How To Use CPT Code 78830

CPT 78830 refers to a nuclear imaging test called SPECT with concurrent CT imaging used to localize a tumor, inflammatory process, or radioactive tracer distribution. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT code 78830.

1. What is CPT 78830?

CPT 78830 is a medical procedure code used to describe a nuclear imaging test called SPECT (Single Photon Emission Computed Tomography) with concurrent CT (Computed Tomography) imaging. This test is performed to localize a tumor, inflammatory process, or radioactive tracer distribution within a patient’s body. The code represents single-day imaging of a single area, such as the head, neck, chest, or pelvis, or a single acquisition on one day.

2. 78830 CPT code description

The official description of CPT code 78830 is: “Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, 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-CT 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 CT scanning uses X-rays to image the patient’s anatomy, while the specialized SPECT camera detects the radioactive tracer absorbed by the body.
5. Vascular flow and blood pool imaging may be included if performed, providing information on blood flow and inflammation.
6. The machine sends the images to a computer that fuses them and creates 3D images of the body.
7. The images show patient anatomy and pathology, as well as areas that absorbed more of the radioactive tracer.
8. The provider reviews the images and produces a formal report for the medical record.

4. Qualifying circumstances

Patients eligible to receive CPT code 78830 services are those who require localization of a tumor, inflammatory process, or radioactive tracer distribution within their body. This may include patients with suspected or confirmed cancer, inflammatory diseases, or other conditions where accurate localization of the affected area is necessary for diagnosis or treatment planning.

5. When to use CPT code 78830

It is appropriate to bill the 78830 CPT code when a provider performs a SPECT with concurrent CT imaging to localize a tumor, inflammatory process, or radioactive tracer distribution in a single area or acquisition on a single day. This code should be used for single-day imaging of areas such as the head, neck, chest, or pelvis.

6. Documentation requirements

To support a claim for CPT 78830, the following information should be documented:

• Patient’s medical history and reason for the test
• Specific area or acquisition being imaged
• Details of the radiopharmaceutical agent administered
• Acquisition protocol used
• Any additional imaging techniques performed, such as vascular flow or blood pool imaging
• Findings from the images, including localization of the tumor, inflammation, or tracer distribution
• Formal report of the imaging study

7. Billing guidelines

When billing for CPT code 78830, keep in mind the following guidelines:

• The entity bearing the cost of the radiopharmaceutical may report it separately using the appropriate code.
• If reporting only the physician’s interpretation for the radiology service, append modifier 26 to the radiology code.
• If reporting only the technical component for the radiology service, append modifier TC to the radiology code. However, payer policy may exempt hospitals from appending modifier TC as their 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 78830 was added to the Current Procedural Terminology system on January 1, 2020. The code was changed on January 1, 2023, with the previous descriptor being the same as the current one.

9. Similar codes to CPT 78830

Five similar codes to CPT 78830 and how they differentiate are:

• CPT 78831: This code represents multiple area imaging or multiple day imaging, unlike CPT 78830, which is for single area or single day imaging.
• CPT 78832: This code is for tomographic (SPECT) imaging only, without concurrent CT imaging, unlike CPT 78830, which includes concurrent CT imaging.
• CPT 78833: This code is for planar imaging only, without tomographic (SPECT) or concurrent CT imaging, unlike CPT 78830.
• CPT 78834: This code is for whole-body imaging, unlike CPT 78830, which is for single area or single day imaging.
• CPT 78835: This code is for imaging with radiopharmaceutical localization and pharmacologic intervention, unlike CPT 78830, which does not include pharmacologic intervention.

10. Examples

Here are 10 detailed examples of CPT code 78830 procedures:

1. A patient with a suspected brain tumor undergoes a SPECT-CT imaging to localize the tumor within the brain.
2. A patient with a history of lung cancer undergoes a SPECT-CT imaging to evaluate for possible recurrence in the chest area.
3. A patient with suspected inflammatory bowel disease undergoes a SPECT-CT imaging to localize areas of inflammation within the abdomen.
4. A patient with a known neck mass undergoes a SPECT-CT imaging to determine the extent of the mass and its relationship to surrounding structures.
5. A patient with a history of breast cancer undergoes a SPECT-CT imaging to evaluate for possible metastasis to the chest wall or nearby lymph nodes.
6. A patient with a suspected pelvic tumor undergoes a SPECT-CT imaging to localize the tumor and assess its relationship to surrounding organs.
7. A patient with a history of melanoma undergoes a SPECT-CT imaging to evaluate for possible metastasis to the lymph nodes in the neck area.
8. A patient with a known liver mass undergoes a SPECT-CT imaging to determine the extent of the mass and its relationship to surrounding structures.
9. A patient with a suspected bone infection undergoes a SPECT-CT imaging to localize the area of inflammation and assess the extent of the infection.
10. A patient with a history of thyroid cancer undergoes a SPECT-CT imaging to evaluate for possible recurrence in the neck area.