Table of Contents

Basics of CPT code 78300,78305,78306, 78315

As a medical coder, I always like to learn how a CPT code procedure is performed. Yes, we are usually only in a hurry to code a CPT code but we hardly care about the exact procedure done behind that code. If you understand that, you can easily code any medical report and which will eventually improve your skills in medical coding. Today we are going to look some Bone scan CPT codes or Nuclear Medicine procedure codes, used in Radiology facility. Generally, X-rays or the DEXA scan procedures, comes in your mind when we talk about bone scan. Yes, we have learnt about, MRI brain or spinal exam, Ultrasound aorta exam, coding PET scan etc. in past. But, today we will learn about CPT code 78300,78305,78306 and 78315 bone scan procedure codes. CPT code 78320 is deleted and the coders should now use CPT code 78803 in place of it.

Procedure for Nuclear medicine Whole body Scan CPT codes

Different pharmaceutical agents are used for diagnostic nuclear imaging of bones and joints. Most commonly a calcium analogue, Gallium, is used as a radiopharmaceutical agent for an inflammatory process. Gallium accumulates in the areas of bone mineral turnover like fractures and helps in localizing the inflamed areas like inflammatory arthritis.

Using a combination of gallium with radiolabeled white blood cells, which also has the ability to localize infection sites, gives more diagnostic specificity when looking for osteomyelitis or osteoarthropathy. Radioactive diphosphonates are used for bony metastatic disease screening. A camera detects the gamma radiation from the radiotracer to detect and localize the disease process.

Radionuclide bone imaging plays an integral part in tumor staging and management; the majority of bone scans are performed in patients with a diagnosis of malignancy, especially carcinoma of the breast, prostate gland, and lung. This modality is extremely sensitive for detecting skeletal abnormalities, and numerous studies have confirmed that it is considerably more sensitive than conventional radiography for this purpose. However, the specificity of bone scan abnormalities can be low since many other conditions may mimic tumor; therefore, it is important that radionuclide bone scans are correlated with available, relevant imaging studies. Existing imaging studies that are available can help inform the diagnosis and treatment for the patient.

Furthermore, correlation with existing radiographs is considered essential to insure that benign conditions are not interpreted as tumor. While there are no formal studies on variations in care in how often correlation with existing studies is not performed, there is significant anecdotal information from physicians practicing in the field that there is a gap in care and that correlation is not occurring frequently when images are available

CPT code 78300, 78306, 78305, 78315 in detail

Bone scan cpt codes in Nuclear medicine exam, are given on the basis of areas examined or the use of SPECT imaging. If you have coded some sample radiology charts, you could see few straight procedures codes like CTA chest or CPT code 93923 etc. but these bone scan codes are little different from the normal ultrasound or CT exams. Let us first check the nuclear medicine bone scan CPT codes description in code book.

78300 Bone and/or joint imaging; limited area

78305 multiple areas

78306 Whole body

78315 3 phase study

78320 (deleted) use below code 78803

78803 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging

78350 Bone density (bone mineral content) study, 1 or more sites; single photon absorptiometry

78351 Bone density (bone mineral content) study, 1 or more sites; single photon absorptiometry

Difference between limited and whole body scan CPT code

A whole body bone scan produces planar images of the skeleton including anterior and posterior views of the axial skeleton. Anterior and/or posterior views of the appendicular skeleton are also obtained. Additional views may be obtained as needed. The limited bone scan records images of only a portion of the skeleton.

A three-phase study includes initial vascular flow followed by blood pool imaging and followed by delayed statis bone scans.

As you can see in the above code description, these codes should be coded on the basis of body areas or the imaging used for bone scan exam.

For CPT code 78300, limited area is examined like only a particular anatomic area like hand and shoulder unilateral.

Cpt code 78305, multiple areas are examined in these exams. Multiple anatomic areas like combine upper and lower extremity region or the bilateral region or two or more body part areas.

Cpt code 78306, whole body imaging should be documented for this procedures. If the report documents multiple areas and does not mention whole body imaging in technique, do not report this code, report CPT code 78305.

CPT code 78315, this exam is specifically of three phase study. For three phase study, vascular flow, blood pool imaging, and delayed status images should be documented, to report CPT code 78315.

Do not code 78300 with CPT code 78305 or 78306. Limited exam procedure code 78300 is a component of multiple or whole body exam. If coded together do use a 59 modifier or X{EPUS} modifiers to bypass the CCI edit.

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HCPCS codes related to CPT code 78300, 78306, 78305 & 78315

A4641 Radiopharmaceutical, diagnostic, not otherwise classified
A4642 Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries
A9500 Technetium Tc-99m sestamibi, diagnostic, per study dose
A9502 Technetium Tc-99m tetrofosmin, diagnostic, per study dose
A9503 Technetium Tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
A9505 Thallium Tl-201 thallous chloride, diagnostic, per millicurie
A9507 Indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries
A9508 Iodine I-131 iobenguane sulfate, diagnostic, per 0.5 millicurie
A9509 Iodine I-123 sodium iodide, diagnostic, per millicurie
A9510 Technetium Tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries
A9512 Technetium Tc-99m pertechnetate, diagnostic, per millicurie
A9515 Choline C-11, diagnostic, per study dose up to 20 millicuries
A9516 Iodine I-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries
A9517 Iodine I-131 sodium iodide capsule(s), therapeutic, per millicurie
A9520 Technetium Tc-99m tilmanocept, diagnostic, up to 0.5 millicuries
A9521 Technetium Tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries
A9524 Iodine I-131 iodinated serum albumin, diagnostic, per 5 microcuries
A9526 Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 millicuries
A9527 Iodine I-125, sodium iodide solution, therapeutic, per millicurie
A9528 Iodine I-131 sodium iodide capsule(s), diagnostic, per millicurie
A9529 Iodine I-131 sodium iodide solution, diagnostic, per millicurie
A9530 Iodine I-131 sodium iodide solution, therapeutic, per millicurie
A9531 Iodine I-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)
A9532 Iodine I-125 serum albumin, diagnostic, per 5 microcuries
A9537 Technetium Tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries
A9538 Technetium Tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries
A9539 Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries
A9540 Technetium Tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries
A9541 Technetium Tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries
A9542 Indium In-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries
A9543 Yttrium Y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries
A9547 Indium In-111 oxyquinoline, diagnostic, per 0.5 millicurie
A9548 Indium In-111 pentetate, diagnostic, per 0.5 millicurie
A9551 Technetium Tc-99m succimer, diagnostic, per study dose, up to 10 millicuries
A9552 Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries
A9553 Chromium CR-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries
A9554 Iodine I-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries
A9555 Rubidium Rb-82, diagnostic, per study dose, up to 60 millicuries
A9556 Gallium Ga-67 citrate, diagnostic, per millicurie
A9557 Technetium Tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries
A9558 Xenon Xe-133 gas, diagnostic, per 10 millicuries
A9560 Technetium Tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries
A9561 Technetium Tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries
A9562 Technetium Tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries
A9563 Sodium phosphate P-32, therapeutic, per millicurie
A9564 Chromic phosphate P-32 suspension, therapeutic, per millicurie
A9567 Technetium Tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries
A9568 Technetium Tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries
A9569 Technetium Tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose
A9570 Indium In-111 labeled autologous white blood cells, diagnostic, per study dose
A9571 Indium In-111 labeled autologous platelets, diagnostic, per study dose
A9572 Indium In-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries
A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries
A9582 Iodine I-123 iobenguane, diagnostic, per study dose, up to 15 millicuries
A9584 Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 millicuries
A9586 Florbetapir F-18, diagnostic, per study dose, up to 10 millicuries
A9587 Gallium Ga-68, dotatate, diagnostic, 0.1 millicurie
A9588 Fluciclovine F-18, diagnostic, 1 millicurie
A9597 Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified
A9598 Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified
A9600 Strontium SR-89 chloride, therapeutic, per millicurie
A9604 Samarium SM-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries
C9898 Radiolabeled product provided during a hospital inpatient stay
G0106 Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema
G0130 Single energy X-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
G0248 Demonstration, prior to initiation of home INR monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and documentation of patient’s ability to perform testing and report results
G0249 Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests
G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
G0398 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
G0400 Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels
G2066 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results
Q0035 Cardiokymography
Q9982 Flutemetamol F-18, diagnostic, per study dose, up to 5 millicuries
Q9983 Florbetaben F-18, diagnostic, per study dose, up to 8.1 millicuries

Additional Code Information for CPT code 78300, 78305, 78315

PC/TC Indicator (26): 1 = Diagnostic Tests for Radiology Services

Multiple Procedures (51): 0 = No payment adjustment rules for multiple procedures apply

Bilateral Surgery (50): 0 = 150% payment adjustment for bilateral procedures does not apply

Physician Supervision: 09 = Concept does not apply

Assistant Surgeon (80,82): 0 = Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted

Co-Surgeons (62): 0 = Co-surgeons not permitted for this procedure

Team Surgery (66): 0 = Team surgeons not permitted for this procedure

Diagnostic Imaging Family: 99 = Concept does not apply

CPT code 78306, 78803

PC/TC Indicator (26): 1 = Diagnostic Tests for Radiology Services

Multiple Procedures (51): 4 = Special rules for the technical component (TC) of diagnostic imaging procedures apply if procedure is billed with another diagnostic imaging procedure in the same family

Bilateral Surgery (50): 0 = 150% payment adjustment for bilateral procedures does not apply

Physician Supervision: 09 = Concept does not apply

Assistant Surgeon (80,82): 0 = Payment restriction for assistants at surgery applies to this procedure unless supporting documentation is submitted

Co-Surgeons (62): 0 = Co-surgeons not permitted for this procedure

Team Surgery (66): 0 = Team surgeons not permitted for this procedure

Diagnostic Imaging Family: 88 = Subject to the reduction of the TC diagnostic imaging (effective for services January 1, 2011 and after)

Sample Report for Bone Scan Procedures

Nuclear medicine (NM) BONE scan 3 PHASE

CLINICAL DATA: LEFT had pain . LEFT hip fracture April 16th with LEFT arthroplasty

EXAM: NUCLEAR MEDICINE 3-PHASE BONE SCAN

TECHNIQUE: Radionuclide angiographic images, immediate static blood pool images, and 3-hour delayed static images were obtained of the hips after intravenous injection of radiopharmaceutical.

RADIOPHARMACEUTICALS: 22.8 mCi Tc-99m MDP

FINDINGS: Vascular phase: No focal hepatic lesion. Postcholecystectomy. No biliary dilatation.

Blood pool phase: No hyperemia on blood pool imaging. Delayed phase: Mild periprosthetic uptake in the proximal RIGHT femur which is felt to be within normal limits following arthroplasty.

IMPRESSION: No evidence of loosening or infection of the LEFT hip prosthetic.

CPT – 78315

NM/NM BONE WHOLE BODY

CLINICAL DATA: RIGHT lung cancer diagnosed 3 weeks ago, RIGHT hip pain for 3 weeks

EXAM: NUCLEAR MEDICINE WHOLE BODY BONE SCAN

TECHNIQUE: Whole body anterior and posterior images were obtained approximately 3 hours after intravenous injection of radiopharmaceutical.

RADIOPHARMACEUTICALS: 23.5 mCi Technetium-99m MDP IV

FINDINGS: Multiple areas of abnormal cortically based linear foci of increased tracer accumulation are identified at the femoral diaphysis and tibia bilaterally. While metastases are not completely excluded, the appearance is suggestive of hypertrophic osteoarthropathy. Questionable abnormal increased tracer localization at the anterior RIGHT seventh rib with negative CT findings at this site.

Focal area of abnormal increased trace localization at the posterior RIGHT pelvis at the supra-acetabular region, corresponding to a lytic lesion at the posterior column on CT. Expected urinary tract and soft tissue distribution of tracer.

IMPRESSION:

Osseous metastatic lesion posterior RIGHT pelvis at the posterior column of the RIGHT hip/ acetabulum. Linear areas of cortically based increased tracee localization along the shafts of the distal femora and tibia bilaterally, raising question of hypertrophic osteoarthropathy; radiographic correlation recommended to differentiate from metastases. Questionable abnormal uptake at RIGHT costovertebral junction

approximately seventh rib.

CPT – 78306

References:

http://www.speedecoder.com/78300.html

https://www.supercoder.com/coding-newsletters/my-radiology-coding-alert/reader-questions-scan-78300-78320-for-correct-code-article

Bone scan CPT code 78300,78305,78306 & 78315 Coding Guide