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A radiologic examination of the upper gastrointestinal (GI) tract is a diagnostic imaging procedure that focuses on visualizing the esophagus, stomach, and duodenum, which is the initial segment of the small intestine. This examination employs X-ray imaging technology, utilizing indirect ionizing radiation to capture images of the body's internal structures. The process relies on the varying densities and compositions of human tissues, allowing certain X-rays to be absorbed while others pass through, ultimately producing a two-dimensional image on a detector positioned behind the area being examined. This imaging technique is instrumental in diagnosing a range of conditions affecting the upper GI tract, including but not limited to ulcers, tumors, inflammation, hiatal hernias, scarring, obstructions, and abnormal anatomical configurations of the organs. Patients typically present with various symptoms that may prompt this examination, such as difficulty swallowing, chest or abdominal pain, vomiting, gastroesophageal reflux, indigestion, or the presence of blood in the stool. The procedure often commences with the acquisition of one or more anteroposterior (AP) abdominal scout films, which are taken in either an erect or supine position prior to the administration of contrast material. These initial images, known as KUB (kidneys, ureters, and bladder) films, provide a baseline view of the abdominal organs. In a single contrast study, designated by CPT® code 74240, the patient ingests a barium sulfate mixture that coats the esophagus and stomach, enhancing visibility during imaging. In contrast, a double contrast study, represented by CPT® code 74246, involves the use of both barium and an effervescent agent to create air contrast. This method requires the patient to ingest a substance that promotes air accumulation in the stomach, in conjunction with the high-density barium sulfate mixture. Additionally, glucagon may be administered to relax the muscles in the area being examined, facilitating a clearer view of the structures. Fluoroscopic X-ray images are then captured and analyzed, with delayed images potentially being necessary to assess the movement of the contrast material or to confirm its emptying from the stomach. It is important to note that not all images may be available for immediate review. If multiple X-ray images of the small intestine are obtained following the barium's progression, CPT® code 74248 should be utilized for billing purposes as an additional follow-through study.
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The radiologic examination of the upper gastrointestinal tract is indicated for a variety of symptoms and conditions that may affect the esophagus, stomach, and duodenum. These indications include:
The procedure for conducting a double-contrast radiologic examination of the upper gastrointestinal tract involves several key steps:
Post-procedure care for patients undergoing a double-contrast radiologic examination of the upper gastrointestinal tract typically involves monitoring for any immediate adverse reactions to the contrast material. Patients may be advised to drink plenty of fluids to help eliminate the barium from their system and to resume normal dietary habits as tolerated. It is also common for patients to be informed about potential changes in bowel habits following the procedure, such as temporary constipation or lighter-colored stools due to the barium. Follow-up appointments may be scheduled to discuss the results of the examination and any further diagnostic steps that may be necessary based on the findings.
| Short Descr | X-RAY XM UPR GI TRC 2CNTRST | Medium Descr | RADIOLOGIC EXAM UPR GI TRC DOUBLE CONTRAST STUDY | Long Descr | Radiologic examination, upper gastrointestinal tract, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high-density barium and effervescent agent) study, including glucagon, when administered | 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) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% 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 | 99 - Concept Does Not Apply | APC Status Indicator | STV-Packaged Codes | ASC Payment Indicator | Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on MPFS nonfacility PE RVUs. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I1D - Standard imaging - contrast gastrointestinal | MUE | 1 | CCS Clinical Classification | 185 - Upper gastrointestinal X-ray |
This is a primary code that can be used with these additional add-on codes.
| 74248 | Add-on Code MPFS Status: Active Code APC N ASC N1 Radiologic small intestine follow-through study, including multiple serial images (List separately in addition to code for primary procedure for upper GI radiologic examination) |
| 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. | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | 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 | 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. | CR | Catastrophe/disaster related | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | FY | X-ray taken using computed radiography technology/cassette-based imaging | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 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. | 95 | Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system. | GA | Waiver of liability statement issued as required by payer policy, individual case | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | 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 | Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | 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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| 2020-01-01 | Changed | Code description changed. |
| 2016-01-01 | Changed | Description Changed |
| Pre-1990 | Added | Code added. |
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