How To Use CPT Code 78803

CPT 78803 is a code used for radiopharmaceutical localization of tumor, inflammatory process, or distribution of radiopharmaceutical agents through tomographic (SPECT) imaging. This article will cover the description, procedure, qualifying circumstances, billing guidelines, documentation requirements, historical information, similar codes, and examples of CPT 78803.

1. What is CPT 78803?

CPT 78803 is a code used to describe a nuclear imaging test called Single Photon Emission Computed Tomography (SPECT) for the localization of tumors, inflammatory processes, or the distribution of radiopharmaceutical agents in a single area of the body. This code is specific to single-day imaging of a single area, such as the head, neck, chest, or pelvis, or a single acquisition on one day.

2. 78803 CPT code description

The official description of CPT code 78803 is: “Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging.”

3. Procedure

  1. The provider administers a radiopharmaceutical agent (radioactive tracer) to the patient, typically through intravenous administration.
  2. Using an acquisition protocol appropriate for the patient, the provider uses a SPECT machine to image the patient.
  3. The patient lies on a table, and the machine rotates around the patient, taking images of the target area.
  4. The machine’s specialized camera detects the radioactive tracer absorbed by the body, with more active tissues absorbing more of the radioactive substance.
  5. Vascular flow and blood pool imaging may be included, showing blood flow to a particular area and highlighting areas of inflammation or capillary leakage.
  6. The machine sends the images to a computer that creates 3D images of the body, showing areas with higher absorption of the radioactive tracer.
  7. The provider reviews the images, ensuring the SPECT data is adequate, and produces a formal report for the medical record.

4. Qualifying circumstances

Patients eligible to receive CPT code 78803 services are those who require localization of a tumor, inflammatory process, or distribution of radiopharmaceutical agents in a single area of the body. This may include patients with suspected or confirmed cancer, inflammatory diseases, or other conditions that require the visualization of blood flow and tracer distribution within the body.

5. When to use CPT code 78803

It is appropriate to bill the 78803 CPT code when a provider performs a SPECT imaging procedure for the localization of a tumor, inflammatory process, or distribution of radiopharmaceutical agents in a single area of the body. This code should be used for single-day imaging of a single area or single-day imaging with a single acquisition.

6. Documentation requirements

To support a claim for CPT 78803, the following information should be documented:

  • Patient’s medical history and reason for the SPECT imaging procedure
  • Specific area of the body being imaged
  • Type and dosage of radiopharmaceutical agent administered
  • Details of the acquisition protocol used
  • Findings from the vascular flow and blood pool imaging, if performed
  • Interpretation of the SPECT images, including localization of tumor, inflammation, or other noteworthy tracer distribution
  • Formal report of the imaging procedure for the medical record

7. Billing guidelines

When billing for CPT code 78803, consider the following guidelines:

  • Compare descriptors to documentation carefully to ensure accurate coding.
  • Report the radiopharmaceutical substance separately using the appropriate code if the entity bears the cost of the radiopharmaceutical.
  • Append modifier 26 to the radiology code when reporting only the physician’s interpretation for the radiology service.
  • Append modifier TC to the radiology code when reporting only the technical component for the radiology service, unless payer policy exempts hospitals from appending modifier TC.
  • 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 78803 was added to the Current Procedural Terminology system on January 1, 1990. The code has undergone several changes since then, with the most recent change occurring on January 1, 2023.

9. Similar codes to CPT 78803

Five similar codes to CPT 78803 and how they differentiate are:

  • CPT 78300: Focuses on imaging bone infectious or inflammatory disease with a bone imaging radiopharmaceutical.
  • CPT 78305: Similar to CPT 78300 but includes additional imaging for more complex cases.
  • CPT 78306: Similar to CPT 78305 but includes whole-body imaging.
  • CPT 78315: Involves a bone imaging study with tomographic (SPECT) imaging.
  • CPT 78800: Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s) without tomographic (SPECT) imaging.

10. Examples

  1. A patient with suspected lung cancer undergoes SPECT imaging of the chest to localize the tumor.
  2. A patient with a history of inflammatory bowel disease undergoes SPECT imaging of the pelvis to assess the extent of inflammation.
  3. A patient with a brain tumor undergoes SPECT imaging of the head to evaluate the distribution of a radiopharmaceutical agent.
  4. A patient with suspected thyroid cancer undergoes SPECT imaging of the neck to localize the tumor and assess blood flow.
  5. A patient with a history of breast cancer undergoes SPECT imaging of the chest to evaluate the distribution of a radiopharmaceutical agent and assess for recurrence.
  6. A patient with suspected bone metastases undergoes SPECT imaging of the pelvis to localize the tumor and assess blood flow.
  7. A patient with a history of liver cancer undergoes SPECT imaging of the abdomen to evaluate the distribution of a radiopharmaceutical agent and assess for recurrence.
  8. A patient with a suspected inflammatory process in the chest undergoes SPECT imaging to assess the extent of inflammation and blood flow.
  9. A patient with a history of prostate cancer undergoes SPECT imaging of the pelvis to evaluate the distribution of a radiopharmaceutical agent and assess for recurrence.
  10. A patient with a suspected tumor in the head undergoes SPECT imaging to localize the tumor and assess blood flow.

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