How To Use CPT Code 78226

CPT 78226 describes the imaging of the hepatobiliary system, including the liver, bile ducts, and gallbladder, to diagnose various conditions such as bile duct obstruction, gallbladder inflammation, and gallstones. 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 78226?

CPT 78226 is used to describe the imaging of the hepatobiliary system, which includes the liver, bile ducts, and gallbladder. This procedure is performed to diagnose conditions such as bile duct obstruction, gallbladder inflammation (cholecystitis), gallstones, and other disorders that affect the hepatobiliary system. The provider uses a gamma camera to obtain images of the abdomen and trace the movement of a radiopharmaceutical or iminodiacetic acid tracer through the bloodstream to the liver, bile, gallbladder, bile ducts, and small intestine. The scan typically lasts for about an hour, with delayed images taken if the gallbladder is not seen within the hour. In some cases, delayed imaging may be necessary at 18 to 24 hours. The scan is stopped when the tracer enters the small intestine.

2. Official Description

The official description of CPT code 78226 is: ‘Hepatobiliary system imaging, including gallbladder when present.’

3. Procedure

1. The provider injects the patient with a radiopharmaceutical or iminodiacetic acid tracer, such as 99mTc–disofenin or 99mTc–mebrofenin.
2. Using a gamma camera, the provider obtains images of the abdomen to trace the movement of the tracer through the bloodstream to the liver, bile, gallbladder, bile ducts, and small intestine.
3. The provider continuously takes pictures for about an hour, monitoring the progress of the scan on a monitor.
4. If the gallbladder is not seen within the hour, delayed images may be taken for up to 3 to 4 hours. In some cases, delayed imaging at 18 to 24 hours may be necessary.
5. The scan is stopped when the tracer enters the small intestine.

4. Qualifying circumstances

CPT 78226 is performed when there is a need to evaluate the hepatobiliary system, including the liver, bile ducts, and gallbladder. This procedure is used to diagnose conditions such as bile duct obstruction, gallbladder inflammation, gallstones, and other disorders affecting the hepatobiliary system. It is important to note that the presence of the gallbladder is not always guaranteed, but when present, it is included in the imaging process.

5. When to use CPT code 78226

CPT code 78226 should be used when the provider performs imaging of the hepatobiliary system, including the liver, bile ducts, and gallbladder. This code is appropriate for cases where the imaging is performed alone, without any additional assessments or interventions. If the provider performs imaging in conjunction with an assessment of the gallbladder and hepatic function by pharmacologic intervention, CPT code 78227 should be used instead.

6. Documentation requirements

To support a claim for CPT code 78226, the provider must document the following information:

• Patient’s medical history and reason for the imaging procedure
• Type of radiopharmaceutical or iminodiacetic acid tracer used
• Date and duration of the imaging procedure
• Images obtained and any abnormalities observed
• Any additional findings or relevant information
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 78226, ensure that the imaging procedure is performed solely for the evaluation of the hepatobiliary system. If the provider also performs an assessment of the gallbladder and hepatic function by pharmacologic intervention, CPT code 78227 should be used instead. It is important to note that 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, no modifier is necessary for reporting a global service.

8. Historical information

CPT code 78226 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes hepatobiliary system imaging to evaluate possible bile duct obstruction.
2. A provider performs imaging of the hepatobiliary system to diagnose gallbladder inflammation (cholecystitis).
3. A patient undergoes imaging of the hepatobiliary system to detect the presence of gallstones.
4. A provider performs hepatobiliary system imaging to evaluate abnormalities in the bile ducts.
5. A patient undergoes imaging of the hepatobiliary system to diagnose a disorder affecting the liver and gallbladder.
6. A provider performs imaging of the hepatobiliary system to assess the flow of bile from the liver to the small intestine.
7. A patient undergoes hepatobiliary system imaging to evaluate the function of the gallbladder.
8. A provider performs imaging of the hepatobiliary system to diagnose a suspected hepatobiliary disorder.
9. A patient undergoes imaging of the hepatobiliary system to assess the production and flow of bile.