How To Use CPT Code 78635

CPT 78635 describes the imaging procedure used to check the size of brain ventricles by imaging the flow of cerebrospinal fluid (CSF). 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 78635?

CPT 78635 is used to describe an imaging procedure that checks the size of brain ventricles by imaging the flow of cerebrospinal fluid (CSF). This diagnostic procedure is commonly performed in children with hydrocephalus, a condition characterized by the abnormal accumulation of CSF in the brain.

2. Official Description

The official description of CPT code 78635 is: ‘Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography.’ This code does not include the introduction of any material.

3. Procedure

1. The provider prepares the patient for the procedure and ensures they are appropriately prepped and anesthetized.
2. The provider performs a lumbar puncture, inserting a spinal needle in the lower back and injecting a radioactive substance into the fluid around the spinal cord.
3. The provider uses a scintillation or gamma camera to detect the gamma rays emitted by the radioactive substance.
4. A computer processes the emission data to produce multi-dimensional images of the radioactive substance’s distribution in the CSF throughout the brain ventricles.

4. Qualifying circumstances

CPT 78635 is typically performed on patients who may have hydrocephalus, a condition characterized by abnormal accumulation of CSF in the brain. The procedure is used to check the size of brain ventricles and diagnose and treat diseases related to the nervous system. It is important to note that this code does not include the introduction of any material.

5. When to use CPT code 78635

CPT code 78635 should be used when the provider performs an imaging procedure to check the size of brain ventricles by imaging the flow of cerebrospinal fluid. It is important to ensure that the procedure does not involve the introduction of any material. If the procedure includes the introduction of material, a different code should be used.

6. Documentation requirements

To support a claim for CPT 78635, the provider must document the following information:

• Patient’s medical history and symptoms indicating the need for the procedure
• Details of the procedure performed, including the use of a radioactive substance and the imaging technique used
• Date and time of the procedure
• Findings and interpretation of the imaging results
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 78635, ensure that the procedure involves imaging the flow of cerebrospinal fluid in the brain ventricles. It is important to note that this code does not include the introduction of any material. If the procedure includes the introduction of material, a different code should be used. Additionally, if the provider only performs the interpretation of the radiology service, modifier 26 should be appended to the radiology code. If only the technical component is provided, modifier TC should be appended. However, payer policies may exempt hospitals from appending modifier TC.

8. Historical information

CPT 78635 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A pediatric patient with suspected hydrocephalus undergoes CPT 78635 to check the size of their brain ventricles.
2. A neurologist performs CPT 78635 on a patient with symptoms indicating a potential nervous system disorder.
3. A radiologist uses CPT 78635 to image the flow of cerebrospinal fluid in the brain ventricles of a patient with a history of hydrocephalus.
4. A neurosurgeon performs CPT 78635 to assess the effectiveness of a previous treatment for a patient with a nervous system condition.
5. A pediatric radiologist uses CPT 78635 to monitor the progression of hydrocephalus in a child.
6. A neurologist performs CPT 78635 on a patient with suspected abnormalities in the size of their brain ventricles.
7. A neurosurgeon uses CPT 78635 to evaluate the flow of cerebrospinal fluid in the brain ventricles of a patient with a history of nervous system disorders.
8. A radiologist performs CPT 78635 to assess the response to treatment in a patient with hydrocephalus.
9. A pediatric neurologist uses CPT 78635 to diagnose and monitor hydrocephalus in a child.
10. A neurosurgeon performs CPT 78635 to evaluate the need for surgical intervention in a patient with suspected hydrocephalus.