How To Use CPT Code 78813

CPT 78813 describes the whole body 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 78813?

CPT 78813 is used to describe a diagnostic nuclear imaging procedure called positron emission tomography (PET) imaging of the whole body. This procedure involves the injection of a radioactive tracer into the patient’s bloodstream, which emits gamma rays that are detected by a PET scanner. The data collected by the scanner is processed by a computer to produce three-dimensional images of the distribution of chemicals in the body. This imaging technique is particularly effective in detecting tumor cells in the body.

2. Official Description

The official description of CPT code 78813 is: ‘Positron emission tomography (PET) imaging; whole body.’

3. Procedure

1. The provider injects a radioactive tracer or radionuclide into the patient’s bloodstream.
2. The radionuclide travels in the bloodstream and reaches the area of interest, such as a tumor.
3. The radionuclide breaks into positrons, emitting gamma rays.
4. A PET scanner detects the gamma rays emitted by the radioactive substance.
5. The computer processes the emitted data to produce three-dimensional images of the distribution of chemicals in the body.
6. The images help the provider differentiate tumor cells from normal cells.

4. Qualifying circumstances

CPT 78813 is used when a provider performs PET imaging of the whole body. This procedure is typically used to diagnose, manage, and treat diseases by tracking the distribution of a substance within the body. It is important to note that this procedure involves the use of a radioactive tracer or radionuclide, and the provider must have the necessary qualifications and equipment to perform the imaging.

5. When to use CPT code 78813

CPT code 78813 should be used when a provider performs PET imaging of the whole body. It is appropriate to use this code when the imaging is necessary for diagnostic purposes or to monitor the progress of a disease or treatment. However, it is important to review payer policies and guidelines to ensure proper coding and billing practices.

6. Documentation requirements

To support a claim for CPT code 78813, the provider must document the following information:

• Indication for the PET imaging procedure
• Details of the radioactive tracer or radionuclide used
• Date and time of the procedure
• Findings and interpretation of the imaging results
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 78813, it is important to ensure that the procedure meets the criteria for whole body PET imaging. Modifier 26 should be appended to the code if only the physician’s interpretation is being reported. Modifier TC should be appended if only the technical component is being reported. However, it is important to review payer policies and guidelines to determine if modifiers are required or exempted. Additionally, it is important to follow proper coding and billing practices to avoid claim denials or audits.

8. Historical information

CPT code 78813 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 whole body PET imaging procedure to detect the presence of tumor cells.
2. A provider performs PET imaging of the whole body to monitor the progress of a cancer treatment.
3. A patient with suspected metastasis undergoes a whole body PET imaging procedure to determine the extent of the disease.
4. A provider uses PET imaging of the whole body to evaluate the response to a targeted therapy in a patient with a specific type of cancer.
5. A patient with a history of cancer undergoes a whole body PET imaging procedure as part of a routine surveillance protocol.
6. A provider performs PET imaging of the whole body to assess the effectiveness of a new treatment approach in a patient with a rare disease.
7. A patient with unexplained symptoms undergoes a whole body PET imaging procedure to aid in the diagnosis of an underlying condition.
8. A provider uses PET imaging of the whole body to guide the surgical planning for a patient with a complex tumor.
9. A patient with a known tumor undergoes a whole body PET imaging procedure to determine if there is any metastasis.
10. A provider performs PET imaging of the whole body to evaluate the response to chemotherapy in a patient with advanced cancer.