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A radiologic examination of the small intestine, specifically coded as CPT® Code 74251, is a specialized imaging procedure designed to visualize the duodenum, jejunum, and ileum. This examination employs a double-contrast technique, which involves the use of both high-density barium and air, administered via an enteroclysis tube. The process begins with the patient undergoing a series of X-ray images, which utilize indirect ionizing radiation to capture detailed pictures of the internal structures of the body. X-rays are particularly effective in imaging non-uniform materials, such as human tissue, due to the varying densities and compositions of these materials. This differential absorption of X-rays results in a two-dimensional representation of the anatomical structures being examined. The primary purpose of this radiologic examination is to diagnose various conditions affecting the small intestine, including but not limited to ulcers, tumors, inflammation, scarring, obstructions, and any abnormal positioning or configuration of the organs. Patients may present with a range of symptoms that warrant this examination, such as unexplained weight loss, the presence of blood in the stool, abdominal pain, indigestion, or abdominal distention. Before the administration of contrast, the procedure typically begins with one or more anteroposterior (AP) scout films, which are taken with the patient in either an erect or supine position. For a single contrast study, the patient ingests a barium sulfate mixture that coats the gastrointestinal tract. In contrast, the double-contrast study (CPT® Code 74251) involves the infusion of a high-contrast barium sulfate mixture through an enteroclysis tube directly into the duodenum, along with the introduction of air to enhance the imaging quality. Additionally, glucagon may be administered to relax the muscles of the small intestine, facilitating a clearer view of the structures. The radiologist then utilizes fluoroscopic X-ray to visualize the small intestine in real-time, allowing for the observation of its function while obtaining multiple serial images as necessary for a comprehensive assessment.
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The radiologic examination of the small intestine, coded as CPT® Code 74251, is indicated for a variety of gastrointestinal symptoms and conditions. The following are explicitly provided indications for performing this procedure:
The procedure for a double-contrast radiologic examination of the small intestine involves several key steps, each critical for ensuring accurate imaging and diagnosis. The following procedural steps are outlined:
After the completion of the double-contrast radiologic examination of the small intestine, the patient may be monitored for a short period to ensure there are no immediate adverse reactions to the contrast material. It is common for patients to be advised to resume normal dietary habits unless otherwise instructed by their healthcare provider. Additionally, the radiologist will review the obtained images and prepare a report detailing the findings, which will be communicated to the referring physician for further evaluation and management. Patients may be informed about potential side effects of the contrast material, such as constipation or changes in bowel habits, and should be encouraged to report any unusual symptoms following the procedure.
| Short Descr | X-RAY XM SM INT 2CNTRST STD | Medium Descr | RADIOLOGIC EXAM SMALL INT DOUBLE CONTRAST STUDY | Long Descr | Radiologic examination, small intestine, including multiple serial images and scout abdominal radiograph(s), when performed; double-contrast (eg, high-density barium and air via enteroclysis tube) 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 OPPS relative payment weight. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | I1D - Standard imaging - contrast gastrointestinal | MUE | 1 | CCS Clinical Classification | 186 - Lower gastrointestinal X-ray |
| 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | 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. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GW | Service not related to the hospice patient's terminal condition | 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 | 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 | 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 |
| 2002-01-01 | Changed | Code description changed. |
| 1994-01-01 | Added | First appearance in code book in 1994. |
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