RCC Contrast Media, Supplies & HCPCS Level II Coding 2 — Questions and Answers
Question 1: Which CPT code represents a CT of the abdomen and pelvis performed WITH intravenous contrast material?
- 74177 (Correct answer)
- 74176
- 74178
- 74182
Correct answer: 74177
CPT 74177 describes a CT of the abdomen and pelvis with contrast; 74176 is without contrast, 74178 is without followed by with contrast, and 74182 is MRI abdomen with contrast.
Question 2: Which modifier does an interpreting radiologist append to a CPT code when billing only for the professional component (interpretation and report)?
- Modifier TC (Technical Component)
- Modifier 26 (Professional Component) (Correct answer)
- Modifier 59 (Distinct Procedural Service)
- Modifier 52 (Reduced Services)
Correct answer: Modifier 26 (Professional Component)
Modifier 26 (Professional Component) is appended when the physician bills only for interpretation and report, separate from the facility's technical component.
Question 3: In the context of radiology contrast safety, 'premedication' most specifically refers to:
- Antibiotics given before interventional procedures to prevent infection
- Corticosteroids or antihistamines given to patients at risk for contrast reactions (Correct answer)
- Sedation administered before MRI for claustrophobic patients
- IV fluids given to hydrate patients before contrast-enhanced CT
Correct answer: Corticosteroids or antihistamines given to patients at risk for contrast reactions
Premedication in radiology refers to corticosteroids (e.g., prednisone) and/or antihistamines administered to patients with prior contrast reactions or allergies to reduce the risk of repeat adverse events.
Question 4: Which of the following is NOT a gadolinium-based contrast agent (GBCA) used in MRI?
- Gadobutrol (Gadavist)
- Gadopentetate dimeglumine (Magnevist)
- Iohexol (Omnipaque) (Correct answer)
- Gadobenate dimeglumine (MultiHance)
Correct answer: Iohexol (Omnipaque)
Iohexol (Omnipaque) is a non-ionic iodinated contrast agent used primarily for CT and myelography; the other three are gadolinium-based MRI contrast agents.
Question 5: Oral contrast media administered to a patient undergoing a CT of the abdomen is typically handled how under Medicare billing?
- Reported separately using HCPCS Q-codes for contrast volume used
- Billed using J-codes as an oral drug administration
- Generally bundled into the CT procedure and not separately billable to Medicare (Correct answer)
- Reported using a separate CPT code for ingestion supervision
Correct answer: Generally bundled into the CT procedure and not separately billable to Medicare
Oral contrast media for CT studies is considered packaged by Medicare and most payers and is not separately billable, unlike intravenous contrast agents which have specific HCPCS codes.
Question 6: Which component of the radiology bill should carry the HCPCS contrast media code when a facility and a physician both bill separately for the same imaging study?
- The professional component (Modifier 26) claim filed by the radiologist
- The technical component (Modifier TC) or facility claim (Correct answer)
- Both the professional and technical component claims simultaneously
- A separate claim filed under the patient's pharmacy benefit only
Correct answer: The technical component (Modifier TC) or facility claim
Contrast media is a supply consumed by the facility; therefore, the HCPCS contrast code is reported on the technical component or facility claim, not the physician's professional component claim.
Question 7: An anaphylactoid reaction to iodinated contrast media is best characterized by which set of clinical findings occurring within minutes of administration?
- Delayed urticaria appearing 1-3 days after administration
- Urticaria, bronchospasm, and hypotension requiring immediate treatment (Correct answer)
- Contrast-induced nephropathy with rising creatinine over 48 hours
- Mild nausea and warmth sensation that resolves spontaneously
Correct answer: Urticaria, bronchospasm, and hypotension requiring immediate treatment
An anaphylactoid (immediate hypersensitivity-type) contrast reaction presents with urticaria, bronchospasm, and hypotension within minutes and requires immediate treatment with epinephrine.
RCC Contrast Media, Supplies & HCPCS Level II Coding 2
Which CPT code represents a CT of the abdomen and pelvis performed WITH intravenous contrast material?