How To Use CPT Code 78261

CPT 78261 describes the imaging of the gastric mucosa, which involves the administration of a radiopharmaceutical or tracer to visualize the lining of the stomach. 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 78261?

CPT 78261 is used to describe the imaging of the gastric mucosa, specifically the lining of the stomach. This procedure involves the administration of a radiopharmaceutical or tracer to the patient, which allows the healthcare provider to visualize the gastric mucosa. It is commonly performed on children to determine the causes of acute gastrointestinal bleeding caused by conditions such as Meckel’s diverticulum, cysts, or other gastrointestinal disorders.

2. Official Description

The official description of CPT code 78261 is: ‘The provider images the lining of the stomach, called the gastric mucosa, after intravenous administration of a radiopharmaceutical or tracer.’

3. Procedure

1. The healthcare provider administers a radiopharmaceutical or tracer, such as technetium-99m pertechnetate, to the patient.
2. Prior to the administration of the tracer, the provider may give the patient a medication to inhibit gastric acid secretion, which helps to increase the uptake of the tracer by the gastric mucosa.
3. Using a gamma camera, the provider images the abdomen and pelvis areas to detect the tracer as it accumulates and secretes in the gastric mucosa.
4. The provider may also take additional views and post-void images to gather more information.
5. Once the imaging is complete, the provider interprets the results, dictates, reviews, and signs the nuclear medicine report.

4. Qualifying circumstances

CPT 78261 is typically performed on patients, especially children, who are experiencing acute gastrointestinal bleeding and require imaging of the gastric mucosa. The procedure helps to identify the underlying causes of the bleeding, such as Meckel’s diverticulum, cysts, or other gastrointestinal disorders. It is important to note that this procedure requires the administration of a radiopharmaceutical or tracer and should only be performed by a qualified healthcare provider.

5. When to use CPT code 78261

CPT code 78261 should be used when a healthcare provider performs imaging of the gastric mucosa using a radiopharmaceutical or tracer. It is appropriate to use this code when the procedure is performed to visualize the lining of the stomach and identify the causes of acute gastrointestinal bleeding. However, it is important to review the specific documentation and guidelines provided by the payer to ensure accurate coding and billing.

6. Documentation requirements

To support a claim for CPT code 78261, the healthcare provider must document the following information:

• Patient’s medical history and symptoms
• Details of the radiopharmaceutical or tracer administered
• Date and time of the procedure
• Images obtained during the procedure
• Interpretation of the results
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT code 78261, it is important to follow the specific guidelines provided by the payer. Ensure that the procedure was performed by a qualified healthcare provider and that the necessary documentation is included in the claim. It is also important to review the payer’s policies regarding the use of modifiers, such as professional component modifier 26 or technical component modifier TC, if applicable. Additionally, consider any specific billing requirements or restrictions that may apply to this procedure.

8. Historical information

CPT code 78261 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 healthcare provider performs imaging of the gastric mucosa using a radiopharmaceutical to determine the cause of acute gastrointestinal bleeding in a child.
2. During the procedure, the provider administers a tracer and uses a gamma camera to visualize the gastric mucosa and identify any abnormalities or disorders.
3. The provider interprets the imaging results and includes the findings in the patient’s medical report.
4. Another healthcare provider performs imaging of the gastric mucosa on a patient with suspected Meckel’s diverticulum to confirm the diagnosis.
5. The procedure involves the administration of a radiopharmaceutical and the use of a gamma camera to visualize the gastric mucosa and detect any abnormal placement of the mucosa outside the stomach.
6. The provider documents the findings and includes them in the patient’s medical record for further evaluation and treatment.
7. A healthcare provider performs imaging of the gastric mucosa on a patient with cysts in the gastrointestinal system to assess the extent and location of the cysts.
8. The procedure involves the administration of a radiopharmaceutical and the use of a gamma camera to visualize the gastric mucosa and identify any abnormal accumulation or secretion of the tracer.
9. The provider interprets the imaging results and discusses the findings with the patient to determine the appropriate treatment plan.
10. Another healthcare provider performs imaging of the gastric mucosa on a patient with gastrointestinal disorders to evaluate the condition of the gastric mucosa and identify any abnormalities.