How To Use CPT Code 78816

CPT 78816 is a code used for Positron Emission Tomography (PET) with concurrently acquired Computed Tomography (CT) for attenuation correction and anatomical localization imaging of the whole body. This article will cover the description, procedure, qualifying circumstances, when to use the code, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 78816 procedures.

1. What is CPT 78816?

CPT 78816 is a medical billing code that refers to a diagnostic imaging procedure that combines Positron Emission Tomography (PET) and Computed Tomography (CT) scans. This combination allows for more accurate detection and localization of cancerous cells within the body. The code is used by medical professionals to bill for this specific procedure.

2. 78816 CPT code description

The official description of CPT code 78816 is: “Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; whole body.”

3. Procedure

The 78816 procedure involves the following steps:

1. The patient is injected with a radiopharmaceutical tracer called FDG (fluoro-deoxyglucose) about one hour before the imaging is scheduled to begin.
2. The radiotracer spreads in the body via the bloodstream and gets absorbed by cells, emitting small amounts of energy (positrons).
3. The positrons collide with electrons, resulting in the production of photons that travel in opposite directions.
4. The photon emission is captured by the PET scanner and processed in a computer to create a three-dimensional image of the body tissues being studied.
5. The CT scan produces thin cross-sectional slices of internal organs.
6. The images produced by the PET and CT scans are combined to obtain accurate details about the size and location of a tumor.

4. Qualifying circumstances

Patients eligible to receive CPT code 78816 services are those who have been diagnosed with or are suspected of having cancer. The procedure is particularly useful for detecting and localizing cancerous cells in the body, as well as monitoring the progress of cancer treatment. It may also be used to evaluate the effectiveness of a treatment plan or to detect cancer recurrence.

5. When to use CPT code 78816

It is appropriate to bill the 78816 CPT code when a PET/CT scan is performed for the purpose of attenuation correction and anatomical localization imaging of the whole body. This code should be used when the primary goal of the imaging is to detect and localize cancerous cells within the body, as well as to monitor the progress of cancer treatment or evaluate the effectiveness of a treatment plan.

6. Documentation requirements

To support a claim for CPT 78816, the following information should be documented:

• Patient’s medical history and physical examination findings
• Indication for the PET/CT scan, such as suspected or confirmed cancer diagnosis
• Details of the radiopharmaceutical tracer used, including dosage and administration method
• Technical aspects of the PET/CT scan, including the equipment used and imaging parameters
• Interpretation of the PET/CT scan results, including any detected abnormalities and their correlation with the patient’s clinical presentation
• Impression and recommendations for further evaluation or treatment, if applicable

7. Billing guidelines

When billing for CPT code 78816, it is important to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 78816 include:

• Report 78811 – 78816 only once per imaging session
• If a CT scan is performed for purposes other than attenuation correction and anatomical localization, use the appropriate site-specific CT code with modifier 59
• Ensure that all required documentation is complete and accurate to support the claim

8. Historical information

CPT 78816 was added to the Current Procedural Terminology system on January 1, 2005. The code was changed on January 1, 2008, with the previous descriptor being “Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; whole body.”

9. Similar codes to CPT 78816

Five similar codes to CPT 78816 and how they differ are:

• CPT 78811: This code is used for PET imaging without CT for attenuation correction and anatomical localization.
• CPT 78812: This code is used for PET with CT for attenuation correction and anatomical localization imaging of the skull base to mid-thigh.
• CPT 78813: This code is used for PET with CT for attenuation correction and anatomical localization imaging of a limited area (e.g., chest, head/neck).
• CPT 78814: This code is used for PET with CT for initial treatment strategy evaluation, including the whole body.
• CPT 78815: This code is used for PET with CT for subsequent treatment strategy evaluation, including the whole body.

10. Examples

Here are 10 detailed examples of CPT code 78816 procedures:

1. A patient with a history of lung cancer undergoes a PET/CT scan to evaluate the extent of the disease and determine the appropriate treatment plan.
2. A patient with breast cancer undergoes a PET/CT scan to monitor the response to chemotherapy and assess for any residual disease.
3. A patient with melanoma undergoes a PET/CT scan to detect any metastatic lesions and guide surgical planning.
4. A patient with lymphoma undergoes a PET/CT scan to evaluate the effectiveness of radiation therapy and detect any residual or recurrent disease.
5. A patient with a history of colorectal cancer undergoes a PET/CT scan to assess for any recurrence or metastasis.
6. A patient with head and neck cancer undergoes a PET/CT scan to determine the extent of the disease and plan for radiation therapy.
7. A patient with a suspected brain tumor undergoes a PET/CT scan to confirm the diagnosis and guide surgical planning.
8. A patient with a history of ovarian cancer undergoes a PET/CT scan to monitor the response to treatment and detect any residual or recurrent disease.
9. A patient with a history of prostate cancer undergoes a PET/CT scan to assess for any recurrence or metastasis.
10. A patient with a suspected bone tumor undergoes a PET/CT scan to confirm the diagnosis and guide surgical planning.