CPT® Code 74247

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1. Indications

The radiological examination of the upper gastrointestinal tract, as described by CPT® Code 74247, is indicated for a variety of gastrointestinal symptoms and conditions. The following are explicitly provided indications for this procedure:

• Difficulty Swallowing - Patients may experience challenges in swallowing, which can indicate underlying esophageal or gastric issues.
• Chest or Abdominal Pain - Unexplained pain in the chest or abdomen may necessitate further investigation of the upper GI tract.
• Vomiting - Persistent vomiting can be a sign of gastrointestinal obstruction or other serious conditions that require evaluation.
• Reflux - Symptoms of gastroesophageal reflux disease (GERD) may prompt the need for imaging to assess the esophagus and stomach.
• Indigestion - Chronic indigestion can be associated with various GI disorders that may be evaluated through this examination.
• Blood in Stool - The presence of blood in the stool is a critical symptom that may indicate serious gastrointestinal pathology.

2. Procedure

The procedure for the radiological examination of the upper gastrointestinal tract involves several key steps, each critical for obtaining accurate diagnostic images. The following procedural steps are outlined:

• Step 1: Patient Preparation - Prior to the examination, the patient is typically instructed to fast for a specified period to ensure that the stomach is empty. This preparation is essential for clear imaging results.
• Step 2: Initial Scout Film (KUB) - The procedure begins with the acquisition of a KUB scout film, which is taken in either an erect or supine position. This initial imaging captures the kidneys, ureters, and bladder, providing a baseline for the subsequent examination of the upper GI tract.
• Step 3: Administration of Contrast Agents - The patient is then given a specific high-density barium sulfate mixture to ingest. This substance coats the esophagus and stomach, enhancing the visibility of these structures during the X-ray imaging process. Additionally, an effervescent agent may be administered to promote the buildup of air in the stomach.
• Step 4: Use of Glucagon - Glucagon may be administered to the patient to relax the muscles of the gastrointestinal tract, facilitating better imaging and reducing discomfort during the procedure.
• Step 5: X-ray Imaging - X-ray images of the esophagus and stomach are taken as indicated. The radiologist may capture multiple images from different angles to ensure comprehensive visualization of the upper GI tract.
• Step 6: Delayed Imaging (if necessary) - If the movement of the contrast material is slow or if there is a need to verify the emptying of the stomach, delayed images may be obtained to provide additional diagnostic information.

3. Post-Procedure

After the completion of the radiological examination, patients may be monitored for any immediate reactions to the contrast agents used during the procedure. It is common for patients to be advised to drink plenty of fluids to help eliminate the barium from their system. Additionally, they may be informed about potential side effects, such as constipation, which can occur due to the barium. Patients should also be instructed to report any unusual symptoms or discomfort following the procedure. The images obtained during the examination will be reviewed by a radiologist, who will provide a detailed report to the referring physician for further evaluation and management of the patient's condition.