How To Use CPT Code 78185

CPT 78185 describes the imaging procedure for the spleen, which involves the use of a radiopharmaceutical to determine the size, position, and presence of tumors, abscesses, or cysts. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 78185?

CPT 78185 is used to describe the imaging procedure for the spleen. It involves the administration of a radiopharmaceutical or radiotracer to the patient to study the size, position, and presence of tumors, abscesses, or cysts in the spleen. This code is used when the provider performs the imaging study solely on the spleen, without combining it with a liver study.

2. Official Description

The official description of CPT code 78185 is: ‘Spleen imaging only, with or without vascular flow.’ If the spleen imaging is combined with a liver study, the appropriate codes to use are 78215 and 78216.

3. Procedure

1. The provider administers a radiopharmaceutical or radiotracer, such as technetium 99 sulfur colloid, intravenously to the patient.
2. If a vascular flow study is required, the provider positions the patient under the gamma camera before administering the radiotracer to obtain blood flow information.
3. After allowing sufficient time for the radiotracer to distribute, typically 10 to 20 minutes, the provider takes planar images of the spleen using a gamma camera.
4. To determine the size of the spleen, the provider places a reference marker on the left costal margin before capturing the image.
5. Once the study is complete, the provider interprets the results, dictates, reviews, and signs the nuclear medicine report.

4. Qualifying circumstances

CPT 78185 is used for patients who require imaging of the spleen to assess its size, position, and the presence of tumors, abscesses, or cysts. The procedure is performed by a provider who specializes in nuclear medicine. The use of a radiopharmaceutical or radiotracer is necessary to obtain accurate imaging results.

5. When to use CPT code 78185

CPT code 78185 should be used when the provider performs a standalone imaging study of the spleen, without combining it with a liver study. If the provider performs both spleen and liver imaging, the appropriate codes to use are 78215 and 78216.

6. Documentation requirements

To support a claim for CPT 78185, the provider must document the following information:

• The reason for performing the spleen imaging
• The radiopharmaceutical or radiotracer used
• The date and time of the procedure
• Any relevant findings or abnormalities observed during the imaging
• The provider’s interpretation of the results
• The provider’s signature on the nuclear medicine report

7. Billing guidelines

When billing for CPT 78185, ensure that the procedure is performed solely on the spleen and not combined with a liver study. If the provider performs both spleen and liver imaging, use the appropriate codes 78215 and 78216. 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, payer policies may exempt hospitals from appending modifier TC. If the provider renders both the professional and technical components, do not append any modifiers.

8. Historical information

CPT 78185 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes spleen imaging to assess the presence of tumors after experiencing unexplained abdominal pain.
2. A provider performs a spleen imaging study to determine the size and position of the spleen in a patient with a suspected spleen disorder.
3. A radiologist administers a radiopharmaceutical and performs spleen imaging to detect the presence of abscesses in a patient with a history of infections.
4. A nuclear medicine specialist conducts a spleen imaging study to evaluate the spleen’s size and detect any cysts in a patient with a known genetic disorder.
5. A provider performs spleen imaging to monitor the response to treatment in a patient with a previously diagnosed spleen tumor.
6. A patient undergoes spleen imaging to assess the size and position of the spleen before a surgical procedure.
7. A provider performs spleen imaging to evaluate the effectiveness of a treatment in reducing the size of a previously detected spleen cyst.
8. A radiologist administers a radiotracer and performs spleen imaging to assess the presence of tumors in a patient with a family history of spleen cancer.
9. A nuclear medicine specialist conducts a spleen imaging study to evaluate the spleen’s size and detect any abscesses in a patient with a suspected infection.
10. A provider performs spleen imaging to assess the response to medication in a patient with a chronic spleen disorder.