CPT® 74177 - Computed tomography, abdomen and pelvis; with contrast material(s) - JE Part B
CPT® 74177 - Computed tomography, abdomen and pelvis; with contrast material(s)
In order to fulfill its contractual obligation with CMS, Noridian Healthcare Solutions (Noridian), your Medicare Contractor, performs pre-payment reviews in accordance with CMS direction. CMS is required by the Social Security Act to ensure that payment is made only for those medical services that are reasonable and necessary. Medical review assesses submitted documentation to validate provider compliance with Medicare payment rules and regulations, including coverage, coding and billing guidelines.
This is to update providers of the claim review findings for CPT® 74177 - Computed tomography, abdomen and pelvis; with contrast material(s). The results of this focused review are not a reflection on providers' competence as a health care professional or the quality of care provided to patients. Specifically, the results are based on the documentation requested by Medicare and/or your facility's compliance with the required documentation.
The Jurisdiction E, Part B Medical Review Department is conducting a Targeted Probe and Educate (TPE) review of CPT® 74177 - Computed tomography, abdomen and pelvis; with contrast material(s). The quarterly edit effectiveness results from October 1, 2024, through December 31, 2024, are as follows:
Top Denial Reasons
- The requested records were not received
- The documentation submitted does not support medical necessity as listed in coverage requirements in the National Coverage Determination or Local Coverage Determination.
- The documentation submitted was incomplete and/or insufficient.
Educational Resources
Education
Computed tomography directs multiple thin beams of x-rays at the body structure being studied and uses computer imaging to produce thin, cross-sectional views of various layers (or slices) of the body. It is useful for the evaluation of trauma, tumor, and foreign bodies as CT is able to visualize soft tissue as well as bones. Patients are required to remain motionless during the study and sedation may need to be administered, as well as a contrast medium for image enhancement. These codes report an exam of the abdomen and pelvis. Report 74176 if no contrast is used; 74177 if performed with contrast; and 74178 if performed first without contrast in one or both body regions followed by the injection of contrast and further sections in one or both body regions.
Failure to Return Records
The Internet-Only Manual (IOM) addresses timeframes for submission of records for pre-payment reviews in the Medicare Program Integrity Manual, Publication 100-08, Chapter 3, Section 3.2.3.2.
"When requesting documentation for prepayment review, the MAC and ZPIC shall notify providers that the requested documentation is to be submitted within 45 calendar days of the request. The reviewer should not grant extensions to providers who need more time to comply with the request. Reviewers shall deny claims for which the requested documentation was not received by day 46."
Incomplete And/or Insufficient Documentation
When additional documentation has been requested to verify compliance with the CPT® code billed and the submitted documentation lacks evidence to support that, the claim will be denied as the documentation submitted was incomplete and/or insufficient. Refer to Internet Only Manual (IOM), Publication (Pub) 100-08, Medicare Program Integrity Manual, Chapter 3, Section 3.2.3.8(C)
For additional educational resources, please visit our Education and Outreach department.
