrepancy between the Radiologist code and the hospital code for the same service (i.e. 74160 vs 74170, or 74193 vs. 72194). In reading the reports they often say something like this: "Abdominal CT performed with oral contrast followed by CT Abdomen/Pelvis after the administration of Optiray 350". My question is this:

    1. What constitutes a CT scan without dye?
    2. Is oral contrast considered "dye" for CPT purposes, or is only the IV contrast considered "dye"?

    Thanks for your insights!

  2. #2
    Albany, New York
    In my opinion, contrast (dye) is contrast regardless of the route of administration.
    Karen Maloney, CPC
    Data Quality Specialist

  3. Default
    Hi there. I code for a radiologist group and the way we do this is that the exam title must say w/contrast and the dictation must state that there was an IV contrast administered. You cannot code w/contrast if it was only oral given.
    Hope that helps.
    Heidi cpc

  4. #4
    Birmingham, Alabama
    procedures "with contrast" include those in which a dye is injected either
    intravascularly (intravenous), intra-articularly or intrathecally. Oral contrast alone does not qualify a procedure as a contrast study.

    see the Radiology Guidelines in the CPT manual, specifically under the heading of "Administration of Contrast".

    hope this helps.

  5. #5
    Flower City Coders
    Default Thanks
    I appreciate your taking the time to answer my question - it helped a lot!!

  6. Question CT of the Abdomen and Pelvis with and without contrast.
    My question is:
    What would be the correct coding for the follow situation.
    A patient had a CT ABD/PELVIS W/O CONTRAST at 12:40 that was read by Dr X. After viewing the findings it was ordered for the patient to have a CT ABD/PELVIS WITH CONTRAST which was done at 18:08 and read by DR Y. Normally we would bill a charge with and without, however since 2 different doctors read, we are unsure of the correct coding.
    Thank you for any help that you can offer.

  7. #7
    Because it's a different rad reading the second one and they deemed it necessary to perform the CT with contrast i would append the 59 modifier.

  8. #8
    If you append the 59 modifier be prepared to appeal the denial for related procedures and probably not get paid. We could contact the physician for a new order and explain the situation to the physicians that read the reports and normally one of them would let us bill for the other. The same thing happened to us recently. Hope this helps!

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