How To Use CPT Code 78278

CPT 78278 describes the imaging procedure used to identify the source of acute gastrointestinal blood loss when there is no direct evidence of active bleeding in the lower gastrointestinal tract or when active bleeding hinders visualization of the bowel. 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 78278?

CPT 78278 is a diagnostic nuclear medicine procedure that involves imaging a wide area of the abdomen and pelvic region to identify the location of acute gastrointestinal blood loss. The provider administers a radiopharmaceutical or tracer and uses a gamma camera to detect the tracer’s distribution in the body. By capturing images of the liver, spleen, and entire abdominal region, the provider can pinpoint the bleeding site when there is no direct evidence of active bleeding in the lower gastrointestinal tract or when active bleeding obstructs visualization of the bowel.

2. Official Description

The official description of CPT code 78278 is: ‘Acute gastrointestinal blood loss imaging, including the lower portion of the liver and spleen and the entire abdomen and pelvic region, following the administration of a radiopharmaceutical or tracer.’

3. Procedure

1. The provider administers a radiopharmaceutical or tracer, such as 99mTc sulfur colloid, intravenously.
2. Using a large field of view gamma camera, the provider images a wide area of the abdomen and pelvic region.
3. Static images, oblique views, or upper abdominal views may be taken to locate the bleeding site.
4. The provider interprets the results, prepares a nuclear medicine report, and reviews and signs it.

4. Qualifying circumstances

CPT 78278 is used when there is a need to identify the source of acute gastrointestinal blood loss in cases where there is no direct evidence of active bleeding in the lower gastrointestinal tract or when active bleeding prevents adequate visualization of the bowel. This procedure is typically performed by a provider trained in nuclear medicine.

5. When to use CPT code 78278

CPT code 78278 should be used when there is a suspicion of acute gastrointestinal blood loss and other diagnostic methods have not provided conclusive results. It is important to ensure that there is no direct evidence of active bleeding in the lower gastrointestinal tract or that active bleeding does not hinder visualization of the bowel. This code should not be used for routine imaging of the gastrointestinal system or for other indications not related to acute gastrointestinal blood loss.

6. Documentation requirements

To support a claim for CPT code 78278, the provider must document the following information:

• Indication for the procedure and the need to identify the source of acute gastrointestinal blood loss
• Type of radiopharmaceutical or tracer administered
• Date and time of the procedure
• Images obtained and any additional views taken
• Interpretation of the results and the provider’s signature on the nuclear medicine report

7. Billing guidelines

When billing for CPT code 78278, ensure that the procedure is performed by a provider trained in nuclear medicine. It is important to follow payer guidelines regarding the use of modifiers, such as modifier 26 for the professional component or modifier TC for the technical component, if applicable. If the provider performs both the professional and technical components, no modifiers are necessary. It is also important to review payer policies regarding the reporting of CPT code 78278 with other codes, as well as any specific documentation requirements.

8. Historical information

CPT code 78278 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 patient presents with acute gastrointestinal bleeding, and other diagnostic methods have not provided conclusive results. The provider administers a radiopharmaceutical and performs imaging of the abdomen and pelvic region to identify the source of the bleeding.
2. A patient with a history of gastrointestinal bleeding undergoes CPT 78278 to locate the bleeding site when there is no direct evidence of active bleeding in the lower gastrointestinal tract or when active bleeding hinders visualization of the bowel.
3. A provider performs CPT 78278 on a patient who presents with symptoms of acute gastrointestinal blood loss but does not show any signs of active bleeding in the lower gastrointestinal tract.
4. A patient with a suspected source of acute gastrointestinal bleeding undergoes CPT 78278 to identify the bleeding site when other diagnostic methods have not provided conclusive results.
5. A provider uses CPT 78278 to image the abdomen and pelvic region of a patient with acute gastrointestinal blood loss, aiming to locate the bleeding site when direct evidence of active bleeding in the lower gastrointestinal tract is absent or when active bleeding obstructs visualization of the bowel.
6. A patient with unexplained acute gastrointestinal bleeding undergoes CPT 78278 to identify the source of the bleeding when other diagnostic methods have not provided definitive results.
7. A provider performs CPT 78278 on a patient with suspected acute gastrointestinal blood loss, aiming to locate the bleeding site when there is no direct evidence of active bleeding in the lower gastrointestinal tract or when active bleeding prevents adequate visualization of the bowel.
8. A patient with recurrent episodes of acute gastrointestinal bleeding undergoes CPT 78278 to identify the source of the bleeding when other diagnostic methods have not provided conclusive results.