Summary & Overview
CPT 74251: Small Bowel Double-Contrast Radiography
CPT code 74251 represents a double-contrast fluoroscopic and radiographic examination of the small intestine performed after infusion of high-density barium and air through an enteric tube. This diagnostic imaging procedure evaluates small-bowel anatomy and motility and can help detect strictures, mucosal disease, obstruction, and other pathology. Nationally, 74251 is relevant for hospitals, outpatient imaging centers, and radiology practices because it requires specialized fluoroscopy equipment, personnel skilled in enteric tube placement, and appropriate contrast handling.
Key payers included in this analysis are Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context and service setting, common billing modifiers and considerations, and comparisons to related imaging services. The publication summarizes typical sites of service and the procedure components covered by the code, highlights payer coverage patterns and administrative considerations where available, and outlines clinical indications that commonly prompt use of this study.
This executive summary is intended to orient billing and clinical staff, revenue cycle teams, and policy analysts to the clinical purpose and billing context of CPT code 74251, including practical notes on documentation and coding workflows. Data not available in the input is explicitly noted in section-level details elsewhere.
Billing Code Overview
CPT code 74251 describes a double-contrast radiographic examination of the small intestine performed after infusion of high-density barium and air through an enteric tube passed via the nose or mouth into the duodenum or small intestine. The service includes a scout film, if performed, and sequential X-ray exposures following contrast instillation. Glucagon, when used, is typically given by intravenous infusion prior to the procedure.
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Service type: Diagnostic radiology procedure — fluoroscopic and radiographic evaluation of the small bowel using double-contrast enteric administration
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Typical site of service: Hospital radiology department or outpatient imaging center with fluoroscopy capability; procedure may also occur in ambulatory surgical centers equipped for enteric tube placement and fluoroscopic imaging
Clinical & Coding Specifications
Clinical Context
A 48-year-old patient presents with chronic intermittent abdominal pain, unexplained weight loss, and intermittent melena despite negative upper endoscopy and colonoscopy. The gastroenterologist orders a double-contrast small bowel follow-through with enteric intubation to evaluate for Crohn disease, small-bowel neoplasm, or subtle mucosal ulceration. The patient arrives to the radiology suite fasting; an initial scout radiograph is obtained. A nasoenteric tube is advanced under fluoroscopic guidance through the nose, past the stomach, and into the duodenum or proximal jejunum. High-density barium is infused through the tube followed by room air (double-contrast technique). Sequential fluoroscopic spot radiographs and timed radiographs of the small intestine are obtained to evaluate mucosal pattern, strictures, or mass effect. Intravenous glucagon may be administered prior to contrast instillation to reduce bowel motility. The procedure is typically performed in an outpatient radiology department or hospital imaging suite with monitoring by radiology technologists and a radiologist for interpretation; sedation is uncommon. Images are processed and a diagnostic radiology report is generated and routed to the referring gastroenterologist for further management decisions.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional Component | Use when reporting only the physician’s interpretation/report for the radiologic service separate from the technical component |