What Is the Correct CPT Code for a CT Abdomen and Pelvis Performed With and Without Contrast?

Medical billing and coding can often feel complex, especially when it comes to imaging services. One common question that arises is: What is the correct CPT code for a CT scan of the abdomen and pelvis performed both with and without contrast? Using the proper Current Procedural Terminology (CPT) code is essential to ensure accurate reimbursement and compliance with payer requirements.

CPT 74178 – CT Abdomen and Pelvis With and Without Contrast

The correct CPT code for this procedure is 74178.

• CPT 74178 specifically represents a computed tomography (CT) scan of the abdomen and pelvis performed with and without intravenous (IV) contrast during the same encounter.
• This comprehensive code ensures that both phases (before contrast and after contrast administration) are covered in a single billing entry.

This procedure is often ordered when physicians need a detailed evaluation of abdominal and pelvic structures to identify abnormalities such as tumors, infections, vascular issues, or organ pathologies.

If you’d like to explore more on similar imaging-related coding, check out our guide on CPT Code 74177 – CT Abdomen and Pelvis with Contrast.

Why Use Contrast in CT Abdomen and Pelvis?

Contrast material is administered to highlight blood vessels, organs, and tissues for clearer imaging.

• Without contrast: Provides a baseline image of the abdomen and pelvis.
• With contrast: Enhances visualization of specific areas, making it easier to detect lesions or abnormal growths.

By combining both approaches in a single session, physicians can obtain a more accurate and complete diagnostic picture.

For practices handling multiple specialties, proper billing can be challenging. That’s why many rely on expert support like our Radiology Billing Services to reduce denials and improve cash flow.

Billing and Documentation Guidelines

When coding CPT 74178, keep the following in mind:

• Medical Necessity: Ensure that the ordering physician documents the reason why both contrast and non-contrast studies were required.
• Modifiers: In most cases, modifiers are not needed when reporting 74178, since the code already encompasses both phases.
• Insurance Coverage: Payers may require prior authorization for advanced imaging studies like CT abdomen/pelvis. Proper documentation is essential to avoid claim denials.

If you’d like to see how our team supports practices across specialties, visit our Medical Billing Services page.

Common Mistakes to Avoid

1. Using Separate Codes: Some coders mistakenly report 74176 (without contrast) and 74177 (with contrast) together. This is incorrect. Instead, use 74178 when both with and without contrast studies are performed in the same encounter.
2. Incomplete Documentation: If the radiology report doesn’t specify why both phases were required, insurance payers may deny reimbursement.
3. Not Verifying Payer Requirements: Different insurance companies may have specific rules for CT billing, so always confirm coverage guidelines.

Insurance and Compliance Considerations

Since CT imaging is a high-cost procedure, insurance companies are strict about approving and reimbursing these services. Providers should:

• Confirm pre-authorization requirements before scheduling.
• Keep detailed patient records explaining the medical necessity.
• Submit claims with the correct CPT code (74178) to prevent rejections.

For official coding guidance, you can reference the American Academy of Professional Coders (AAPC) CPT Code 74178 page.

Final Thoughts

The correct CPT code for a CT abdomen and pelvis performed with and without contrast is 74178. Using this code helps streamline billing, ensures compliance, and reduces the likelihood of claim denials. Healthcare providers should always pair accurate coding with thorough documentation to support medical necessity and secure proper reimbursement.