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Official Description

Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections

© Copyright 2025 American Medical Association. All rights reserved.

Common Language Description

Computed tomography (CT) of the upper extremity is a diagnostic imaging procedure that provides detailed visualization of the arm's tissues and bone structures. This technique employs multiple, narrow X-ray beams that rotate around a single axis, capturing a series of two-dimensional (2D) images from various angles. The initial phase of the procedure is performed without the use of contrast material, allowing for a baseline assessment of the upper extremity. Following this, contrast material is administered to enhance the visibility of the structures within the arm, facilitating a more comprehensive evaluation. The contrast material, typically an iodine-based dye, improves the differentiation of tissues, making it easier to identify abnormalities. Advanced computer software processes the collected data to generate several thin, cross-sectional 2D slices of the targeted area, which can be stacked to create three-dimensional models of the arm. This imaging technique is particularly useful for diagnosing a range of conditions, including tumors, abscesses, and masses, as well as evaluating bone integrity for degenerative conditions, fractures, or injuries resulting from trauma. The physician interprets the CT scan results, documenting any findings and abnormalities in a written report for further clinical consideration.

© Copyright 2025 Coding Ahead. All rights reserved.

1. Indications

The procedure is indicated for various clinical scenarios where detailed imaging of the upper extremity is necessary. The following conditions may warrant the use of this CT scan:

  • Suspected Tumors - The procedure is performed to locate and evaluate the presence of tumors within the arm.
  • Abscesses or Masses - CT imaging helps in identifying and assessing abscesses or other abnormal masses in the upper extremity.
  • Bone Evaluation - The scan is utilized to evaluate the bones for degenerative conditions, fractures, or other injuries, particularly after trauma.
  • Pain or Swelling Investigation - The procedure assists in determining the underlying causes of unexplained pain or swelling in the arm.

2. Procedure

The procedure consists of several key steps that ensure comprehensive imaging of the upper extremity:

  • Initial CT Imaging Without Contrast - The patient is positioned on the CT scanner table, and initial images of the upper extremity are obtained without the use of contrast material. This step provides a baseline view of the arm's structures.
  • Administration of Contrast Material - After the initial imaging, contrast material is administered intravenously. This enhances the visibility of the tissues and structures within the arm, allowing for a more detailed assessment.
  • Acquisition of Additional Sections - Following the administration of contrast, further sections of the upper extremity are obtained. This step captures additional images that highlight the enhanced areas, providing a clearer view of any abnormalities.
  • Image Review and Interpretation - The physician reviews the acquired images, noting any abnormalities or areas of concern. A written interpretation of the findings is then documented for clinical use.

3. Post-Procedure

After the procedure, patients may be monitored briefly to ensure there are no adverse reactions to the contrast material. Typically, there are no specific post-procedure care requirements, and patients can resume normal activities unless otherwise directed by their physician. The results of the CT scan will be communicated to the patient during a follow-up appointment, where the physician will discuss the findings and any necessary next steps based on the results.

Short Descr CT UPPR EXTREMITY W/O&W/DYE
Medium Descr CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL
Long Descr Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections
Status Code Active Code
Global Days XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC) 1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51) 4 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic imaging procedures apply...
Bilateral Surgery (50) 3 - The usual payment adjustment for bilateral procedures does not apply.
Physician Supervisions 09 - Concept does not apply.
Assistant Surgeon (80, 82) 0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62) 0 - Co-surgeons not permitted for this procedure.
Team Surgery (66) 0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family 88 -
APC Status Indicator Codes That May Be Paid Through a Composite APC
ASC Payment Indicator Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight.
Type of Service (TOS) 4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS) I2B - Advanced imaging - CAT/CT/CTA: other
MUE 2
CCS Clinical Classification 180 - Other CT scan

This is a primary code that can be used with these additional add-on codes.

0722T Add On Code MPFS Status: Carrier Priced APC S Quantitative computed tomography (CT) tissue characterization, including interpretation and report, obtained with concurrent CT examination of any structure contained in the concurrently acquired diagnostic imaging dataset (List separately in addition to code for primary procedure)
RT Right side (used to identify procedures performed on the right side of the body)
26 Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
LT Left side (used to identify procedures performed on the left side of the body)
50 Bilateral procedure: unless otherwise identified in the listings, bilateral procedures that are performed at the same session, should be identified by adding modifier 50 to the appropriate 5 digit code. note: this modifier should not be appended to designated "add-on" codes (see appendix d).
51 Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
59 Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
76 Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
77 Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
CT Computed tomography services furnished using equipment that does not meet each of the attributes of the national electrical manufacturers association (nema) xr-29-2013 standard
GA Waiver of liability statement issued as required by payer policy, individual case
GC This service has been performed in part by a resident under the direction of a teaching physician
GW Service not related to the hospice patient's terminal condition
MC Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues
ME The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
MF The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
MG The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional
MH Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider
Q1 Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q6 Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
TC Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
X5 Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
XE Separate encounter, a service that is distinct because it occurred during a separate encounter
XS Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
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2003-01-01 Changed Code description changed.
Pre-1990 Added Code added.
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