A: No, an order that specifically requests the performance of wall motion and ejection fraction studies is not required in addition to a request for a cardiac stress SPECT or thallium stress SPECT study. The performance of wall motion and ejection fraction is part of the test design exception, as codified in the Medicare Carriers Manual Internet Only Manual, Section 80.6.5, which states:
Unless specified in the order, the interpreting physician may determine, without notifying the treating physician/practitioner, the parameters of the diagnostic test (e.g., number of radiographic views obtained, thickness of tomographic sections acquired, use or non-use of contrast media).
A: A noncontrast (un-enhanced) computed tomography of the abdomen, followed by the injection of 50 mL of air, and repeated noncontrast CT imaging of the abdomen is appropriately reported with CPT code 74150 (Computed tomography, abdomen; without contrast material). It is not appropriate to code for a contrast enhanced CT scan because the air injection is not considered sufficient to fulfill the requirements for a contrast study. As always, there needs to be an appropriate medical indication for this examination and an order from the referring physician.
More commonly, evaluation for position of an enteral catheter is done under fluoroscopic guidance and is reported with CPT code 49465 (Contrast injection(s) for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, from a percutaneous approach including image documentation and report) which includes the imaging guidance.