Summary & Overview
CPT 74270: Contrast Radiographic Examination of the Colon
CPT code 74270 designates a contrast radiographic examination of the colon performed with rectal instillation of a contrast agent (such as barium), including a pre-contrast scout film and any delayed images. This diagnostic fluoroscopic procedure is used to evaluate colonic anatomy and pathology when endoscopic or cross-sectional imaging may be limited or as a complementary study. Nationally, the code matters because it defines billing, documentation, and coverage considerations for a commonly performed diagnostic radiology service across hospital and outpatient settings.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical purpose of the service, typical sites of service, and common modifiers used with the code. The publication provides benchmarking context for utilization and reimbursement patterns, highlights relevant policy and coverage considerations that affect access and billing, and summarizes clinical scenarios where this examination is typically considered.
This piece is written for a national audience and is intended to serve radiology administrators, billing and coding staff, and policy analysts seeking a clear summary of CPT code 74270, how it is used clinically, and the types of payer considerations that commonly arise.
Billing Code Overview
CPT code 74270 describes radiographic imaging of the colon after instillation of a contrast agent (for example, barium) introduced per rectum. The service includes a scout abdominal film obtained prior to contrast administration and any delayed images obtained as part of the examination.
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Service type: Contrast fluoroscopic radiographic examination of the colon (barium enema/contrast enema study).
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Typical site of service: Hospital radiology department, outpatient imaging center, or ambulatory surgical center where diagnostic fluoroscopic studies are performed.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old adult referred by primary care for evaluation of chronic lower abdominal pain and intermittent rectal bleeding. The gastroenterologist orders a contrast radiographic study of the colon to evaluate colonic anatomy and detect filling defects, strictures, or diverticular disease when colonoscopy is incomplete, contraindicated, or not tolerated. The patient arrives to the radiology suite after bowel preparation. A scout abdominal radiograph is obtained, followed by retrograde instillation of barium (or water-soluble contrast) via a rectal catheter. Spot images and delayed views are obtained to assess mucosal contour, transit, and extraluminal leakage if suspected. The study is performed under fluoroscopic guidance by a radiologist or qualified provider; a radiologic technologist assists with positioning, contrast administration, and image acquisition. Clinical workflow includes informed consent, review of anticoagulation status, verification of bowel prep adequacy, performance of the scout film, contrast administration with fluoroscopic monitoring, acquisition of requisite spot and delayed images, interpretation by the reporting provider, and documentation of findings and any immediate complications in the radiology report.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the interpreting physician's professional portion in a split technical/professional arrangement. |