How To Use CPT Code 78306

CPT 78306 refers to a whole-body bone and/or joint imaging procedure used to examine the skeleton and diagnose bone diseases. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 78306.

1. What is CPT 78306?

CPT 78306 is a medical billing code used to describe a whole-body bone and/or joint imaging procedure, also known as scintigraphy. This specialized nuclear medicine procedure involves the injection of a radionuclide (tracer) prior to imaging to examine the various bones of the skeleton and/or diagnose bone disease. The code is used by medical coders and billers to report this specific procedure for reimbursement purposes.

2. 78306 CPT code description

The official description of CPT code 78306 is: “Bone and/or joint imaging; whole body.”

3. Procedure

The 78306 procedure involves the following steps:

1. The patient arrives at the imaging facility and is prepared for the procedure.
2. A physician or qualified healthcare professional injects a radionuclide (tracer) into the patient’s vein.
3. The patient waits for 4-6 hours to allow the radionuclide to circulate and accumulate in the bones.
4. The patient is positioned on the imaging table, and a gamma camera captures images of the bones and joints throughout the entire body.
5. The images are processed and analyzed by a radiologist or nuclear medicine specialist to identify any abnormalities or signs of bone disease.
6. The results are documented and reported to the referring physician for further evaluation and treatment planning.

4. Qualifying circumstances

Patients who are eligible to receive CPT code 78306 services include those with:

• Suspected or known bone metastases from cancer
• Unexplained bone pain or fractures
• Osteomyelitis or other bone infections
• Arthritis or other joint disorders
• Metabolic bone diseases, such as Paget’s disease or osteoporosis
• Monitoring response to treatment for bone diseases

5. When to use CPT code 78306

It is appropriate to bill the 78306 CPT code when a whole-body bone and/or joint imaging procedure is performed to diagnose or evaluate bone diseases, infections, or abnormalities. This code should be used when the entire skeleton is imaged, rather than a specific region or limited area.

6. Documentation requirements

To support a claim for CPT 78306, the following information should be documented:

• Patient’s medical history and presenting symptoms
• Physical examination findings
• Indication for the whole-body bone and/or joint imaging procedure
• Details of the radionuclide injection, including the type, dose, and route of administration
• Time elapsed between injection and imaging
• Imaging technique and equipment used
• Findings and interpretation of the images, including any identified abnormalities or signs of bone disease
• Impression and recommendations for further evaluation or treatment

7. Billing guidelines

When billing for CPT code 78306, keep in mind the following guidelines and rules:

• The entity that bears the cost of the radiopharmaceutical may report the radiopharmaceutical substance separately using the appropriate code.
• If you are reporting only the physician’s interpretation for the radiology service, you should append modifier 26, professional component, to the radiology code.
• If you are reporting only the technical component for the radiology service, you would append modifier TC to the radiology code. Note, however, that payer policy may exempt hospitals from appending modifier TC because the hospital’s portion is inherently technical.
• Do not append a professional or technical modifier to the radiology code when reporting a global service in which one provider renders both the professional and technical components.

8. Historical information

CPT 78306 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Similar codes to CPT 78306

Five similar codes to CPT 78306 and how they differ are:

• CPT 78300: Limited bone and/or joint imaging, focusing on a specific region or area of the body.
• CPT 78305: Multiple areas bone and/or joint imaging, covering more than one region but not the entire body.
• CPT 78315: Bone and/or joint imaging with tomographic (SPECT) imaging, providing three-dimensional images for better visualization of bone abnormalities.
• CPT 78320: Bone and/or joint imaging with blood pool imaging, assessing blood flow to the bones and joints in addition to the standard bone scan.
• CPT 78800: Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent(s), focusing on the detection of tumors or the distribution of the radiopharmaceutical agent in the body.

10. Examples

Here are 10 detailed examples of CPT code 78306 procedures:

1. A patient with a history of breast cancer presents with unexplained back pain. A whole-body bone scan is performed to evaluate for possible bone metastases.
2. A patient with persistent joint pain and swelling undergoes a whole-body bone and joint imaging procedure to assess for inflammatory arthritis.
3. A patient with a history of multiple fractures and low bone density undergoes a whole-body bone scan to evaluate for osteoporosis.
4. A patient with suspected osteomyelitis in the lower extremity undergoes a whole-body bone scan to confirm the diagnosis and assess for other areas of infection.
5. A patient with Paget’s disease undergoes a whole-body bone scan to evaluate the extent of the disease and monitor response to treatment.
6. A patient with a history of prostate cancer and elevated PSA levels undergoes a whole-body bone scan to evaluate for possible bone metastases.
7. A patient with unexplained bone pain and abnormal laboratory results undergoes a whole-body bone scan to assess for metabolic bone disease.
8. A patient with a history of multiple myeloma undergoes a whole-body bone scan to evaluate for lytic bone lesions and monitor response to treatment.
9. A patient with suspected rheumatoid arthritis undergoes a whole-body bone and joint imaging procedure to assess for joint inflammation and damage.
10. A patient with a history of lung cancer and new-onset hip pain undergoes a whole-body bone scan to evaluate for possible bone metastases.