When do you order a CT scan (abdomen and pelvis) together ? A Guide for Ordering Clinicians/Non-Radiology Physicians (internal medicine, family practice, etc).

When do you order a CT abdomen/pelvis with contrast or without contrast.  When do you order a CT abdoment and pelvis together?
These are common questions radiologists get daily.

First year radiology residents:  Review this guide because it will help you decide which protocol to use when a technician calls into the reading room during your Body rotation.

This is a helpful primer for non-radiologist physicians (i.e. family practice, internal medicine, surgeons, etc) on when to order a CT Abdomen with a CT Pelvis for common indications/symptoms.  Plus, it discusses which indications require IV and Oral Contrast.   This will be helpful for other ordering clinicians such a Nurse Practitioners (NPs) and Physician Assistants (PA).

When to Order a CT Abdomen AND CT Pelvis TOGETHER
CT Abdomen / Pelvis WITHOUT IV CONTRAST	CT Abdomen / Pelvis WITH IV CONTRAST	CT Abdomen / Pelvis W & WITHOUT IV CONTRAST
CPT 74176	CPT 74177	CPT 74178
Order when evaluating for:	Order when evaluating for:	Order when evaluating for:
·      Hematuria / STONE STUDY	·      Abdominal Pain (upper and lower quadrants) ·      Inflammatory Bowel Disease (including Crohns, Ulcerative Colitis) ·      Appendicitis ·      Abscess ·      Hernia (ventral, umbilical, inguinal) ·      CT Enterography	·      Cyst vs Mass (kidney) ·      Painless Hematuria ·      Transitional Cell Carcinoma of Kidney ·      CT Renal Mass ·      CT Urogram

Please Note – In 2011 the AMA COMBINED the CT Abdomen CT Pelvis CPT Codes into singular combined CPT Codes (74176, 74177, and 74178).  Although the individual studies for a single CT Abdomen and CT Pelvis still exist, the above codes are designed to capture those cases where the codes (pre 2011) would have been billed together. 

When to Order a CT Abdomen ONLY
CT Abdomen WITHOUT IV CONTRAST	CT Abdomen WITH IV CONTRAST	CT Abdomen W & WITHOUT IV CONTRAST
CPT 74150	CPT 74160	CPT 74170
Order when evaluating for:	Order when evaluating for:	Order when evaluating for:
·      Follow up for patients with Renal Cell Carcinoma in Renal Failure (recommend MRI)	·      Epigastric issues / evaluation ·      RUQ Pain ·      LUQ Pain ·      Pseudocyst	·      Pancreatitis ·      Pancreas Mass ·      Liver Mass ·      Adrenal Protocol ·      CT Dual Phase Liver  - Hepatic Protocol ·      CT Pancreas (Pancreatic Protocol)

NOTE - The UHS Protocol for a CT Abdomen covers from the diaphragm dome (Xiphoid Process) to iliac crests (Belly Button).

When to Order a CT Pelvis ONLY
CT Pelvis WITHOUT IV CONTRAST	CT Pelvis WITH IV CONTRAST	CT Pelvis W & WITHOUT IV CONTRAST
CPT 72192	CPT 72193	CPT 72194
Order when evaluating for:	Order when evaluating for:	Order when evaluating for:
·      Prostate Treatment Planning (Pubic Arch Study Protocol)	·      Cancer Staging ·      Mass in pelvic region* ·      Cysts in pelvic region* ·      Pain in pelvic region* ·      Infection in pelvic region*

*The Pelvic Region as defined by Medicare is the “lower abdomen.”  The UHS Protocol for a CT Pelvis covers from the Iliac crest (Belly Button) through Ischial Tuberosities (Upper Thigh)

Source:M.Langenberg 2014

For ordering physicians and patients,  this should be helpful information when ordering  CT scans ("cat scans").


Hope this helps answer some questions about when you order a CT abdomen/pelvis with contrast or without contrast.