Ask Dr. Z

One of the changes made this year is to break CPT 74220 into two codes, to distinguish between single contrast exams and double contrast exams. Code 74220 has been retained, but redefined as "single contrast". Code 74221 has been added as a new code for "double contrast" exams. The example given for 74221 is an exam in which both barium and a solution of sodium bicarbonate crystals in water are administered. Scenario 1: Does the definition of 74221 apply only to studies in which both barium and an effervescent agent are administered, or does it also apply to studies in which any two contrast agents are used? Scenario 2: How would we code the occasional study in which water-soluble contrast, barium, and an effervescent agent all are administered? The definition of 74221 is specifically "double contrast". Would we have to report such a study with unlisted code 76499?