How To Use CPT Code 78804

CPT 78804 describes the use of a gamma-emitting radioactive tracer to diagnose and localize tumors, inflammatory processes, or the distribution of radiopharmaceutical agents in the body. 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 78804?

CPT 78804 can be used to describe the procedure in which a gamma-emitting radioactive tracer is administered to a patient to diagnose and localize tumors, inflammatory processes, or the distribution of radiopharmaceutical agents. This code represents imaging of the whole body over a period of two or more days.

2. Official Description

The official description of CPT code 78804 is: ‘Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, requiring 2 or more days imaging.’

3. Procedure

1. The provider administers a gamma-emitting radioactive tracer to the patient.
2. The tracer is directed against a specific cellular antigen and helps in localizing tumors or inflammatory processes.
3. If necessary, vascular flow and blood pool imaging may be performed to assess heart function.
4. A scintillation or gamma camera detects the gamma rays emitted by the tracer, and a computer generates planar images of the body.
5. The provider analyzes the images to assess anatomy and detect and localize tumors, inflammation, or other pathology.
6. This procedure may involve imaging of the whole body over a period of two or more days.

4. Qualifying circumstances

CPT 78804 is used when the provider uses a gamma-emitting radioactive tracer to diagnose and localize tumors, inflammatory processes, or the distribution of radiopharmaceutical agents. The procedure may also include vascular flow and blood pool imaging to assess heart function. This code represents imaging of the whole body over a period of two or more days.

5. When to use CPT code 78804

CPT code 78804 should be used when the provider performs planar imaging of the whole body over a period of two or more days to diagnose and localize tumors, inflammatory processes, or the distribution of radiopharmaceutical agents. This code should not be used for single-day whole-body imaging for tumor localization, which is represented by CPT code 78802.

6. Documentation requirements

To support a claim for CPT 78804, the provider must document the following information:

• Administration of the gamma-emitting radioactive tracer
• Specific cellular antigen targeted by the tracer
• Performance of vascular flow and blood pool imaging, if applicable
• Date and duration of the imaging procedure
• Analysis of the images and findings related to tumor localization, inflammatory processes, or radiopharmaceutical distribution
• Signature of the provider

7. Billing guidelines

When billing for CPT 78804, ensure that the procedure involves planar imaging of the whole body over a period of two or more days. If the provider performs single-day whole-body imaging for tumor localization, use CPT code 78802 instead. 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. If reporting a global service in which one provider renders both the professional and technical components, do not append any modifiers.

8. Historical information

CPT 78804 was added to the Current Procedural Terminology system on January 1, 2004. There have been two code changes since its addition, with the most recent change occurring on January 1, 2020.

9. Examples

1. A patient undergoes planar imaging of the whole body over a period of two days to diagnose and localize a tumor.
2. A provider performs planar imaging of the whole body over three days to assess the distribution of a radiopharmaceutical agent.
3. A patient receives planar imaging of the whole body over four days to evaluate an inflammatory process.
4. A provider conducts planar imaging of the whole body over five days to monitor the response to a radiopharmaceutical treatment.
5. A patient undergoes planar imaging of the whole body over six days to investigate the distribution of a radiopharmaceutical agent for research purposes.
6. A provider performs planar imaging of the whole body over seven days to assess the response to a targeted therapy for a specific tumor.
7. A patient receives planar imaging of the whole body over eight days to evaluate the distribution of a radiopharmaceutical agent in a clinical trial.
8. A provider conducts planar imaging of the whole body over nine days to monitor the progression of an inflammatory process.
9. A patient undergoes planar imaging of the whole body over ten days to assess the response to a new radiopharmaceutical agent.
10. A provider performs planar imaging of the whole body over eleven days to investigate the distribution of a radiopharmaceutical agent in a rare disease.