72193

Computed tomography, pelvis; without contrast material

Computed tomography (CT) of the pelvis without contrast material (CPT code 72193) is a non-invasive diagnostic imaging procedure utilized to obtain cross-sectional, high-resolution images of the pelvic region. This modality utilizes ionizing radiation and advanced computer processing to generate detailed representations of the bony pelvis, reproductive organs, urinary bladder, distal ureters, lower gastrointestinal tract, and surrounding vascular and soft tissue structures. The procedure is specifically performed without the administration of intravascular, intra-articular, or intrathecal contrast media. This unenhanced approach is primarily indicated when assessing for calcifications, such as renal or ureteral calculi, where radiopaque contrast might obscure the naturally dense stones, or in the evaluation of acute pelvic trauma to identify occult fractures of the sacrum, ilium, ischium, pubis, and acetabulum. Additionally, it is frequently utilized for patients who have severe allergies to iodinated contrast material, renal impairment (e.g., elevated creatinine or acute kidney injury) precluding the safe use of intravenous contrast, or when the primary clinical question pertains strictly to osseous anatomy, such as in the preoperative planning for orthopedic interventions. The scanning process typically involves the patient lying supine on the motorized CT examination table, which moves incrementally through the gantry. The x-ray tube rotates around the patient, capturing multiple projections that are reconstructed by specialized software into axial, coronal, and sagittal planes, and often into three-dimensional volume-rendered models. The radiologist meticulously reviews these images to evaluate bone integrity, detect pathological calcifications, identify gross hematomas or fluid collections, and assess for any obvious structural anomalies. The lack of contrast limits the detailed evaluation of vascular structures, subtle soft tissue masses, and active inflammatory processes (such as early appendicitis or diverticulitis), for which a contrasted study would generally be preferred unless clinically contraindicated. Overall, CPT code 72193 represents a fundamental and rapidly accessible imaging tool, pivotal in emergency medicine for trauma evaluation and urology for stone protocols, providing critical clinical data to guide subsequent medical or surgical management.

Clinical Indications

  • Suspected or known pelvic bone fractures, including occult fractures of the acetabulum, sacrum, or pubic rami.
  • Evaluation of suspected distal ureteral or bladder calculi (urinary tract stones) in a non-contrast stone protocol.
  • Contraindication to intravenous iodinated contrast material (e.g., severe allergy, acute renal failure, chronic kidney disease) when pelvic imaging is still required.
  • Preoperative planning for complex orthopedic procedures or revisions involving the pelvic ring or hip joints.
  • Evaluation of bony lesions, primary bone tumors, or metastatic disease affecting the pelvic skeletal structures.
  • Assessment of large, gross pelvic hematomas or retroperitoneal hemorrhage where active extravasation is not the primary diagnostic target.

Procedure Steps

  1. Review the patient's medical history, clinical indications, and confirm the absence of a need for intravascular contrast material.
  2. Instruct the patient to remove any metallic objects, clothing, or jewelry over the pelvic area that could cause artifact interference.
  3. Position the patient supine on the CT scanner examination table, ensuring proper anatomical alignment and immobilization of the pelvis.
  4. Acquire initial scout images (topogram or scanogram) to accurately map the scanning field, typically extending from the iliac crests superiorly to the symphysis pubis inferiorly.
  5. Execute the helical or axial scanning sequence through the defined pelvic region using predetermined non-contrast parameters.
  6. Process and reconstruct the acquired raw data into axial, coronal, and sagittal image planes using both standard soft-tissue and high-resolution bone algorithms.
  7. Perform a technical quality control check by the CT technologist to ensure adequate anatomical coverage, lack of motion artifact, and optimal diagnostic quality.
  8. Perform a detailed diagnostic review and interpretation of the reconstructed images by a qualified radiologist.
  9. Generate and finalize a comprehensive radiological report detailing the osseous, soft tissue, and incidental findings.

Coding Guidelines

  • Do not report CPT 72193 in conjunction with 72194 (with contrast) or 72192 (without contrast followed by contrast) for the same anatomical region during the same imaging session.
  • If the CT scan covers both the abdomen and pelvis without contrast material during the same session, report the combined code 74176 (Computed tomography, abdomen and pelvis; without contrast material) instead of billing 74150 and 72193 separately.
  • According to CPT guidelines, the phrase 'with contrast' refers to contrast material administered intravascularly, intra-articularly, or intrathecally. Oral or rectal contrast administration alone does not qualify an exam as 'with contrast'.
  • Append modifier 26 for the professional component when the physician only interprets the study, and modifier TC for the technical component when the facility performs the scan. Use the global code without modifiers if both components are provided by the same entity.
  • Ensure documentation explicitly states that the pelvic region was imaged and specifically notes that no intravascular contrast material was administered.

Associated ICD-10 Codes