CPT® Code 74246

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

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.