How To Use CPT Code 78016

CPT 78016 describes the imaging procedure used to evaluate the presence and spread of thyroid carcinoma metastases. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 78016?

CPT 78016 is a diagnostic nuclear medicine procedure used to assess thyroid carcinoma metastases. It involves the use of a radionuclide to examine the functioning of the thyroid gland and to detect any nodules or abnormalities. This code is specifically used when additional studies, such as urinary recovery, are performed in conjunction with the thyroid scan.

2. Official Description

The official description of CPT code 78016 is: ‘Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery).’ This code is part of the range of diagnostic nuclear medicine procedures on the endocrine system, specifically focusing on thyroid carcinoma metastases imaging.

3. Procedure

1. During a thyroid scan, a nuclear radiologist administers a radioactive iodine dose orally or injects 99mTc pertechnetate.
2. The radiation levels in the thyroid are measured at various intervals, starting from 20 minutes after administration and up to 24 hours later.
3. Thyroid uptake values are obtained, which help the nuclear radiologist detect and quantify the effects of thyroid disease.
4. Imaging studies may also be performed to evaluate the location, size, and morphology of the thyroid.
5. Intravenous injection of a radiopharmaceutical may be used, with images taken 20 or 40 minutes later. Alternatively, an oral administration of the radiopharmaceutical may be given, and images are obtained at six and/or 24 hours later.

4. Qualifying circumstances

CPT 78016 is used for patients who have been diagnosed with thyroid carcinoma and require imaging to assess the presence and spread of metastases. The procedure is performed by a nuclear radiologist and may involve additional studies, such as urinary recovery. It is important to note that this code is specific to thyroid carcinoma metastases imaging and should not be used for other thyroid-related conditions or procedures.

5. When to use CPT code 78016

CPT code 78016 should be used when a patient with thyroid carcinoma requires imaging to evaluate the presence and spread of metastases. It is important to ensure that the additional studies, such as urinary recovery, are performed in conjunction with the thyroid scan. This code should not be used for other thyroid-related conditions or procedures.

6. Documentation requirements

To support a claim for CPT code 78016, the following documentation is required:

• Diagnosis of thyroid carcinoma
• Indication for the imaging procedure
• Details of the additional studies performed, such as urinary recovery
• Date and time of the procedure
• Results and findings of the imaging study
• Signature of the nuclear radiologist performing the procedure

7. Billing guidelines

When billing for CPT code 78016, ensure that the procedure is performed by a nuclear radiologist and includes the additional studies specified in the code description. It is important to follow the specific guidelines and requirements of the payer when submitting the claim. Additionally, be aware of any bundling or unbundling issues that may arise when reporting this code with other related procedures or services.

8. Historical information

CPT code 78016 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with a history of thyroid carcinoma undergoes a thyroid scan with additional studies, including urinary recovery, to assess the presence of metastases.
2. A nuclear radiologist administers a radioactive iodine dose and performs a thyroid scan with urinary recovery studies on a patient recently diagnosed with thyroid carcinoma.
3. A patient with suspected thyroid carcinoma metastases undergoes a thyroid scan with additional studies, including urinary recovery, to determine the extent of the disease.
4. A nuclear radiologist performs a thyroid scan with urinary recovery studies on a patient who has undergone thyroidectomy for thyroid carcinoma.
5. A patient with a previous diagnosis of thyroid carcinoma undergoes a thyroid scan with additional studies, including urinary recovery, to monitor the progression of the disease.