Basics about Renal Scan with Lasix Procedure code

In Radiology, there are a lot of nuclear medicine procedures which are coded regularly by radiology coders. Use of different pharmaceutical agents is common for performing the nuclear medicine exams. For example, the bone scan procedure with CPT code 78300, 78305, 78306 which are also performed with the injection of radio-pharmaceutical agents. Today we will learn about similar CPT code 78707, 78708 & 78709, used in renal scan.

Even for Renal scan procedure the codes have been differentiated with or without use of diuretics and/or ACE-inhibitors. This is major reason coders find it difficult to code renal scan with lasix CPT codes. Being a coder, I always take a little time in coding nuclear medicine procedure. You can learn more about radiology procedures in the below posts.

Abdominal Aorta with Runoff CPT code

Upper GI CPT codes in Radiology

When to use CPT code 76881 and 76882

Carotid Ultrasound doppler exam procedure codes

Procedure performed for CPT code 78707, 78708 & 78709

The size, shape, and structure (morphology) of the kidney and its function, including vascular flow, is assessed using scintigraphy and a radiolabeled isotope tracer. The kidneys filter waste from the blood; maintain a balance of certain chemicals; and produce erythropoietin for red blood cell growth, renin for blood pressure control, and calcitriol for calcium uptake by the bones. This procedure may be used to evaluate renal blood flow, renovascular hypertension, renal cysts, tumors, abscesses, and kidney disease, as well as monitoring kidney transplants.

An intravenous line is established and the radiolabeled isotope tracer is injected directly into the circulatory system. The patient is positioned on the imaging table with the gamma camera focused on the kidneys. Scanning is performed at specific intervals and the radioactive energy emitted is converted into an image.

Code 78700 is used when only the morphology of the kidney is being studied.

Code 78701 is used when morphology and vascular flow are studied. The physician interprets the study and provides a written report of the findings.

A diuretic may be administered during the procedure for more detailed images of kidney obstruction. An angiotensin converting enzyme (ACE-inhibitor) medication may be administered to help determine if hypertension is associated with renal vascular flow.

For reporting CPT code 78707 and 78708, a diagnostic nuclear imaging study of kidney structure with vascular flow and function test is performed. A radiopharmaceutical is injected that follows the blood flow through the kidneys in the normal pathway for urine production. Obstructions in the collecting system are identified, along with the rate at which the kidneys are filtering the blood, and how well the tubules and ducts are functioning. A scintillation or gamma camera scans the study area and takes images on computer screen or film by detecting the gamma radiation from the radiopharmaceutical as it flows through the kidney.

If pharmacological intervention is used, a diuretic may also be injected that will increase urine flow during the exam. If the radiotracer accumulates and the kidney fails to clear it after diuretic administration, surgery may be necessary to correct the obstruction. Report 78707 for a single study without pharmacological intervention; 78708 for a single study with intervention; and 78709 for multiple studies, done with and without intervention.

Code 78707 is used when kidney morphology, vascular flow, and function are assessed in a single study without the use of diuretics or ACE-inhibitor medications.

Code 78708 is used when kidney morphology, vascular flow, and function are assessed in a single study with the use of diuretics and/or ACE-inhibitors.

Code 78709 is used when morphology, vascular flow, and function are assessed in multiple studies both with and without the use of diuretics and/or ACE-inhibiting medications. The physician interprets the study and provides a written report of the findings.

Description of CPT code CPT code 78707, 78708 & 78709

78700  – Kidney Imaging morphology

78701  – Kidney imaging morphology; with vascular flow

78707     Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention

78708 – Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)

78709 – Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic)

78710 – Kidney imaging morphology; tomographic (SPECT)

Read also: Coding tips for Intracapsular and Extracapsular Cataract Extraction

HCPCS codes used with Nuclear Medicine Renal Scan Lasix Procedures

A9551-Technetium Tc-99m succimer, diagnostic, per study dose, up to 10 millicuries 

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

A9562 -Technetium Tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries 

A4641 Hippurate radiopharmaceutical, diagnostic, not otherwise classified

Read also: When to use Brain Imaging CPT codes in Radiology facility

Sample report for Renal Scan with Lasix CPT code

Lasix renal scan with diuretic washout 

PROCEDURE:
10.0 mCi technetium 99m MAG3 was injected. Imaging of the kidneys was
performed for 20 minutes. The patient then received 20 Lasix intravenously,
and imaging was continued for a total of 60 minutes.

FINDINGS:
Perfusion to the kidneys is prompt and symmetric.

There is prompt right renal uptake and excretion with complete washout
following Lasix administration.

Left kidney shows prompt tubular function and transit to the renal pelvis.
Following the administration of Lasix there is increasing activity in the
renal pelvis with minimal washout. This represents obstruction and is at
the ureteropelvic junction.

The split function is 45.6% on the left and 54.4% on the right.

Left ureteropelvic junction obstruction.

 CPT code : 78708 (Renal Scan with Lasix)

A nuclear medicine renal scan can be performed with 2 different substances – DTPA(diethylene triamine pentaacetic acid) or MAG3(mercaptoacetyltriglycine) . DTPA is the radiopharmaceutical used in a DTPA renal scan, but sometimes the nuclear medicine specialist will decide that another radiopharmaceutical called MAG3 should be used. These radiopharmaceuticals are similar, but MAG3 gives significantly better images in some patients, particularly very young children and those patients with poor kidney function.