How To Use CPT Code 78800

CPT 78800 describes the use of a gamma-emitting radioactive tracer to diagnose and localize tumors, inflammatory processes, or the distribution of radiopharmaceutical agents in a single body area. 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 78800?

CPT 78800 can be used to describe the use of a gamma-emitting radioactive tracer to diagnose and localize tumors, inflammatory processes, or the distribution of radiopharmaceutical agents in a specific area of the body. This code is used for planar imaging, which produces two-dimensional images of a single area such as the head, neck, chest, or pelvis.

2. Official Description

The official description of CPT code 78800 is: ‘Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, single area (eg, head, neck, chest, pelvis), single day imaging.’

3. Procedure

1. The provider administers or injects a gamma-emitting radioactive tracer, which is directed against a specific cellular antigen, into the patient.
2. The provider then uses an external gamma camera to perform planar imaging of the specific area of the body.
3. If necessary, the provider may also perform vascular flow and blood pool imaging to assess the blood flow through the heart and lungs.
4. The gamma rays emitted by the radioactive tracer are detected by the gamma camera, and a computer uses this data to create two-dimensional images of the area.
5. The provider analyzes the images to assess anatomy and detect and localize tumors, inflammatory processes, or other pathology in the specific area of the body.

4. Qualifying circumstances

CPT 78800 is used for patients who require the localization of tumors, inflammatory processes, or the distribution of radiopharmaceutical agents in a specific area of the body. The procedure is typically performed by a provider who administers or injects the radioactive tracer and performs the planar imaging using an external gamma camera. Vascular flow and blood pool imaging may also be performed if necessary.

5. When to use CPT code 78800

CPT code 78800 should be used when a provider performs planar imaging to diagnose and localize tumors, inflammatory processes, or the distribution of radiopharmaceutical agents in a specific area of the body. This code is appropriate for single-day imaging of a single area, such as the head, neck, chest, or pelvis.

6. Documentation requirements

To support a claim for CPT 78800, the provider must document the following information:

• Reason for performing the procedure, such as suspected tumor or inflammatory process
• Specific area of the body imaged
• Date of the imaging procedure
• Details of the radioactive tracer used
• Results of the imaging and any findings of tumors, inflammatory processes, or other pathology
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 78800, ensure that the procedure is performed by a provider who administers or injects the radioactive tracer and performs the planar imaging using an external gamma camera. If only the physician’s interpretation of the radiology service is being reported, append modifier 26 to the radiology code. If only the technical component is being reported, append modifier TC to the radiology code. 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 78800 was added to the Current Procedural Terminology system on January 1, 1990. There have been two code changes since its addition, with the most recent change occurring on January 1, 2020.

9. Examples

1. A provider performs planar imaging of the head to diagnose and localize a suspected brain tumor.
2. A patient undergoes planar imaging of the neck to assess the distribution of a radiopharmaceutical agent used for thyroid imaging.
3. A provider performs planar imaging of the chest to detect and localize an inflammatory process in the lungs.
4. A patient undergoes planar imaging of the pelvis to assess the distribution of a radiopharmaceutical agent used for bone imaging.
5. A provider performs planar imaging of the abdomen to diagnose and localize a suspected tumor in the liver.
6. A patient undergoes planar imaging of the head to assess the distribution of a radiopharmaceutical agent used for brain perfusion imaging.
7. A provider performs planar imaging of the neck to detect and localize an inflammatory process in the salivary glands.
8. A patient undergoes planar imaging of the chest to assess the distribution of a radiopharmaceutical agent used for lung ventilation imaging.
9. A provider performs planar imaging of the pelvis to diagnose and localize a suspected tumor in the prostate.
10. A patient undergoes planar imaging of the abdomen to assess the distribution of a radiopharmaceutical agent used for liver and spleen imaging.