E874

PDF page 376 / D18

DIAGNOSTIC RADIOLOGY
      COMPUTED TOMOGRAPHY (CT)
                                                                                                               H             P
                 Head
               X400 - without IV contrast..............................................................   - 43.25
               X401 - with IV contrast................................................................... - 64.95
               X188 - with and without IV contrast ...............................................        - 75.85
               E874    - with CT perfusion study, to X188, X400, X401, X402,
                         X405, or X408 ............................................................ add     64.00
                   Note:
                   1.E874 is only eligible for payment when the study is rendered as part of the investigation of
                     acute stroke and the interpretation is rendered within the limited period of time following
                     acute stroke during which the treating physician must render therapeutic decisions.
                                          2.E874 includes the administration of contrast necessary to complete the CT perfusion study.
                                          3.E874 includes creation and interpretation of post-imaging colour mapping of cerebral
                                            perfusion maps for regional cerebral blood flow, cerebral blood volume, and mean blood
                                            transit time.
                                          [Commentary:
                                          For example, when a CT perfusion study is only performed in conjunction with a non-contrast
                                          CT head scan, the appropriate claim is E874 and the non-contrast CT head service (e.g. X400,
                                          X402). In this example, a claim for E874 with a contrast enhanced CT head service (e.g. X401,
                                          X405) would not be appropriate.]

Master, record 1561. Record Layout PDF, page 1.

E87420250401999999990000064000000000000000000000000000000000000000000000000

Auxiliary master fields are preserved as raw scaled values. The linked layout calls them zero-filled, but this edition contains non-zero values. They are not presented as final dollar fees or PDF units.