74183

Magnetic resonance (MR) imaging, abdomen and pelvis; without and with contrast material(s)

CPT code 74183 describes a comprehensive diagnostic imaging procedure utilizing magnetic resonance technology to visualize anatomical structures within both the abdomen and pelvis. The study is performed first without the administration of intravenous contrast material, followed by images taken after the administration of contrast material. This dual approach allows for detailed evaluation of organs, soft tissues, blood vessels, and bone structures, enhancing the detection and characterization of various pathologies through the assessment of tissue contrast enhancement patterns.

Clinical Indications

  • Evaluation of unexplained abdominal or pelvic pain, especially when other imaging modalities are inconclusive.
  • Characterization of masses, lesions, or abnormalities identified by other imaging methods (e.g., ultrasound, CT).
  • Staging and surveillance of malignancies originating or suspected to be spreading within the abdomen or pelvis.
  • Assessment of inflammatory conditions such as inflammatory bowel disease (Crohn's disease, ulcerative colitis) or pelvic inflammatory disease.
  • Investigation of liver, kidney, pancreatic, adrenal gland, or splenic abnormalities.
  • Evaluation of gynecological conditions (e.g., uterine fibroids, endometriosis, adenomyosis, ovarian cysts/masses).
  • Assessment of urinary tract abnormalities (e.g., renal masses, bladder pathology).
  • Pre-operative planning for complex abdominal or pelvic surgeries.
  • Detection and characterization of vascular abnormalities (e.g., aneurysms, stenosis, thrombosis).
  • Monitoring response to treatment for abdominal or pelvic pathologies.

Procedure Steps

  1. Patient screening for contraindications to MRI (e.g., metallic implants, claustrophobia, kidney function for contrast) and obtaining informed consent.
  2. Establishment of intravenous access for the administration of contrast material.
  3. Patient positioning on the MRI table with appropriate coils for abdominal and pelvic imaging.
  4. Acquisition of initial scout images to localize the region of interest.
  5. Performance of multiple non-contrast MRI sequences (e.g., T1-weighted, T2-weighted, diffusion-weighted imaging) to acquire detailed images of the abdomen and pelvis.
  6. Intravenous administration of gadolinium-based contrast material according to institutional protocol and patient weight.
  7. Acquisition of additional post-contrast MRI sequences to evaluate the enhancement patterns of tissues and lesions, often including dynamic imaging.
  8. Post-processing of acquired images, which may include multi-planar reconstructions (MPR), 3D renderings, and quantitative analysis.
  9. Review of images by a qualified radiologist for interpretation and generation of a comprehensive diagnostic report.

Coding Guidelines

  • CPT code 74183 is reported when both non-contrast and post-contrast MRI of the abdomen and pelvis are performed during the same encounter.
  • Do not report 74183 in conjunction with 74181 (without contrast) or 74182 (with contrast only) for the same anatomic region during the same session.
  • If only non-contrast images are performed, report 74181.
  • If only contrast-enhanced images are performed (e.g., for follow-up of a known lesion without prior non-contrast images during the same encounter), 74182 should be used, potentially with modifier 52 if a complete study including pre-contrast images would typically be expected but not performed. However, 74183 implies both are done.
  • Medical necessity for both abdominal and pelvic imaging and the use of contrast material must be clearly documented in the patient's medical record.
  • The radiologist's report should detail findings from both pre- and post-contrast sequences to support the use of this code.
  • Payer-specific policies may apply regarding the indications and necessity for combined abdominal and pelvic MRI with contrast.

Associated ICD-10 Codes