How To Use CPT Code 78130

CPT 78130 describes the procedure for a red cell survival study, which involves studying the lifespan of a patient’s red blood cells after they have been tagged with a radiopharmaceutical. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 78130?

CPT 78130 can be used to describe the procedure for a red cell survival study. In this study, the healthcare provider measures the patient’s red blood cell volume, withdraws a sample of blood, separates the red blood cells, and tags them with a radiopharmaceutical. The tagged red blood cells are then re-injected into the patient, and blood samples are taken over the next few weeks or until the volume of tagged red blood cells drops to half of the initial sample. The provider interprets the results to determine the patient’s red blood cell survival compared to the norm.

2. Official Description

The official description of CPT code 78130 is: ‘Red cell survival study;’

3. Procedure

1. The healthcare provider measures the patient’s red blood cell volume.
2. A sample of blood is withdrawn from the patient.
3. The red blood cells are separated from the blood sample.
4. The separated red blood cells are tagged with a radiopharmaceutical.
5. The tagged red blood cells are re-injected into the patient.
6. Blood samples are taken over the next few weeks or until the volume of tagged red blood cells drops to half of the initial sample.
7. The samples collected are centrifuged and counted using a gamma or scintillation counter attached to a computer.
8. The provider interprets the results and determines the patient’s red blood cell survival compared to the norm.

4. Qualifying circumstances

CPT 78130 is used when a healthcare provider suspects that the patient’s bone marrow is unable to replace red blood cells that are being prematurely destroyed. This may be due to a genetic defect, infection, or the patient’s own antibodies attacking the red blood cells. The procedure helps determine the cause of anemia of unknown etiology.

5. When to use CPT code 78130

CPT code 78130 should be used when a red cell survival study is performed to investigate the cause of anemia of unknown etiology. It is not appropriate to use this code for other purposes or when studying different aspects of red blood cells.

6. Documentation requirements

To support a claim for CPT 78130, the healthcare provider must document the following information:

• Patient’s symptoms or suspected condition
• Red blood cell volume measurement
• Details of the blood sampling and separation process
• Type of radiopharmaceutical used for tagging the red blood cells
• Results of the red cell survival study
• Interpretation of the results by the provider
• Signature of the provider

7. Billing guidelines

When billing for CPT 78130, ensure that the procedure is performed by a qualified healthcare provider. The professional component modifier 26 should be appended if only the physician’s interpretation is being reported. The technical component modifier TC should be appended if only the technical component is being reported. However, payer policies may exempt hospitals from appending modifier TC. If both the professional and technical components are rendered by the same provider, no modifier is necessary.

8. Historical information

CPT 78130 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition.

9. Examples

1. A patient with anemia of unknown etiology undergoes a red cell survival study to determine the cause of their condition.
2. A healthcare provider suspects that a patient’s bone marrow is unable to replace red blood cells and performs a red cell survival study to investigate further.
3. A patient with a genetic defect that affects red blood cell production undergoes a red cell survival study to assess their red blood cell survival compared to the norm.
4. A provider suspects that a patient’s own antibodies are attacking their red blood cells and performs a red cell survival study to confirm the diagnosis.
5. A patient with a suspected infection that may be causing premature destruction of red blood cells undergoes a red cell survival study to investigate the underlying cause.