Abdomen Imaging Guidelines

This policy covers abdominal imaging modalities (CT, MRI, ultrasound and associated contrast protocols) for evaluation of common abdominal symptoms and a wide range of specific conditions including abdominal pain, suspected abscess/sepsis, renal/ureteral stones, post‑operative pain, blunt abdominal trauma, bariatric/hernia evaluation, abdominal masses, and vascular aneurysm assessment. Advanced imaging generally requires a current clinical evaluation within 60 days and physician review for atypical presentations; contrast rules include separate coding for IV contrast (oral contrast not coded), CT without IV contrast for renal insufficiency or severe contrast allergy, precontrast CT rarely needed except after locoregional embolic/ablative therapy, and gadolinium is contraindicated in pregnancy.

"CT abdomen and pelvis with contrast (CPT® 74177) if ultrasound is nondiagnostic and MRI/MRCP cannot be performed"