Insight on Radiopharmaceutical Localization of Tumor Code 78800

As you may remember, major changes including revisions, additions, and deletions were finalized in 2020 for (SPECT/CT) and myocardial PET for nuclear medicine services. Medical coders across the country may still struggle with understanding how and when to report related CPT® codes. Let’s break down some tips for code 78800 to give greater understanding and confidence.

77048Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis) when performed; unilateral
77049Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion detection, characterization and pharmacokinetic analysis) when performed; bilateral

How is 78800 used?

Planar imaging using a radiotracer is localized to a single area (i.e., abdomen, chest, breast, neck, etc.). An organ-specific planar imaging CPT code takes precedent as  a coding choice when one is available.

What tips do I need to know for coding success?

  • If planar imaging of a single area is performed over multiple days, see 78801.
  • CPT 78800 may be used for breast imaging studies with 99mTc sestamibi on traditional gamma planar cameras or with breast-specific gamma imaging (BSGI) equipment. Imaging both or one breast(s) would be considered a single area study.
  • If planar imaging is performed on the same day, or next day as part of a whole-body scan, do not report CPT 78800 twice or in addition to other nuclear medicine CPT codes as delayed or single planar imaging is part of any other higher-level nuclear medicine procedure.
  • Understand this code may be reported for planar studies using technetium PYP for cardiac amyloidosis as the area is a single area of the heart or chest region.
  • Note that CPT code 78800 can also be used for imaging inflammation or abscess agents, however, when performing imaging using bone agents for inflammatory disease, see codes 78300, 78305, 78306, or 78315.

Below is a coding case study that demonstrates 78800.


CASE: NUCLEAR MEDICINE CARDIAC AMYLOIDOSIS WITH PYROPHOSPHATE (PYP)

CLINICAL HISTORY

75-year-old presents with cardiomyopathy.

PROCEDURE

Radiopharmaceutical: 21 mCi technetium 99m pyrophosphate. Anterior, LAO, and left lateral projections of the chest were obtained.

IMPRESSION

There is intense diffuse uptake of activity in the left ventricle, greater intensity than bone. Activity is also seen in the right ventricle, similar intensity to bone.

CONCLUSION

Findings support a diagnosis of ATTR amyloidosis. This is a grade 3 scan.

CPT/HCPCS CodeUnits for this ClaimMAIMUE
78800121
A9538131

Check out our 2021 Nuclear Medicine Coding, Reimbursement & Compliance Review for further expert insight on (SPECT/CT) and myocardial PET CPT coding and other important topics to master success.