How To Use CPT Code 78650

CPT 78650 describes the detection and localization of cerebrospinal fluid leakage using a diagnostic nuclear imaging technique. 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 78650?

CPT 78650 can be used to describe the detection and localization of cerebrospinal fluid leakage using a diagnostic nuclear imaging technique. This code is used when a provider uses a radioactive substance or tracer to detect and locate the site of cerebrospinal fluid leakage within the brain and spinal cord.

2. Official Description

The official description of CPT code 78650 is: ‘Cerebrospinal fluid leakage detection and localization using a diagnostic nuclear imaging technique.’

3. Procedure

1. 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.
2. A special device called a scintillation or gamma camera is used to detect the gamma rays emitted by the radioactive substance.
3. The computer processes the emission data to produce multi-dimensional images of the distribution of the radioactive substance in the cerebrospinal fluid throughout the brain and spinal cord.
4. The provider evaluates these images to detect and localize the site of cerebrospinal fluid leakage.

4. Qualifying circumstances

Patients eligible to receive CPT 78650 services are those suspected of having cerebrospinal fluid leakage within the brain and spinal cord. This procedure is typically performed when the patient experiences symptoms such as persistent headaches, changes in vision, or other signs of cerebrospinal fluid leakage. The provider must use a diagnostic nuclear imaging technique involving a radioactive substance or tracer to detect and localize the leakage.

5. When to use CPT code 78650

CPT code 78650 should be used when a provider performs a diagnostic nuclear imaging technique to detect and localize cerebrospinal fluid leakage within the brain and spinal cord. This code is specific to the detection and localization of cerebrospinal fluid leakage and should not be used for other diagnostic imaging procedures.

6. Documentation requirements

To support a claim for CPT 78650, the provider must document the following information:

• Reason for performing the procedure, including the patient’s symptoms and suspected cerebrospinal fluid leakage
• Details of the lumbar puncture procedure, including the use of a radioactive substance or tracer
• Date and time of the procedure
• Images obtained from the diagnostic nuclear imaging technique
• Evaluation of the images and localization of the site of cerebrospinal fluid leakage
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 78650, ensure that the provider performs the diagnostic nuclear imaging technique using a radioactive substance or tracer to detect and localize cerebrospinal fluid leakage. This code should not be reported with other codes for injection procedures. If reporting only the physician’s interpretation for the radiology service, append modifier 26. If reporting only the technical component, append modifier TC. However, payer policy may exempt hospitals from appending modifier TC. Do not append a professional or technical modifier when reporting a global service in which one provider renders both components.

8. Historical information

CPT 78650 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 patient presents with persistent headaches and suspected cerebrospinal fluid leakage. The provider performs a diagnostic nuclear imaging technique using a radioactive substance to detect and localize the site of leakage.
2. A patient experiences changes in vision and is suspected of having cerebrospinal fluid leakage. The provider performs a lumbar puncture and uses a diagnostic nuclear imaging technique with a radioactive tracer to detect and localize the leakage.
3. A patient exhibits signs of cerebrospinal fluid leakage following trauma. The provider performs a diagnostic nuclear imaging technique using a radioactive substance to detect and localize the site of leakage.
4. A patient complains of persistent headaches and is suspected of having cerebrospinal fluid leakage. The provider performs a lumbar puncture and uses a diagnostic nuclear imaging technique with a radioactive tracer to detect and localize the leakage.
5. A patient presents with neurological symptoms and is suspected of having cerebrospinal fluid leakage. The provider performs a diagnostic nuclear imaging technique using a radioactive substance to detect and localize the site of leakage.
6. A patient experiences persistent headaches and is suspected of having cerebrospinal fluid leakage. The provider performs a lumbar puncture and uses a diagnostic nuclear imaging technique with a radioactive tracer to detect and localize the leakage.
7. A patient exhibits signs of cerebrospinal fluid leakage following trauma. The provider performs a diagnostic nuclear imaging technique using a radioactive substance to detect and localize the site of leakage.
8. A patient complains of persistent headaches and is suspected of having cerebrospinal fluid leakage. The provider performs a lumbar puncture and uses a diagnostic nuclear imaging technique with a radioactive tracer to detect and localize the leakage.
9. A patient presents with neurological symptoms and is suspected of having cerebrospinal fluid leakage. The provider performs a diagnostic nuclear imaging technique using a radioactive substance to detect and localize the site of leakage.
10. A patient experiences persistent headaches and is suspected of having cerebrospinal fluid leakage. The provider performs a lumbar puncture and uses a diagnostic nuclear imaging technique with a radioactive tracer to detect and localize the leakage.