CurrentKaiser PermanentePolicy N/A

CT Enterography (CTE) for Small Bowel Disease

Defines indications, contraindications, and operational notes for performing CT enterography (and MR enterography) in the Georgia region Kaiser Permanente system for evaluation of suspected small bowel disease, tumors, and obscure GI bleeding.

Policy Summary

PayerKaiser Permanente

PolicyCT Enterography (CTE) for Small Bowel Disease

Policy CodePolicy N/A

Change TypeReviewed/Revised

Effective Date10/1/2008

Next Review Date8/8/2025

Key ActionDocument the clinical indication and prior negative upper endoscopy and colonoscopy when applicable to support the use of CT enterography.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

3CPT/HCPCS codes listed

8/8/2024Last revision date

10/1/2008Effective since

Indications and Contraindications for CT Enterography

Indications (When CT Enterography is Appropriate)

CT enterography is acceptable and preferred in the following clinical situations:

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ANY of the following

Suspected small bowel disease including Crohn's disease
Suspected or known small bowel tumors
Anemia and gastrointestinal bleeding when upper endoscopy (EGD) and colonoscopy are negative (obscure GI bleeding)
Suspected small bowel abnormalities and malabsorption
Monitoring of Crohn's disease progression or regression via imaging changes between CT enterography examinations

Preference note when Crohn's suspected

If Crohn's disease is suspected, CT enterography is preferable over capsule endoscopy because significant inflammation can lead to capsule obstruction

Contraindications / When CT Enterography is Not Appropriate

CT enterography should not be performed when any of the following are present:

ANY of the following

Known or suspected bowel ischemia
Question of perforation and/or free intraperitoneal air on plain abdominal radiograph

Operational/Administrative Requirements

Local practice and operational notes relevant to scheduling and performance:

ALL of the following

CT enterography and MR enterography are performed internally and should not be sent out
CT enterography is distinct from CT colonography and should not be conflated

Relevant CPT / HCPCS and ICD-10 Codes

CPT / HCPCS codes referencedCPT|HCPCS

74160	Computed tomography, abdomen; with contrast material(s), including computed tomographic angiography when performed
72193	Magnetic resonance (eg, proton) imaging, pelvis; without contrast material, followed by contrast material and further sequences
74177	Computed tomography, abdomen and pelvis; with contrast material(s)

ICD-10 diagnoses listedICD-10

C26.9	Malignant neoplasm of digestive organ, unspecified
D13.2	Benign neoplasm of colon
D13.3	Benign neoplasm of rectum and anal canal
D13.39	Benign neoplasm of other and ill-defined parts of large intestine
K50.00	Crohn's disease of small intestine without complications

Documentation, Denial Risks, and Operational Requirements

Documentation Required

Document indication and prior workup

Document clinical indication (e.g., suspected Crohn's, obscure GI bleeding) and prior negative upper endoscopy and colonoscopy when applicable to support the use of CT enterography.

Affected codes: 74160, 74177

Denial Risk

Avoid in ischemia/perforation

Do not perform CT enterography if there is known or suspected bowel ischemia or evidence of perforation/free air; such use would be contraindicated and may be denied.

Billing Rule

Internal performance requirement

CT enterography and MR enterography exams should be performed internally within the Kaiser system and not referred out.

Clinical and Modality Context

CT enterography (CTE) uses multidetector CT with large-volume neutral oral contrast to distend the small bowel and enhance visualization of the bowel wall, lumen, mural and perienteric disease; it is the first-line imaging modality for suspected inflammatory bowel disease, including Crohn's disease, because it clearly depicts mural hyperenhancement, stratification, thickening, engorged vasa recta, and perienteric inflammatory changes. [

Terms and Definitions

Definitions

CT Enterography (CTE)A CT study of the small bowel using ingestion of neutral enteric contrast to distend the bowel and enhance visualization of the bowel wall and lumen.

MR Enterography (MRE)Magnetic resonance imaging of the small bowel using neutral oral contrast; avoids ionizing radiation and is useful for serial imaging.

Obscure GI bleedingGastrointestinal bleeding for which no source is identified after adequate upper endoscopy (EGD) and colonoscopy.