How To Use CPT Code 78811

CPT 78811 describes the limited area positron emission tomography (PET) imaging procedure. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 78811?

CPT 78811 can be used to describe a specific type of positron emission tomography (PET) imaging procedure. This code is used when the provider performs PET imaging on a small, defined area of the body, such as the chest or head/neck. PET imaging is a diagnostic nuclear imaging test that produces three-dimensional images of functional processes in the body. It is an effective method for detecting tumor cells in the body.

2. Official Description

The official description of CPT code 78811 is: ‘Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck).’ This code is used when the provider performs PET imaging on a specific area of the body, such as the chest or head/neck. There are no additional notes or modifiers specified for this code.

3. Procedure

1. In this diagnostic procedure, the provider performs PET imaging on a small, defined area of the body, such as the chest or head/neck.
2. The provider injects a radioactive tracer or radionuclide into the patient’s bloodstream.
3. The radionuclide travels in the bloodstream and reaches the target area, where it breaks into tiny positively charged particles called positrons.
4. The positrons emit gamma rays, which are detected by a PET scanner.
5. The PET scanner captures the emitted data and processes it using a computer to produce three-dimensional images of the distribution of the chemicals throughout the structure being examined.
6. These images help the provider differentiate tumor cells from normal cells in the body.

4. Qualifying circumstances

CPT 78811 is used when the provider performs PET imaging on a limited area of the body, such as the chest or head/neck. This procedure is typically used to detect tumor cells in the specific area being imaged. It is important to note that this code should only be used for PET imaging and not other types of imaging procedures.

5. When to use CPT code 78811

CPT code 78811 should be used when the provider performs PET imaging on a limited area of the body, such as the chest or head/neck. This code is appropriate when the purpose of the imaging is to detect tumor cells in the specific area being imaged. It should not be used for PET imaging of other areas or for other types of imaging procedures.

6. Documentation requirements

To support a claim for CPT code 78811, the provider must document the following information:

• The specific area of the body that was imaged (e.g., chest, head/neck)
• The reason for performing the PET imaging on the limited area
• The date of the procedure
• The start and end time of the procedure
• Any additional relevant information or findings from the imaging
• The provider’s signature

7. Billing guidelines

When billing for CPT code 78811, ensure that the provider performed PET imaging on a limited area of the body, such as the chest or head/neck. There are no specific guidelines regarding reporting this code with other codes. However, it is important to follow payer policies and guidelines when submitting claims for reimbursement.

8. Historical information

CPT code 78811 was added to the Current Procedural Terminology system on January 1, 2005. On January 1, 2008, the code description was changed to specify ‘Tumor imaging’ in addition to ‘Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck).’ There have been no further updates or changes to the code since its addition.

9. Examples

1. A provider performs PET imaging on a patient’s chest to detect tumor cells in the area.
2. A patient undergoes PET imaging of their head/neck to identify any tumor cells in that specific region.
3. A provider performs PET imaging on a limited area of a patient’s body to assess the effectiveness of a cancer treatment.
4. A patient undergoes PET imaging of their chest to determine the extent of tumor spread in that area.
5. A provider performs PET imaging on a specific area of a patient’s body to guide a surgical procedure.
6. A patient undergoes PET imaging of their head/neck to monitor the progression of a known tumor in that region.
7. A provider performs PET imaging on a limited area of a patient’s body to evaluate the response to a targeted therapy.
8. A patient undergoes PET imaging of their chest to assess the metabolic activity of tumor cells in that area.
9. A provider performs PET imaging on a specific area of a patient’s body to aid in the diagnosis of a suspected tumor.
10. A patient undergoes PET imaging of their head/neck to determine the presence of any tumor recurrence in that region.