How To Use CPT Code 78815

CPT 78815 is a code used for combined PET/CT imaging procedures for tumor detection and anatomical localization from the skull base to mid-thigh. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 78815.

1. What is CPT 78815?

CPT 78815 is a medical billing code used to describe a specific type of diagnostic imaging procedure that combines Positron Emission Tomography (PET) and Computed Tomography (CT) scans. This combined imaging technique is primarily used for tumor detection and anatomical localization within the body, specifically from the skull base to the mid-thigh region. The code is utilized by medical professionals to accurately document and bill for this specific procedure.

2. 78815 CPT code description

The official description of CPT code 78815 is: “Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging; skull base to mid-thigh.”

3. Procedure

The 78815 procedure involves the following steps:

1. The patient is positioned in the PET/CT scanner chamber.
2. A CT scan is performed, sending X-rays through the body to create detailed two-dimensional images of internal organs or tumors.
3. The patient receives an injection of glucose infused with radionuclide (radioactive) material for the PET scan.
4. The PET scan measures important body functions, such as blood flow, oxygen use, and sugar metabolism in organs and tissues.
5. Cancer cells, which consume more sugar than normal cells, are detected by the PET scan and transformed into images.
6. The data from both the PET and CT scans are fused together, providing a more complete picture of tumor location and metabolism for the physician.

4. Qualifying circumstances

Patients eligible to receive CPT code 78815 services are those who:

• Have a known or suspected cancer diagnosis.
• Require imaging for tumor detection and anatomical localization within the skull base to mid-thigh region.
• Need a more comprehensive imaging study than a standalone PET or CT scan can provide.
• Have no contraindications for undergoing PET/CT imaging, such as pregnancy or allergy to the injected radionuclide material.

5. When to use CPT code 78815

It is appropriate to bill the 78815 CPT code when a combined PET/CT imaging procedure is performed for the purpose of tumor detection and anatomical localization within the skull base to mid-thigh region. This code should be used when the procedure is medically necessary and meets the qualifying circumstances outlined above.

6. Documentation requirements

To support a claim for CPT 78815, the following information should be documented:

• Patient’s medical history and relevant clinical findings.
• Indication for the PET/CT imaging procedure, such as known or suspected cancer diagnosis.
• Details of the PET/CT procedure, including the injected radionuclide material and dosage.
• Findings from the PET/CT imaging, including tumor location, size, and metabolic activity.
• Physician’s interpretation of the PET/CT imaging results and any recommendations for further evaluation or treatment.

7. Billing guidelines

When billing for CPT code 78815, it is important to follow the appropriate guidelines and rules. Some tips and codes that apply to CPT code 78815 include:

• Ensure that the procedure is medically necessary and meets the qualifying circumstances outlined above.
• Document all required information to support the claim, as mentioned in the documentation requirements section.
• Use the appropriate ICD-10 diagnosis codes to indicate the patient’s medical condition and reason for the PET/CT imaging.
• Check with the patient’s insurance provider for any specific billing requirements or restrictions related to PET/CT imaging procedures.

8. Historical information

CPT 78815 was added to the Current Procedural Terminology system on January 1, 2005. The code was changed on January 1, 2008, with the previous descriptor being “Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; skull base to mid-thigh.”

9. Similar codes to CPT 78815

Five similar codes to CPT 78815 and how they differentiate from CPT 78815 are:

• CPT 78811: This code is used for PET imaging limited to a single organ or anatomic region.
• CPT 78812: This code is used for PET imaging of the whole body, not limited to the skull base to mid-thigh region.
• CPT 78813: This code is used for PET imaging with concurrent CT for attenuation correction and anatomical localization, limited to a single organ or anatomic region.
• CPT 78814: This code is used for PET imaging with concurrent CT for attenuation correction and anatomical localization, covering the whole body.
• CPT 78816: This code is used for PET imaging with concurrent CT for attenuation correction and anatomical localization, covering a specific limited area of the body.

10. Examples

Here are 10 detailed examples of CPT code 78815 procedures:

1. A patient with a known lung cancer diagnosis requires PET/CT imaging to assess the extent of the disease and determine if it has spread to other areas within the skull base to mid-thigh region.
2. A patient with suspected lymphoma undergoes PET/CT imaging to identify the location and size of any tumors within the skull base to mid-thigh region.
3. A patient with a history of breast cancer undergoes PET/CT imaging to monitor for any signs of recurrence or metastasis within the skull base to mid-thigh region.
4. A patient with a known brain tumor requires PET/CT imaging to assess the metabolic activity of the tumor and guide treatment planning.
5. A patient with suspected bone cancer undergoes PET/CT imaging to identify the location and size of any tumors within the skull base to mid-thigh region.
6. A patient with a known pancreatic cancer diagnosis requires PET/CT imaging to assess the extent of the disease and determine if it has spread to other areas within the skull base to mid-thigh region.
7. A patient with suspected liver cancer undergoes PET/CT imaging to identify the location and size of any tumors within the skull base to mid-thigh region.
8. A patient with a history of colorectal cancer undergoes PET/CT imaging to monitor for any signs of recurrence or metastasis within the skull base to mid-thigh region.
9. A patient with a known esophageal cancer diagnosis requires PET/CT imaging to assess the extent of the disease and determine if it has spread to other areas within the skull base to mid-thigh region.
10. A patient with suspected ovarian cancer undergoes PET/CT imaging to identify the location and size of any tumors within the skull base to mid-thigh region.