How To Use CPT Code 78815

CPT 78815 describes the combined imaging procedure of positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging from the skull base to the mid-thigh. 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 78815?

CPT 78815 is used to describe the combined imaging procedure of PET with concurrently acquired CT for attenuation correction and anatomical localization imaging. This code specifically covers the imaging of the area from the skull base to the mid-thigh. It allows doctors to evaluate the location and metabolic actions of tumors or cancer inside the body before beginning an active treatment regimen. By combining the results of PET and CT scans, a more complete picture and information on tumor location and metabolism can be obtained.

2. Official 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

1. Initially, the patient is placed in the PET/CT chamber.
2. The CT scanner sends X-rays through the body, which are measured by CT detectors and processed via computer algorithms to produce detailed two-dimensional images of the size, shape, and location of internal organs or tumors.
3. For the PET scan, an injection of glucose infused with radionuclide (radioactive) material is given to the patient.
4. The PET scan measures important body functions, such as blood flow, oxygen use, and sugar metabolism in bodily organs and tissues, to help doctors assess function.
5. The PET and CT data are fused together, rectifying the limitation of PET alone, to provide a detailed picture of the internal structure of the targeted organ or tumor.
6. The combined PET/CT scan allows for the detection of abnormal metabolic activity of tumor cells and provides a more comprehensive understanding of the patient’s condition for the physician.

4. Qualifying circumstances

CPT 78815 is used for patients who require imaging of the area from the skull base to the mid-thigh. This procedure is typically performed on individuals suspected of having tumors or cancer in this region. It is important to note that this code specifically covers the combined PET/CT imaging and not the individual PET or CT scans alone.

5. When to use CPT code 78815

CPT code 78815 should be used when a combined PET/CT imaging procedure is performed on a patient from the skull base to the mid-thigh. It is important to ensure that the procedure meets the specific criteria outlined in the code description. If the imaging is performed on a different region of the body or does not involve both PET and CT scans, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT code 78815, the following documentation is required:

• Indication for the combined PET/CT imaging procedure
• Specific region imaged (skull base to mid-thigh)
• Date of the procedure
• Start and end time of the procedure
• Results and findings of the imaging
• Signature of the healthcare professional performing or interpreting the procedure

7. Billing guidelines

When billing for CPT code 78815, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately report the region imaged and the use of both PET and CT scans. Additionally, be aware of any specific guidelines or requirements from insurance providers or payers. It is also important to note that CPT code 78815 should not be reported if other related codes, such as CPT codes 78800-78999, have already been performed within a certain time frame.

8. Historical information

CPT code 78815 was added to the Current Procedural Terminology system on January 1, 2005. It was previously known as ‘Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; skull base to mid-thigh.’ There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes a combined PET/CT imaging procedure from the skull base to the mid-thigh to evaluate the extent and metabolic activity of a suspected tumor in the pelvic region.
2. A patient with a history of lymphoma undergoes a combined PET/CT imaging procedure from the skull base to the mid-thigh to assess the response to treatment and detect any residual disease.
3. A patient with suspected bone metastases undergoes a combined PET/CT imaging procedure from the skull base to the mid-thigh to determine the location and extent of the metastatic lesions.
4. A patient with a known primary tumor in the chest undergoes a combined PET/CT imaging procedure from the skull base to the mid-thigh to evaluate the presence of distant metastases.
5. A patient with a suspected tumor in the abdomen undergoes a combined PET/CT imaging procedure from the skull base to the mid-thigh to assess the location and metabolic activity of the tumor.