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Computed Tomography (CT) Enterography

CT enterography is not a specific procedure but rather a protocol used with CT abdomen, CT pelvis or CT abdomen and pelvis. It uses CT imaging and two types of contrast to better visualize the anatomy of the interior small intestines.

For years endoscopic techniques were the only tools available and they were not as effective in visualizing or producing clear images of the anatomy, diseases and conditions affecting the small bowel. Advances in technology have brought about the double balloon enteroscopy and capsule endoscopy but visualizing the interior anatomy of the small intestines remained an issue.

CT enterography has been very successful in properly diagnosing such problems as:

• identifying areas of inflammation
• locating tumors and abscesses
• visualizing bleeding ulcers
• diagnosing bowel obstruction
• finding the source of bleeding
• diagnosing diseases and disorders such as: Crohn's, celiac sprue, and neoplasms

Technique:

The patient is asked to drink a large amount of neutral or low density oral contrast to allow for better visualization of the walls of the small bowel during CT. Additional high density contrast is administered intravenously to highlight the edges or lumen of the small bowel for better identification of the interior portions.

There is a risk of radiation exposure, as CT enterography does use x-ray technology and allergic reaction to the low and high density contrast.

How do you code CT enterography?

Review the report carefully, looking for what was ordered and the technique used. Verify if the CT enterography was performed on the abdomen, pelvis, or both (abdomen/pelvis) and whether or not contrast was intravenously administered or not. The oral contrast is not a factor for code decision in this case.

In January of 2011 CT abdomen and pelvis (with 74177, without 74176, and with and without 74178 contrast) was added to the CPT code book. Look through the report to verify the location and whether or not IV contrast was used.

• John Hopkins Medicine; Health Library, CT Enterography (http://www.hopkinsmedicine.org/healthlibrary/test_procedures/gastroenterology/ct_enterography_135,60/)
• Medlearn, February 28, 2011, question and answer (http://www.medlearn.com/bracco_qa/radbrcoa.htm)
  Nick Anderson, Interview with a CT technician

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Aimee Wilcox, MA, CST, CCS-P is a Certified Coding Guru (CCG) for Find-A-Code. For more information about ICD-10-CM, ICD-10-PCS, and medical coding and billing please visit FindACode.com where you will find the ICD-10 code sets and the current ICD-9-CM, CPT, and HCPCS code sets plus a wealth of additional information related to medical billing and coding.

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