71260

CT Scan of the Chest with Contrast

Computed Tomography (CT) of the thorax with contrast, designated by CPT code 71260, is a specialized radiographic imaging procedure used to provide detailed cross-sectional views of the chest cavity. This specific modality utilizes intravenous iodinated contrast material to increase the radiodensity of the blood vessels and highly vascularized tissues, thereby providing a clearer distinction between normal anatomical structures and pathological lesions. The scan encompasses the area from the lung apices through the adrenal glands, which are a common site for lung cancer metastasis. The addition of contrast is particularly critical for evaluating the mediastinum, the hila, and the pleural surfaces. It allows for the identification of enlarged lymph nodes, vascular invasions by tumors, and the characterization of pleural effusions or masses. The procedure involves the patient lying supine on a motorized table that moves through a circular opening in the CT scanner (the gantry). Inside the gantry, an X-ray source and electronic detectors rotate around the patient, capturing raw data that a computer processes into "slices." Contrast is typically administered via a power injector at a specific flow rate to ensure optimal opacification during the arterial or venous phases of the scan. This diagnostic tool is indispensable in the workup of primary lung cancer, metastatic disease, mediastinal masses, and infectious processes like lung abscesses or complicated pneumonia. Radiologists interpret the enhancement patterns, measured in Hounsfield units, to differentiate between cystic and solid components of a mass, which significantly impacts the patient's management plan.

Clinical Indications

  • Evaluation of primary or secondary lung malignancy
  • Assessment of mediastinal or hilar lymphadenopathy
  • Characterization of pleural disease or empyema
  • Evaluation of suspected pulmonary embolism (when CTA is not performed)
  • Pre-operative planning for thoracic surgery
  • Follow-up of abnormal findings on chest X-ray
  • Investigation of hemoptysis or chronic unexplained cough
  • Monitoring of treatment response in oncological patients
  • Evaluation of trauma to the thoracic cage or vascular structures

Procedure Steps

  1. Review patient history and screen for contrast allergies and renal insufficiency.
  2. Position the patient supine on the CT scanner gantry.
  3. Establish intravenous access, typically in the antecubital vein.
  4. Obtain a scout/topogram image to define the scanning range from apices to adrenals.
  5. Administer iodinated contrast material via a power injector.
  6. Initiate the CT scan sequence at a predetermined delay to capture peak enhancement.
  7. The patient is instructed to hold their breath to minimize motion artifact during image acquisition.
  8. Reconstruct the raw data into axial, sagittal, and coronal planes using soft tissue and lung algorithms.
  9. Post-processing of images to generate 3D renderings if clinically indicated.
  10. Radiologist interpretation and report generation.

Coding Guidelines

  • The code 71260 specifically refers to a study performed with intravenous or intra-arterial contrast.
  • If oral or rectal contrast is used without intravenous contrast, the procedure should be coded as 71250 (without contrast).
  • For a study performed without contrast followed by contrast during the same session, use code 71270.
  • 3D rendering (76376 or 76377) may be reported separately if performed on an independent workstation with a separate report.
  • Contrast material (e.g., Q-codes) may be reported separately depending on the payer and setting.
  • Do not report 71260 in conjunction with 71275 (CT Angiography) for the same anatomical area during the same session unless medically necessary and supported by documentation.

Associated ICD-10 Codes