If a patient is scheduled for a CT with and without contrast, but the patient refuses the contrast, should we bill the code for the CT without contrast, or should we bill for the exam with/without a modifier? What modifier would be appropriate to use in this scenario?
When contrast is not administered, the service performed is the non-contrast CT only. Instead, you should proceed to bill the CPT® code for CT without contrast. You should not report the CT with-and-without-contrast code, because the full service was not performed. If the scan was intended to be with-and-without contrast, but the contrast portion was canceled due to patient refusal, append modifier 52 (Reduced Services) to the with/without code only if payer policy directs this approach. Many payers prefer reporting the actual service performed (non-contrast only) with no modifier, which is the cleanest and most defensible approach. Code the exam that was actually completed (the “without contrast” CPT code). Check payer policies if considering modifier 52, as usage varies.
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
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