Table of Contents

Basics of HIDA scan CPT code 78226 and 78227

Hepatobiliary system nuclear imaging tracks the production and flow of bile from the liver to the small intestine using a radioactive tracer that highlights the liver, bile ducts, and gallbladder if the gallbladder has not been surgically removed. This procedure may also be referred to as a HIDA scan, which stands for hepatobiliary iminodiacetic acid scan.

The procedure (CPT code 78226 & 78227) is performed to evaluate liver function, specifically bile production and excretion, and to evaluate the drainage system (bile ducts) and gallbladder for obstruction, inflammation, or other abnormalities. An intravenous catheter is placed. The radioactive tracer is injected. A gamma camera travels back and forth over the abdomen and multiple images are obtained as the radioactive tracer flows through the bloodstream and is taken up by the bile-producing cells in the liver.

Images are obtained continuously as the radioactive tracer, which is now contained in the bile, travels from the liver through the biliary ducts into the gallbladder, and then from the gallbladder through the common bile duct into the duodenum. The patient is monitored throughout the procedure. Upon completion, the physician reviews the images and provides a written report of findings. In CPT code 78227, the procedure is performed as described above except that during the procedure additional medications are administered. These medications may be given to enhance the gallbladder images or to trigger the gallbladder to empty. The physician may also perform a test called gallbladder ejection fraction, which is a measurement of the rate at which bile is released from the gallbladder.

A HIDA, or hepatobiliary scan is a diagnostic test. It’s used to capture images of the liver, gallbladder, bile ducts, and small intestine to help diagnose medical conditions related to those organs. Bile is a substance that helps digest fat. In Radiology facility, CPT code 78226 & 78227 are used for coding HIDA or hepatobiliary scan. Below is the description of these cpt codes.

78226 – Hepatobiliary system imaging, including gallbladder when present; ;

78227 – Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed

Procedure performed for HIDA scan CPT code 78226 & 78227

Hepatobiliary (HIDA) Scan With/Without CCK (cholecystokinin)– Hepatobiliary imaging is a type of nuclear medicine imaging that helps evaluate the liver, gallbladder and the ducts that are part of the biliary system. This test will show whether there are any blockages in the gallbladder or biliary duct.

During HIDA scan, a radioactive tracer is injected. Images are obtained continuously as the radioactive tracer, which is now contained in the bile, travels from the liver through the biliary ducts into the gallbladder, and then from the gallbladder through the common bile duct into the duodenum. Images are obtained and then physician reviews the images and provides a written report of findings.

Aetna considers cholecystokinin (CCK) administration as an adjunct to cholescintigraphy medically necessary for any of the following indications:
1. After cholescintigraphy, to confirm or exclude chronic calculous cholecystitis; or

2. After cholescintigraphy, to confirm the diagnosis of chronic acalculous cholecystitis; or
3. After cholescintigraphy, to differentiate common duct obstruction from normal hypertonic sphincter of Oddi; or
4. After cholescintigraphy, to exclude acute acalculous cholecystitis; or

5. During cholescintigraphy, as a non-invasive method of diagnosing sphincter
of Oddi dysfunction; or

6. Prior to cholescintigraphy, as an alternative to delayed imaging so cholescintigraphy can be completed in 60 minutes (rather than 3 to 4 hours); or
7. Prior to cholescintigraphy, to empty the gallbladder in members fasting more than 24 hours

For some hepatobiliary studies, the ejection fraction (EF) quantification is performed with the use of fatty meal in absence of intravenous CCK, in such case use CPT code 78226 instead of code 78227.

It is not appropriate to report code 78227 if only a pretreatment pharmacological intervention (eg, phenobarbital prior to the hepatobiliary study) is performed. In addition, a fatty meal is not considered a pharmacologic intervention whether it is done before or during the procedure.

HCPCS codes used with CPT code 78226 & 78227

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 CPT code 78226 & 78227

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

Sample Coded chart for HIDA scan CPT code 78226 & 78227

NM/NM BILIARY IMG INC GB W/PHARM

CLINICAL DATA: Right upper quadrant abdominal pain

EXAM: NUCLEAR MEDICINE HEPATOBILIARY IMAGING WITH GALLBLADDER EF

TECHNIQUE: Sequential images of the abdomen were obtained out to 60 minutes following intravenous administration of radiopharmaceutical. After slow intravenous infusion of 1.09 micrograms Cholecystokinin, gallbladder ejection fraction was determined.

RADIOPHARMACEUTICALS: 5.5 Technetium-99m Choletec IV

COMPARISON: Abdominal ultrasound of March 18, 2016

FINDINGS: There is adequate uptake of the radiopharmaceutical by the liver. Activity is visible within intrahepatic ducts by 12 minutes and in the common bowel duct by 16 minutes. The caliber of the intrahepatic ducts and common bile duct does appear distended consistent with the ultrasound findings. Gallbladder activity is visualized by 26 minutes. There is bowel activity by 48 minutes. Following CCK administration the 45 minutes gallbladder ejection fraction is 81%.

The patient experienced a pressure sensation over the epigastric region during CCK administration.. At 45 min, normal ejection fraction is greater than 40%.

IMPRESSION:

Normal hepatobiliary scan with normal gallbladder ejection fraction. Mild prominence of the caliber of the intrahepatic and common bile ducts is demonstrated.

CPT code : 78227 – Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed

References:

https://www.aetnabetterhealth.com/pennsylvania/assets/pdf/provider/guidelines/medical/Medical/0266_Cholecystokinin%20Cholescintigraphy-.pdf