CPT® Code 74280

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

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.