How To Use CPT Code 78831

CPT 78831 describes the radiopharmaceutical localization of a tumor, inflammatory process, or distribution of radiopharmaceutical agent(s) using a nuclear imaging test called SPECT. 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 78831?

CPT 78831 can be used to describe the radiopharmaceutical localization of a tumor, inflammatory process, or distribution of radiopharmaceutical agent(s) using a nuclear imaging test called SPECT. This code represents single-day imaging of at least two areas or separate acquisitions on one day.

2. Official Description

The official description of CPT code 78831 is: ‘Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), minimum 2 areas (eg, pelvis and knees, chest and abdomen) or separate acquisitions (eg, lung ventilation and perfusion), single day imaging, or single area or acquisition over 2 or more days.’

3. Procedure

1. The provider administers a radiopharmaceutical agent (radioactive tracer) to the patient, typically through intravenous administration.
2. The provider uses a SPECT machine to image the patient, rotating around the patient and taking images of the target area.
3. The machine’s specialized camera detects the radioactive tracer absorbed by the body, with more active tissues absorbing more of the substance.
4. The images are sent to a computer that creates 3D images of the body, allowing the provider to localize a tumor, inflammatory process, or distribution of the radioactive tracer.
5. The service may include vascular flow and blood pool imaging, which show blood flow to a particular area and highlight areas of inflammation or leakage in capillaries.
6. The provider reviews the images, ensures the adequacy of the SPECT data, and produces a formal report for the medical record.

4. Qualifying circumstances

CPT 78831 is used when there is a need to localize a tumor, inflammatory process, or distribution of radiopharmaceutical agent(s) using SPECT imaging. The procedure may include vascular flow and blood pool imaging. The patient must receive a radiopharmaceutical agent and undergo imaging of at least two areas or separate acquisitions on one day.

5. When to use CPT code 78831

CPT code 78831 should be used when there is a need to localize a tumor, inflammatory process, or distribution of radiopharmaceutical agent(s) using SPECT imaging. It is appropriate for single-day imaging of at least two areas or separate acquisitions on one day. This code should not be used for other diagnostic nuclear medicine procedures.

6. Documentation requirements

To support a claim for CPT 78831, the provider must document the following information:

• Reason for the radiopharmaceutical localization procedure
• Details of the radiopharmaceutical agent used
• Date of the procedure
• Areas imaged or separate acquisitions performed
• Presence or absence of vascular flow and blood pool imaging
• Review and interpretation of the images
• Formal report for the medical record

7. Billing guidelines

When billing for CPT 78831, ensure that the procedure meets the criteria for radiopharmaceutical localization using SPECT imaging. It is important to compare the descriptors and documentation carefully to select the appropriate code. If reporting only the physician’s interpretation, append modifier 26 to the radiology code. If reporting only the technical component, append modifier TC to the radiology code. However, payer policy may exempt hospitals from appending modifier TC. Do not append a professional or technical modifier when reporting a global service where one provider renders both components. It is also important to consider the cost of the radiopharmaceutical, which may be reported separately using the appropriate code.

8. Historical information

CPT 78831 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes radiopharmaceutical localization using SPECT imaging to identify the location of a tumor in the pelvis and knees.
2. A provider performs separate acquisitions of lung ventilation and perfusion using radiopharmaceutical localization with SPECT imaging.
3. A patient receives radiopharmaceutical localization using SPECT imaging to assess the distribution of a radioactive tracer in the chest and abdomen.
4. A provider conducts radiopharmaceutical localization using SPECT imaging to identify the presence of an inflammatory process in the brain and spine.
5. A patient undergoes radiopharmaceutical localization using SPECT imaging to evaluate the distribution of a radiopharmaceutical agent in the liver and spleen.
6. A provider performs radiopharmaceutical localization using SPECT imaging to assess the distribution of a radioactive tracer in the heart and lungs.
7. A patient receives radiopharmaceutical localization using SPECT imaging to identify the location of a tumor in the head and neck.