How To Use CPT Code 78812

CPT 78812 describes the use of positron emission tomography (PET) imaging to detect cancerous cells 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 78812?

CPT 78812 is used to report a limited PET scan that covers the area from the skull base to the mid thigh. This code is specifically used for imaging procedures that aim to detect malignant tumors in the body. By utilizing a radiopharmaceutical tracer called FDG (fluoro-deoxyglucose), which contains glucose and emits small amounts of energy, the PET scan can produce a three-dimensional image that highlights cancerous cells with a higher metabolic rate than normal cells.

2. Official Description

The official description of CPT code 78812 is: ‘Positron emission tomography (PET) imaging; skull base to mid-thigh.’

3. Procedure

1. Prior to the PET scan, the patient is injected with a radiopharmaceutical tracer called FDG.
2. The FDG tracer spreads throughout the body via the bloodstream and is absorbed by cells.
3. The absorbed FDG tracer emits positrons, which collide with electrons and produce photons that travel in opposite directions.
4. The PET scanner captures the emitted photons, and a computer processes the data to create a three-dimensional image of the body tissues.
5. The resulting image helps identify malignant tumors and their locations.

4. Qualifying circumstances

CPT 78812 is used when performing a PET scan to detect cancerous cells in the body. The patient must receive an injection of the radiopharmaceutical tracer FDG, which highlights the metabolic activity of cancer cells. This code specifically covers imaging from the skull base to the mid thigh, and it is important to ensure that the scan is limited to this specific area.

5. When to use CPT code 78812

CPT code 78812 should be used when conducting a PET scan that focuses on imaging from the skull base to the mid thigh. It is important to note that this code is specific to limited scans and should not be used for scans that cover a larger or different area of the body.

6. Documentation requirements

To support a claim for CPT 78812, the following documentation is required:

• Confirmation of the radiopharmaceutical tracer used, specifically FDG
• Date and time of the PET scan
• Details of the area imaged, from the skull base to the mid thigh
• Identification of any malignant tumors detected
• Signature of the healthcare professional performing or supervising the scan

7. Billing guidelines

When billing for CPT 78812, it is important to ensure that the scan is limited to the area from the skull base to the mid thigh. This code should not be reported with other codes unless specifically instructed to do so. It is crucial to follow the guidelines provided by the payer and accurately document the procedure to support the claim.

8. Historical information

CPT 78812 was added to the Current Procedural Terminology system on January 1, 2005. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes a PET scan from the skull base to the mid thigh to detect the presence of a malignant tumor in the pelvic region.
2. A PET scan is performed on a patient to identify cancerous cells in the abdomen, focusing on the area from the skull base to the mid thigh.
3. A limited PET scan is conducted on a patient to assess the presence of a malignant tumor in the thigh area, covering the region from the skull base to the mid thigh.
4. A PET scan is performed on a patient to detect cancerous cells in the lower back and pelvis, specifically imaging from the skull base to the mid thigh.
5. A limited PET scan is conducted on a patient to identify the presence of a malignant tumor in the hip area, covering the region from the skull base to the mid thigh.
6. A PET scan is performed on a patient to assess the presence of cancerous cells in the upper leg, focusing on the area from the skull base to the mid thigh.
7. A limited PET scan is conducted on a patient to detect the presence of a malignant tumor in the groin area, covering the region from the skull base to the mid thigh.
8. A PET scan is performed on a patient to identify cancerous cells in the thigh and lower abdomen, specifically imaging from the skull base to the mid thigh.
9. A limited PET scan is conducted on a patient to assess the presence of a malignant tumor in the pelvic region, covering the region from the skull base to the mid thigh.
10. A PET scan is performed on a patient to detect cancerous cells in the lower abdomen and upper leg, focusing on the area from the skull base to the mid thigh.