How To Use CPT Code 78265

CPT 78265 describes the procedure for a gastric emptying imaging study with small bowel transit. 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 78265?

CPT 78265 is used to describe a gastric emptying imaging study with small bowel transit. This procedure involves administering a meal to the patient that contains a radiopharmaceutical or tracer. The provider then evaluates the speed at which the stomach and small intestine empty by capturing various images and monitoring the passage of the food. This study helps assess the functioning of the gastric muscles.

2. Official Description

The official description of CPT code 78265 is: ‘Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit.’

3. Procedure

1. The provider gives the patient a liquid, solid, or semisolid meal with a radiopharmaceutical or tracer added to it.
2. After the patient completes the meal, the provider uses scintigraphy to immediately image the esophagus, stomach, and small bowel.
3. The provider evaluates the rate at which the tracer leaves the stomach and small intestine, which reflects the rate at which food is emptying from these organs.
4. Continuous or intermittent imaging is performed for three to four hours to assess the strength of the gastric muscles.

4. Qualifying circumstances

CPT 78265 is used for patients who require a gastric emptying imaging study with small bowel transit. This procedure is typically performed to evaluate the functioning of the gastric muscles. The patient must ingest a meal containing a radiopharmaceutical or tracer, and scintigraphy is used to capture images of the esophagus, stomach, and small bowel. The study helps determine the rate at which food empties from the stomach and small intestine.

5. When to use CPT code 78265

CPT code 78265 should be used when a provider performs a gastric emptying imaging study with small bowel transit. This code is appropriate when evaluating the functioning of the gastric muscles and assessing the rate at which food empties from the stomach and small intestine. It should not be used if the provider only evaluates the stomach muscles or if the study includes the evaluation of the stomach, small intestine, and large intestine over multiple days.

6. Documentation requirements

To support a claim for CPT code 78265, the provider must document the following information:

• Details of the meal administered to the patient, including whether it was liquid, solid, or semisolid
• The specific radiopharmaceutical or tracer used
• Date and time of the procedure
• Images captured during the study, including those of the esophagus, stomach, and small bowel
• Assessment of the rate at which the tracer leaves the stomach and small intestine
• Duration of continuous or intermittent imaging

7. Billing guidelines

When billing for CPT code 78265, ensure that the procedure performed includes both gastric emptying imaging and small bowel transit. If only the physician’s interpretation is being reported, append modifier 26 to the radiology code. If only the technical component is being reported, append modifier TC to the radiology code. However, note that payer policies may exempt hospitals from appending modifier TC. If the provider evaluates only the stomach muscles, use code 78264. If the provider evaluates the stomach, small intestine, and large intestine over multiple days, use code 78266.

8. Historical information

CPT code 78265 was added to the Current Procedural Terminology system on January 1, 2016. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes a gastric emptying imaging study with small bowel transit after ingesting a solid meal with a radiopharmaceutical. The provider captures images of the esophagus, stomach, and small bowel to assess the rate at which the food empties from these organs.
2. During a gastric emptying imaging study with small bowel transit, a patient consumes a liquid meal with a tracer. The provider performs continuous imaging for four hours to evaluate the strength of the gastric muscles and the rate at which the food leaves the stomach and small intestine.
3. A provider administers a semisolid meal with a radiopharmaceutical to a patient for a gastric emptying imaging study with small bowel transit. The provider uses scintigraphy to monitor the passage of the food and assess the functioning of the gastric muscles.
4. During a gastric emptying imaging study with small bowel transit, a patient ingests a solid meal with a tracer. The provider captures images of the esophagus, stomach, and small bowel to determine the rate at which the food empties from these organs.
5. A provider performs a gastric emptying imaging study with small bowel transit on a patient who consumes a liquid meal with a radiopharmaceutical. The provider evaluates the strength of the gastric muscles and monitors the rate at which the food leaves the stomach and small intestine.
6. During a gastric emptying imaging study with small bowel transit, a patient ingests a semisolid meal with a tracer. The provider uses scintigraphy to capture images of the esophagus, stomach, and small bowel and assess the functioning of the gastric muscles.