CPT® Code 74249 | Case2Code

Code deleted, see 74246, 74248

Official Description

Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with small intestine follow-through

Common Language Description

A radiological examination of the upper gastrointestinal (GI) tract, specifically coded as CPT® Code 74249, involves the use of advanced imaging techniques to visualize the esophagus, stomach, and duodenum, which is the initial segment of the small intestine. This procedure employs indirect ionizing radiation to capture images of the GI tract, taking advantage of the varying densities and compositions of human tissues. The process allows certain x-rays to be absorbed while others pass through, resulting in a two-dimensional representation of the internal structures. This examination is crucial for diagnosing a range of gastrointestinal conditions, including ulcers, tumors, inflammation, hiatal hernias, scarring, obstructions, and abnormal anatomical configurations. Patients typically present with symptoms such as difficulty swallowing, chest or abdominal pain, vomiting, reflux, indigestion, or the presence of blood in the stool, which may prompt the need for this diagnostic procedure. The examination often commences with an anteroposterior (AP) scout film, which is a preliminary x-ray taken in either an erect or supine position, capturing images of the kidneys, ureters, and bladder, collectively referred to as a KUB. For the air contrast study, the patient ingests a specific high-density barium sulfate mixture, which coats the esophagus and stomach, while also facilitating the buildup of air in the stomach as it is digested. Additionally, glucagon may be administered to relax the muscles in the area being examined, enhancing the clarity of the images obtained. X-ray images of the esophagus and stomach are captured as needed, and if the movement of the contrast is slow, delayed images may be taken to assess the emptying of the contrast material. It is important to note that not all images from this procedure may be available for immediate review, and specific coding is required based on the components of the procedure performed, such as using code 74246 for procedures without a KUB, or 74247 when a KUB is included, while CPT® Code 74249 is designated for instances where x-ray images of the small intestine are also captured following the administration of the barium sulfate mixture.

1. Indications

The radiological examination of the upper gastrointestinal tract, coded as CPT® Code 74249, is indicated for a variety of gastrointestinal symptoms and conditions. These include:

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 imaging to identify potential gastrointestinal disorders.
Vomiting - Persistent vomiting can be a sign of obstructions or other serious conditions within the GI tract.
Reflux - Symptoms of gastroesophageal reflux disease (GERD) may require evaluation of the esophagus and stomach.
Indigestion - Chronic indigestion can warrant further investigation to rule out structural abnormalities.
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, which are detailed as follows:

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, which aids in obtaining clear images.
Step 2: Anteroposterior (AP) Scout Film - The procedure begins with the acquisition of a single AP scout film, which is taken in either an erect or supine position. This initial imaging captures the kidneys, ureters, and bladder (KUB) and serves as a baseline for further examination.
Step 3: Administration of Contrast Agents - The patient ingests a high-density barium sulfate mixture, which coats the esophagus and stomach, providing contrast for the x-ray images. Additionally, an effervescent agent may be used to create air within the stomach, enhancing the visibility of the structures.
Step 4: Use of Glucagon - Glucagon may be administered to relax the muscles of the gastrointestinal tract, facilitating better imaging of the esophagus and stomach.
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 area.
Step 6: Delayed Imaging - If the movement of the barium contrast is slow, delayed images may be obtained to assess the emptying of the contrast material from the stomach into the small intestine.

3. Post-Procedure

After the completion of the radiological examination, patients may be monitored for any immediate reactions to the contrast agents used. 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. Follow-up instructions may include monitoring for any unusual symptoms and scheduling further evaluations if necessary, based on the findings from the imaging study. The results of the examination will be interpreted by a radiologist, and a report will be generated for the referring physician to discuss with the patient.

Short Descr	CONTRST X-RAY UPPR GI TRACT
Medium Descr	RADEX GI UPR W/WO GLUCOSE W/SM INTEST FOLLW-THRU
Long Descr	Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with small intestine follow-through
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	Procedure or Service, Not Discounted when Multiple
Type of Service (TOS)	4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS)	I1D - Standard imaging - contrast gastrointestinal
MUE	Not applicable/unspecified.
CCS Clinical Classification	185 - Upper gastrointestinal X-ray