70450

Computed tomography, head or brain; without contrast material

Computed tomography (CT) of the head or brain performed without the administration of intravenous contrast material. This diagnostic imaging procedure utilizes specialized X-ray equipment and computer processing to generate detailed cross-sectional images of the brain, skull, and surrounding structures. It is a rapid, non-invasive study primarily used to evaluate acute neurological conditions, trauma, and suspected intracranial pathologies where the use of contrast is either not indicated or contraindicated.

Clinical Indications

  • Acute head trauma (e.g., suspected intracranial hemorrhage, skull fracture, subdural hematoma, epidural hematoma)
  • Acute onset of severe headache (e.g., to rule out subarachnoid hemorrhage, mass lesion, hydrocephalus)
  • Sudden neurological deficits (e.g., suspected ischemic stroke or hemorrhagic stroke, transient ischemic attack (TIA) in the acute setting)
  • Altered mental status, syncope, or unexplained coma
  • New onset seizures or change in seizure pattern (to evaluate for structural causes)
  • Suspected intracranial mass, tumor, or metastatic disease (initial evaluation)
  • Evaluation of hydrocephalus or ventricular enlargement
  • Suspected intracranial infection or abscess
  • Evaluation for cerebral edema or herniation
  • Suspected inflammatory conditions of the brain or meninges
  • Pre-procedural planning for certain neurosurgical interventions

Procedure Steps

  1. Patient is positioned supine on the CT scanner table, with the head stabilized to minimize movement.
  2. A preliminary scout (localizer) image is acquired to define the precise scanning range.
  3. A series of X-ray images are obtained as the CT gantry rotates around the patient's head, acquiring multiple thin axial slices.
  4. Image data is processed by a computer to reconstruct detailed axial, coronal, and sagittal images of the brain, skull, and associated soft tissues.
  5. A radiologist reviews the reconstructed images for abnormalities such as hemorrhage, infarction, tumors, fractures, edema, or hydrocephalus.
  6. A formal interpretive report is generated by the radiologist, outlining findings and conclusions.

Coding Guidelines

  • CPT code 70450 is specifically used when no intravenous contrast material is administered during the CT head scan.
  • If only oral or rectal contrast is used, 70450 is typically reported, as the code differentiator pertains to intravenous contrast.
  • If intravenous contrast is administered, CPT code 70460 (with contrast) or 70470 (without contrast followed by with contrast) should be reported.
  • Documentation must clearly state that no intravenous contrast was used for the procedure.
  • The professional (interpretation) and technical (equipment and staff) components of the service may be billed separately using modifier 26 and modifier TC, respectively, when appropriate.
  • This code has a global period of 0 days.

Associated ICD-10 Codes