Basics of CPT code 78600 & 78601

Brain imaging in nuclear medicine provides functional diagnostic information of the central nervous system. Brain imaging is particularly useful when paired with information from a patient’s clinical evaluation and other brain imaging studies, such as computerized tomography (CT) and magnetic resonance imaging (MRI).

In medical coding, we have separate procedure codes for brain imaging studies. 

78600 – Brain imaging, less than 4 static views;

78601 – Brain imaging, less than 4 static views; with vascular flow

Before we move ahead, let us check some similar procedures coded in outpatient facility.

Coding guide for bone Scan procedures

When to use Pelvic Ultrasound CPT codes

When to code MRI brain CPT code

Procedure performed for CPT code 78600 & 78601

Static brain imaging with or without vascular flow imaging is primarily used to document brain death. Brain death is characterized by irreversible cessation of brain and brain stem function caused by significant reduction in cerebral blood flow. A radiolabeled isotope like 99mTc-pertechnetate, 99mTc-pentetate (TcDTPA) and 99mTc-gluceptate (Tc-GH) and the diffusible tracers 99mTc-exametazime (Tc-HMPAO) and 99mTc-bicisate (Tc-ECD), is injected directly into the circulatory system.

The imaging begins as soon as the isotope bolus arrives in the neck and continues to the end of the venous phase. A radiation detector (usually a scintillation detector) is used to record the spatial distribution of the radiopharmaceutical in the brain.

Diagnostic nuclear medicine uses small amounts of gamma-emitting radioactive materials, or tracers, to determine the cause of the medical problem based on the function, or chemistry, of the organ or tissue. This is in contrast to diagnostic tests that determine disease presence based on structural appearance. In a static test, the radionuclide travels to the intended organ. The organ, tissue, or bone under study determines the type of radioactive material used and it is introduced by injection, swallowing, or inhalation.

A scintillation or gamma camera takes planar images of the study area on computer screen or film by detecting the gamma radiation from the radiopharmaceutical in the body tissue as it “scintillates” or gives off energy in a flash of light when coming in contact with the camera’s detector. Report less than four static views of the brain with CPT code 78600 and four or more with CPT code 78605.

Report CPT code 78601 for less than four static views of the brain with vascular flow and CPT code 78606 for four or more views with vascular flow.

Views are obtained from anterior, right lateral, and left lateral positions for this study. For static imaging, the camera captures images at a single point in time for about 5 minutes in each of the 3 view positions.

CPT code  78600 is used for brain imaging with less than 4 static views only. CPT Code 78601 is used when vascular flow studies are obtained with the static views.

78605 – Brain imaging, minimum 4 static views;

78606 – Brain imaging, minimum 4 static views; with vascular flow

CPT code Code 78605 is used for brain imaging with at least 4 static views only.  CPT Code 78606 is used when vascular flow studies are obtained with the static views.

78610 – Brain imaging, vascular flow only

Brain perfusion single-photon emission computed tomography (SPECT) imaging is a functional nuclear imaging technique performed to evaluate regional cerebral perfusion.

Single photon emission computed tomography (SPECT) studies are based on the decay of a single-photon emitting nuclide, such as technetium-99. Because blood flows at different rates in the brain depending on location and neural activity, SPECT imaging can identify areas of activity when specific tasks are performed.

This procedure may be helpful in the detection and evaluation of cerebrovascular disease, dementia, epilepsy and brain injury. The patient is positioned on the imaging table with the gamma camera(s) focused on the head and neck. The computed tomographic (CT) images obtained are studied for areas of activity and inactivity in the brain.

Read also: When to use MRI CPT code for Lumbar Spine

HCPCS codes used with CPT code 78600-78606 & 78610

A9539-Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries

A9521-Technetium Tc-99m exametazine, diagnostic, per study dose, up to 25 millicuries 

A9512-Technetium Tc-99m-pertechnetate, diagnostic, per millicurie

A9524-Iodinated I-131-serum albumin, diagnostic, per 5 microcuries 

A9557-Technetium Tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries