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A radiologic examination of the colon, designated by CPT® Code 74280, is a diagnostic imaging procedure that provides detailed visualization of the colon, which includes the right ascending colon, transverse colon, left descending colon, sigmoid colon, and rectum. This examination may also capture images of the appendix and a portion of the distal small intestine. The procedure employs X-ray imaging, which utilizes indirect ionizing radiation to create images of the body's internal structures. The varying densities and compositions of human tissues allow some X-rays to be absorbed while others pass through, resulting in a two-dimensional representation of the anatomical structures on a detector. This imaging technique is instrumental in diagnosing various gastrointestinal conditions, including tumors, inflammatory bowel diseases such as Crohn's disease and ulcerative colitis, irritable bowel syndrome, obstructions, and abnormal anatomical configurations, such as Hirschsprung's disease in pediatric patients. Patients typically present with a range of symptoms that may include weight loss, the presence of blood in the stool, abdominal pain, and alterations in bowel habits, such as diarrhea or constipation. The examination process often begins with one or more scout films taken in an anteroposterior (AP) view, either in an erect or supine position, prior to the administration of contrast material. These initial images help visualize surrounding organs, including the kidneys, ureters, and bladder, as well as the colon itself. In a single contrast study, a small tube is inserted into the rectum to instill high-density barium contrast material, which is allowed to flow via gravity. The patient may be repositioned to facilitate the distribution of the contrast throughout the large intestine. In contrast, a double contrast study, as indicated by CPT® Code 74280, involves the use of both high-density barium and air contrast, with the air being insufflated into the colon. Additionally, glucagon may be administered intravenously to induce colonic hypotonia, thereby alleviating discomfort and spasms associated with the distension of the colon during the procedure. The physician utilizes fluoroscopic X-ray to visualize the colon in real-time, allowing for direct observation of its function and the acquisition of spot films as necessary. In some cases, delayed images may be required to assess slow movement or to confirm the complete emptying of the contrast material from the colon.
© Copyright 2025 Coding Ahead. All rights reserved.
The radiologic examination of the colon, as described by CPT® Code 74280, is indicated for a variety of gastrointestinal conditions and symptoms. The following are explicitly provided indications for this procedure:
The procedure for a double-contrast radiologic examination of the colon 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 colon, patients may be monitored for any immediate post-procedural effects. It is common for patients to experience some mild discomfort or cramping due to the insufflation of air and the presence of barium in the colon. Patients are typically advised to increase their fluid intake to help facilitate the elimination of the barium from their system. Additionally, they may be instructed to resume normal dietary habits unless otherwise directed by their healthcare provider. Follow-up appointments may be scheduled to discuss the results of the examination and any further diagnostic or therapeutic steps that may be necessary based on the findings.
| Short Descr | X-RAY XM COLON 2CNTRST STD | Medium Descr | RADIOLOGIC EXAM COLON DOUBLE CONTRAST STUDY | Long Descr | Radiologic examination, colon, including scout abdominal radiograph(s) and delayed image(s), when performed; double-contrast (eg, high density barium and air) 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 | Packaged service/item; no separate payment made. | 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. | 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 | 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). | 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) | CR | Catastrophe/disaster related | FY | X-ray taken using computed radiography technology/cassette-based imaging | GA | Waiver of liability statement issued as required by payer policy, individual case | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | PN | Non-excepted service provided at an off-campus, outpatient, provider-based department of a hospital | 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 | 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 | 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. |
| Pre-1990 | Added | Code added. |
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