Wednesday, February 26, 2014

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.  

3 comments:

  1. HeartburnThe burning sensation that rises from your stomach to either shoot up your throat or settle just under your sternum in your chest is one of the most common signs of gastrointestinal problems. Colon Polyps

    ReplyDelete
  2. Thanks for this blog.Farr Laboratories provide Prostate supplements/tablets online which is an effective treatment for prostate cancer & provides pain relief. Visit us on Enlarged prostate treatment tablets

    ReplyDelete
  3. I agree with a lot of the points you made in this article. If you are looking for high quality Reputable Canadian Online Pharmacies for a wide range of information.

    ReplyDelete