For the CPT 2023 code set, four codes (78803, 78830-78832) were revised to further explain the use and intent of these codes. These revisions distinguish between a single area or a single acquisition vs two or more separate acquisitions with two radiopharmaceuticals that are performed on the same date of service or over two or more days. The intent and use of these codes remain the same. This article provides an overview of the editorial revisions.
Nuclear Medicine CPT codes
78800 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, single area (eg, head, neck, chest, pelvis), single day imaging
(For specific organ, see appropriate heading)
Δ78803 tomographic (SPECT), single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging
(For imaging bone infectious or inflammatory disease with a bone imaging radiopharmaceutical, see 78300, 78305, 78306, 78315)
Δ78830 tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging
Δ78831 tomographic (SPECT), minimum 2 areas (eg, pelvis and knees, chest and abdomen) or separate acquisitions (eg, lung ventilation and perfusion), single day imaging, or single area or acquisition over 2 or more days
Δ78832 tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, minimum 2 areas (eg, pelvis and knees, chest and abdomen) or separate acquisitions (eg, lung ventilation and perfusion), single day imaging, or single area or acquisition over 2 or more days
(For cerebrospinal fluid studies that require injection procedure, see 61055, 61070, 62320, 62321, 62322, 62323)
Prior to 2023, codes 78803 and 78830-78832 were not differentiated according to acquisition; instead, they were differentiated according to the anatomic area imaged and/or whether single-day or multiple-day imaging was performed. Adding “or acquisition” to the code descriptors of these four codes enables more specific reporting (ie, according to anatomic area or acquisition performed) while maintaining uniformity in the code family. The term “acquisition” for nuclear medicine services and procedures is also referred to as “a scan.” Note that the size of the gamma camera head essentially defines the field of view (FOV) or the area that the camera can image. While camera heads and patients vary in size, there are FOVs (or acquisition fields) in nuclear medicine that are commonly considered a single area or multiple areas of acquisitions.
| Examples of Areas and Acquisitions | |
|---|---|
| Examples of single area or single acquisition | Examples of minimum two areas or separate acquisitions |
| Head and neck | Head, neck, and upper chest |
| Head | Head, neck, and shoulders |
| Chest | Chest and abdomen |
| Abdomen | Abdomen and pelvis |
| Pelvis | Chest, abdomen, and pelvis |
| Pelvis and upper thighs | Pelvis and knees |
| Knees | Pelvis to knees |
| Feet | Bilateral knees and feet |
| Left or right extremity or part of the extremity | Both left and right extremity or part of bilateral extremities |
An acquisition is a scan consisting of static or dynamic planar images, which are acquired with the gamma camera (or scintillation camera) in a fixed position for the duration of imaging. In single-photon emission computed tomography (SPECT) imaging, a series of images is acquired as the gamma camera rotates around a defined area of the patient. These images are then reconstructed to form a three-dimensional dataset from which coronal, sagittal, and transverse slices through the body can be reconstructed, similar to CT exams.
Note that repeat imaging is not always considered a separate acquisition (eg, a scan repeated due to patient motion). For a SPECT study, any planar or “spot” imaging of an area that was imaged by SPECT is not separately reported and is included in the SPECT or SPECT-CT study. A separate acquisition should be distinctly different, such as the next-day or time-delayed imaging, a different or separate area or a different radiotracer (eg, lung ventilation and perfusion imaging).
Coding Tip
A “single area” is defined as a planar, SPECT, or SPECT-CT acquisition of images, such as the chest or pelvis.
When two different acquisitions of the same area are performed on the same day (eg, a lung ventilation study to identify the distribution of a tracer given via the airways and a lung perfusion study to identify the distribution of blood flow in the lungs using a tracer given intravenously), a reporting mechanism is needed to show or indicate that multiple acquisitions were performed for the same anatomical area on the same day at different times using different radioactive tracers.
Therefore, “or separate acquisitions” was added to the code descriptors for codes 78831 and 78832 to include not only studies of different areas on the same day or the same area imaged on different days but also studies for which the acquisitions are separate and distinct even though they are acquired for the same anatomic region and on the same day.
To assist with proper code selection, codes 78831 and 78832 were revised to include “pelvis and knees, chest and abdomen” as examples of anatomic areas for which these procedures may be performed, and “lung ventilation and perfusion” as an example for separate acquisitions.
Reference: CPT assistant September month