How To Use CPT Code 78264

CPT 78264 refers to a gastric emptying imaging study used to assess the speed at which the stomach empties. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 78264.

1. What is CPT 78264?

CPT 78264 is a medical procedure code used to describe a gastric emptying imaging study. This diagnostic test is performed to evaluate the rate at which a patient’s stomach empties after consuming a meal containing a radiopharmaceutical or tracer. The results of this study can help healthcare providers diagnose and treat various gastrointestinal disorders and symptoms.

2. 78264 CPT code description

The official description of CPT code 78264 is: “Gastric emptying imaging study (eg, solid, liquid, or both)”.

3. Procedure

The 78264 procedure involves the following steps:

1. The patient consumes a meal containing a radiopharmaceutical or tracer, such as Tc-99m sulfur colloid.
2. Immediately after the meal, the provider takes planar images of the esophagus, stomach, and proximal small bowel to determine the rate at which the tracer leaves the stomach.
3. Continuous or intermittent imaging is performed for 60-120 minutes.
4. If there is prolonged retention of the meal in the stomach, delayed images are taken up to 4 hours or more as required.
5. The provider interprets the results, dictates, reviews, and signs the nuclear medicine report.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 78264 services are those experiencing symptoms that may be due to slow gastric emptying, such as nausea, vomiting, and abdominal fullness after eating, or symptoms of rapid gastric emptying, including diarrhea, weakness, or lightheadedness after eating. The test may also be used to evaluate patients with suspected gastrointestinal motility disorders or to monitor the effectiveness of treatments for these conditions.

5. When to use CPT code 78264

It is appropriate to bill the 78264 CPT code when a healthcare provider performs a gastric emptying imaging study to assess the rate at which a patient’s stomach empties and to diagnose or monitor gastrointestinal disorders or symptoms related to gastric emptying. The test should be medically necessary and ordered by a qualified healthcare professional.

6. Documentation requirements

To support a claim for CPT 78264, the following information should be documented:

• Patient’s medical history and presenting symptoms
• Indication for the gastric emptying imaging study
• Description of the meal consumed, including the radiopharmaceutical or tracer used
• Details of the imaging process, including the duration and any delayed images taken
• Interpretation of the results, including any abnormalities or findings related to gastric emptying
• Impression and recommendations for further evaluation or treatment, if applicable
• Signature of the interpreting provider

7. Billing guidelines

When billing for CPT code 78264, it is essential to follow payer-specific guidelines and rules. If only the physician’s interpretation for the radiology service is being reported, professional component modifier 26 should be appended to the radiology code. If only the technical component for the radiology service is being reported, modifier TC should be appended to the radiology code. However, payer policy may exempt hospitals from appending modifier TC because the hospital’s portion is inherently technical. Do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 78264 was added to the Current Procedural Terminology system on January 1, 1990. The code was changed on January 1, 2016, with the previous descriptor being “Gastric emptying study”.

9. Similar codes to CPT 78264

Five similar codes to CPT 78264 and how they differentiate from CPT 78264 are:

1. CPT 78261: This code is used for a gastroesophageal reflux study, which evaluates the reflux of stomach contents into the esophagus.
2. CPT 78262: This code is for a gastrointestinal blood loss study, which detects the presence of blood in the gastrointestinal tract.
3. CPT 78265: This code is for a hepatobiliary system imaging study, which evaluates the function and anatomy of the liver, gallbladder, and bile ducts.
4. CPT 78266: This code is for a hepatobiliary system imaging study with drug intervention, which involves the administration of a drug to stimulate gallbladder contraction.
5. CPT 78267: This code is for a breath test analysis, which measures the presence of certain gases in the breath to diagnose gastrointestinal disorders.

10. Examples

Here are 10 detailed examples of CPT code 78264 procedures:

1. A patient with unexplained nausea and vomiting undergoes a gastric emptying imaging study to evaluate for gastroparesis.
2. A patient with suspected rapid gastric emptying due to postprandial diarrhea undergoes a gastric emptying imaging study to confirm the diagnosis.
3. A patient with a history of gastric bypass surgery experiences abdominal pain and fullness after eating, prompting a gastric emptying imaging study to assess for complications.
4. A patient with diabetes and gastrointestinal symptoms undergoes a gastric emptying imaging study to evaluate for diabetic gastroparesis.
5. A patient with a history of scleroderma and gastrointestinal symptoms undergoes a gastric emptying imaging study to assess for gastrointestinal involvement.
6. A patient with suspected functional dyspepsia undergoes a gastric emptying imaging study to rule out gastroparesis as a contributing factor.
7. A patient with a history of gastric emptying disorder undergoes a gastric emptying imaging study to monitor the effectiveness of a new treatment regimen.
8. A patient with unexplained weight loss and early satiety undergoes a gastric emptying imaging study to evaluate for possible gastric emptying abnormalities.
9. A patient with a history of gastric surgery and recurrent vomiting undergoes a gastric emptying imaging study to assess for post-surgical complications affecting gastric emptying.
10. A patient with suspected dumping syndrome after gastric surgery undergoes a gastric emptying imaging study to confirm the diagnosis and guide treatment.