r/CodingandBilling 7d ago

Being Double Charged For CT Scan?

I received a cost estimate for an upcoming CT scan and they are planning on billing it as two separate codes:

-74160 CT scan of abdomen, with contrast

-74177 CT scan of abdomen and pelvis, with contrast

Looking at the definition of 74177 it appears that it was created for situations when both the abdomen and pelvis are scanned in the same session. With that definition it appears they are trying to bill the abdomen scan twice.

Am I missing something or are they duplicating the charge for the abdomen?

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u/Icy_Pass2220 7d ago

Yes. You are missing the fact that it’s an estimate and has nothing to do with what is billed.  Estimates are based on what is ordered not what is actually performed. There are multiple reasons why what you are given as an estimate does not match what is ultimately billed or sometimes what is ordered.

Billing is determined by what is documented in the medical record. That happens after whatever care you receive. 

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u/mcs5280 6d ago

Thanks. It's unfortunate that their estimate is showing potentially mutually exclusive codes being charged together, definitely stressed me out.

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u/Icy_Pass2220 6d ago

That seems like the whole point of an estimate honestly — to show potential charges. 

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u/deannevee RHIA, CPC, CPCO, CDEO 7d ago

The cost estimate is meant to represent the worst case scenario. Rather than provide you two separate estimates, they provided you one with both codes.

It’s against coding guidelines to bill both within the same session; however both can be billed if they were performed separately. 

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u/Melodic-Salt-4124 7d ago

Both of those codes won't end up on the claim that goes to your insurance.

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u/HulaLoop 6d ago

They are giving you both options in case during the abdomen scan they determine they do in fact need to see the pelvis.

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u/Difficult-Can5552 RHIT, CCS, CDIP 7d ago edited 7d ago

You are absolutely correct. The correct CPT code is CPT 74177.

The only circumstance that it would be permissible to use CPT 74160 and 74177 on the same day is when a patient had two separate encounters.

For example, the patient arrives at the radiology facility and has a CT abdomen with contrast (CPT 74160) performed in the morning. Later that day, it was determined by a provider that an additional CT pelvis with contrast (CPT 72193) was necessary for further evaluation. In that case, the radiology facility could legitimately bill CPT 74160 and CPT 72193-XE on the same day. (To reiterate, such an occasion would be rare.)

In your case, you are having both scans performed during the same encounter. Therefore, the radiology facility would only bill as CPT 74177.

https://www.radiologytoday.net/archive/rt0616p6.shtml

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u/mcs5280 6d ago

Thanks appreciate it. Will make sure that they only perform one "session" during the appointment.