What CPT (Current Procedural Terminology) codes are used for a CT (Computed Tomography) angiography of the chest, abdomen, and pelvis with ECG (Electrocardiogram) gating?

CPT Coding for CT Angiography of Chest, Abdomen, and Pelvis with ECG Gating

For a CT angiography of the chest, abdomen, and pelvis with ECG gating, use CPT code 71275 (CTA chest with contrast) in combination with CPT code 74175 (CTA abdomen and pelvis with contrast), and append modifier 26 if interpreting only, or no modifier if performing both technical and professional components.

Primary CPT Code Selection

• CPT 71275 covers CT angiography of the chest with contrast material, including noncontrast images if performed and image postprocessing 1
• CPT 74175 covers CT angiography of the abdomen and pelvis with contrast material, including noncontrast images if performed and image postprocessing 1
• These codes should be reported together when imaging extends from chest through pelvis, as is standard practice for thoracic aortic pathology evaluation 1

ECG Gating Considerations

• ECG gating is included in the base CTA codes and does not require separate coding 1, 2
• ECG gating is particularly critical for temporal resolution of the ascending aorta where cardiac motion creates artifacts, and ensures measurements are made reliably in the same cardiac cycle phase 1
• Studies demonstrate 5-10% differences in proximal descending thoracic aortic measurements between systole and diastole, making ECG gating essential for accurate assessment 1
• ECG-gated CTA shows superior diagnostic performance compared to non-gated CTA for ascending aortic pathology, with better inter-rater correlation and observer confidence 3

Technical Components Included in Base Codes

• 3D rendering and multiplanar reformations are included in the CTA codes and should not be separately reported 1
• Arterial phase timing is standard for CTA protocols and included in the base code 1
• Thin-section acquisition (typically 0.5-0.75mm) is standard protocol and included 1

Common Coding Pitfalls to Avoid

• Do not separately code for ECG gating - this is considered integral to the CTA procedure when performed 2
• Do not use standard CT codes (71260,74177) instead of CTA codes when angiographic technique with arterial phase timing and 3D postprocessing is performed 1
• Do not report CT chest (71275) alone when imaging extends to abdomen and pelvis, as comprehensive vascular assessment requires full coverage for thoracic aortic pathology 1
• Avoid coding triphasic protocols separately - if noncontrast, arterial, and delayed phases are all performed, the CTA codes still apply as they include noncontrast images when performed 1, 2

Documentation Requirements

• Medical record should specify that ECG gating was utilized to justify the technical complexity 1, 3
• Document the clinical indication requiring comprehensive chest-abdomen-pelvis coverage (e.g., thoracic aortic aneurysm, dissection, pre-TEVAR planning) 1
• Include documentation of 3D postprocessing and multiplanar reformations as these are expected components of CTA 1

Alternative Scenarios

• If only the chest is imaged with ECG gating, report CPT 71275 alone 1
• If cardiac-specific protocols are used (e.g., coronary CTA), different codes apply (75574 for coronary CTA) 4
• For post-procedure surveillance (e.g., post-TEVAR), the same CTA codes apply as the technique remains identical 1