How To Use CPT Code 78014

CPT 78014 describes the procedure for thyroid imaging, including quantitative measurements of single or multiple uptakes, as well as stimulation, suppression, or discharge tests if performed. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 78014?

CPT 78014 is used to describe the procedure for thyroid imaging, specifically evaluating the amount of radioiodine that reaches the thyroid and how the thyroid handles it. This procedure involves administering radioiodine to the patient, either in pill form or through intravenous injection, and then using a scintillation or gamma camera to image the thyroid from different angles. The provider may also perform stimulation, suppression, or discharge tests to further evaluate the thyroid’s function. The purpose of this procedure is to assess the structure and function of the thyroid and determine the cause of any abnormalities.

2. Official Description

The official description of CPT code 78014 is: ‘Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including stimulation, suppression, or discharge, when performed).’ This code encompasses the imaging of the thyroid gland after the administration of radioiodine, as well as the quantitative measurement of the radioiodine uptake. It also includes any additional tests performed, such as stimulation, suppression, or discharge tests.

3. Procedure

1. The provider administers radioiodine to the patient, either in pill form or through intravenous injection.
2. If a pill form is used, the patient is advised to return for imaging within a specific timeframe, usually within 4 hours but potentially up to 24 hours. If an intravenous injection is used, the imaging begins within 30-60 minutes.
3. The provider uses a scintillation or gamma camera to scan the thyroid from different angles, acquiring multiple images in various projections. The patient’s position during the scan is documented.
4. The provider may also assess the vascular flow in and around nodules to determine benign or malignant characteristics and identify suitable locations for biopsy.
5. In some cases, a radioactive marker may be placed near the thyroid gland to estimate the size of the thyroid and the presence and location of nodules.
6. The provider may administer medications to affect the uptake of radioiodine by the thyroid or to suppress the uptake. These additional evaluations are known as stimulation, suppression, or discharge tests.
7. Additional counts may be taken at the patient’s neck to determine the thyroid absorption of the radioiodine.
8. The provider reviews the data, compares it with any prior studies, calculates the percentages of radioiodine uptake, and interprets the results.
9. A nuclear medicine report is then dictated, reviewed, and signed by the provider.

4. Qualifying circumstances

CPT 78014 is performed on patients who require evaluation of their thyroid function and structure. This procedure is commonly used to diagnose and manage conditions such as hyperthyroidism, underactive thyroid gland, and toxic nodular goiter. The provider must use a scintillation or gamma camera to perform the imaging, and may also perform stimulation, suppression, or discharge tests if necessary.

5. When to use CPT code 78014

CPT code 78014 should be used when a provider performs thyroid imaging, including quantitative measurements of single or multiple uptakes, and stimulation, suppression, or discharge tests if performed. This code is appropriate when evaluating the structure and function of the thyroid gland and determining the cause of any abnormalities. It should not be used for other types of imaging studies or procedures unrelated to the thyroid.

6. Documentation requirements

To support a claim for CPT code 78014, the provider must document the following information:

• Patient’s medical history and reason for the thyroid imaging
• Type of radioiodine administration (pill or intravenous injection)
• Date and time of the imaging procedure
• Details of the imaging procedure, including the use of a scintillation or gamma camera, angles and projections scanned, and patient’s position
• Results of any additional tests performed, such as stimulation, suppression, or discharge tests
• Counts taken at the patient’s neck to determine radioiodine uptake
• Comparison with any prior studies
• Interpretation of the results
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 78014, ensure that the procedure meets the criteria outlined in the official description. It is important to accurately report the type of radioiodine administration and any additional tests performed. If both the professional and technical components of the procedure are performed by the same provider, a global service code should be used. Modifier 26 should be appended to the radiology code if reporting only the physician’s interpretation, and modifier TC should be appended if reporting only the technical component. However, it is important to review payer policies as hospitals may be exempt from appending modifier TC. It is not appropriate to report both CPT codes 78012 and 78013 together for the same service; instead, use the comprehensive code 78014 to report the procedure.

8. Historical information

CPT code 78014 was added to the Current Procedural Terminology system on January 1, 2013. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with symptoms of hyperthyroidism undergoes thyroid imaging with quantitative measurements of single uptake to assess the function of the thyroid gland.
2. A patient with a history of thyroid nodules undergoes thyroid imaging with multiple uptakes and stimulation tests to determine the nature of the nodules and plan for a biopsy.