How To Use CPT Code 78315

CPT 78315 describes a three-phase bone scan, a specialized nuclear medicine procedure used to examine the bones of the skeleton and diagnose bone diseases. 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 78315?

CPT 78315 is used to describe a three-phase bone scan, a nuclear medicine procedure that involves injecting a radionuclide into a patient’s vein to examine the bones of the skeleton and diagnose bone diseases. This code is used when the physician performs a three-phase study, including vascular flow, blood pool, and delayed status images of a specific body part(s).

2. Official Description

The official description of CPT code 78315 is: ‘Bone and/or joint imaging; three-phase study.’

3. Procedure

1. The physician injects a radionuclide (also known as a tracer) into the patient’s vein.
2. The physician performs a three-phase study, which includes vascular flow, blood pool, and delayed status images of the specific body part(s) being examined.
3. The three-phase study typically involves taking a series of images immediately after the radionuclide administration, 20 minutes after administration, and three hours after administration.

4. Qualifying circumstances

CPT 78315 is used when a physician performs a three-phase bone scan to examine the bones of the skeleton and diagnose bone diseases. This procedure is commonly ordered for conditions such as fractures, osteomyelitis, or metastatic bone disease. The use of a radionuclide as a radioactive tracer is essential for this procedure.

5. When to use CPT code 78315

CPT code 78315 should be used when a physician performs a three-phase bone scan to examine the bones of the skeleton and diagnose bone diseases. It is important to ensure that the procedure includes all three phases: vascular flow, blood pool, and delayed status images. If any of these phases are not performed, a different CPT code should be used to accurately report the procedure.

6. Documentation requirements

To support a claim for CPT 78315, the physician must document the following information:

• Specific body part(s) being examined
• Injection of the radionuclide
• Performance of the three-phase study, including images taken immediately after administration, 20 minutes after administration, and three hours after administration

7. Billing guidelines

When billing for CPT 78315, it is important to ensure that the procedure includes all three phases: vascular flow, blood pool, and delayed status images. If any of these phases are not performed, a different CPT code should be used. Additionally, if the radiopharmaceutical substance used for the procedure is billed separately, the appropriate code should be reported. 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.

8. Historical information

CPT 78315 was added to the Current Procedural Terminology system on January 1, 1990. The code was later changed on January 1, 2009, to its current description of ‘Bone and/or joint imaging; three-phase study.’

9. Examples

1. A physician performs a three-phase bone scan on a patient with a suspected fracture in their wrist.
2. A patient with suspected osteomyelitis undergoes a three-phase bone scan to aid in diagnosis.
3. A physician orders a three-phase bone scan for a patient with suspected metastatic bone disease.
4. A three-phase bone scan is performed on a patient with unexplained bone pain to identify any abnormalities.
5. A patient with a history of bone tumors undergoes a three-phase bone scan for surveillance purposes.
6. A physician performs a three-phase bone scan on a patient with suspected bone infection following a recent surgery.
7. A three-phase bone scan is ordered for a patient with suspected bone metastases from a known primary cancer.
8. A patient with chronic bone pain undergoes a three-phase bone scan to evaluate for any underlying bone diseases.
9. A physician performs a three-phase bone scan on a patient with suspected bone abnormalities seen on previous imaging studies.
10. A three-phase bone scan is performed on a patient with unexplained bone swelling to determine the cause.