How To Use CPT Code 78801

CPT 78801 describes the use of a gamma-emitting radioactive tracer to diagnose and localize tumors, inflammatory processes, or the distribution of radiopharmaceutical agents. 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 78801?

CPT 78801 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. This code represents imaging of two or more areas over one or more days, or imaging of a single area over two or more days. It may also include vascular flow and blood pool imaging to assess heart function.

2. Official Description

The official description of CPT code 78801 is: ‘Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, 2 or more areas (eg, abdomen and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or more days.’

3. Procedure

1. The provider administers a gamma-emitting radioactive tracer to the patient.
2. The tracer reacts with specific tumor cell antigens or helps in localizing inflammatory processes.
3. The provider uses an external gamma camera to capture images of the area of interest.
4. A computer analyzes the data from the gamma camera to create planar images of the targeted areas.
5. The provider reviews the images to assess anatomy and detect and localize tumors, inflammation, or other pathology.
6. The procedure may also include vascular flow and blood pool imaging to evaluate heart function.

4. Qualifying circumstances

CPT 78801 is used when a provider needs to diagnose and localize tumors, inflammatory processes, or the distribution of radiopharmaceutical agents. This procedure is typically performed when other imaging modalities, such as CT or MRI, are not sufficient or when specific cellular antigens need to be targeted. The imaging may involve two or more areas over one or more days, or a single area over two or more days. Vascular flow and blood pool imaging may be included to assess heart function.

5. When to use CPT code 78801

CPT code 78801 should be used when a provider performs planar imaging of two or more areas over one or more days, or imaging of a single area over two or more days. This code is appropriate when using a gamma-emitting radioactive tracer to diagnose and localize tumors, inflammatory processes, or the distribution of radiopharmaceutical agents. Vascular flow and blood pool imaging may also be included in the procedure.

6. Documentation requirements

To support a claim for CPT 78801, the provider must document the following information:

• Reason for the procedure and the need for radiopharmaceutical localization
• Specific areas imaged and the duration of imaging
• Details of any vascular flow and blood pool imaging performed
• Findings and interpretation of the images
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 78801, ensure that the procedure meets the criteria for this code. The imaging should involve two or more areas over one or more days, or a single area over two or more days. Vascular flow and blood pool imaging should be documented if performed. Modifier 26 should be appended 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. If reporting a global service, where one provider performs both the professional and technical components, no modifier is necessary.

8. Historical information

CPT 78801 was added to the Current Procedural Terminology system on January 1, 1990. There have been several changes to the code over the years, including updates to the description and the addition of modifiers.

9. Examples

1. A patient undergoes planar imaging of the abdomen and pelvis over two consecutive days to localize a suspected tumor.
2. A provider performs planar imaging of the head and chest on separate days to assess the distribution of a radiopharmaceutical agent.
3. A patient receives imaging of the pelvis and knees over three consecutive days to diagnose and localize an inflammatory process.
4. A provider conducts planar imaging of the neck and chest over two days to evaluate the distribution of a radiopharmaceutical agent.
5. A patient undergoes planar imaging of the head and neck on three separate days to diagnose and localize a tumor.
6. A provider performs planar imaging of the chest and pelvis over four consecutive days to assess the distribution of a radiopharmaceutical agent.
7. A patient receives imaging of the abdomen and pelvis over two days to diagnose and localize an inflammatory process.
8. A provider conducts planar imaging of the head and chest on separate days to evaluate the distribution of a radiopharmaceutical agent.
9. A patient undergoes planar imaging of the pelvis and knees over three consecutive days to diagnose and localize a tumor.
10. A provider performs planar imaging of the neck and chest over two days to assess the distribution of a radiopharmaceutical agent.