Home » Radiology » Coding rules for CPT code 78300,78305,78306, 78315 and 78320

Coding rules for CPT code 78300,78305,78306, 78315 and 78320

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, 78315 and 78320 bone scan procedure codes.

Coding rules for CPT code 78300,78305,78306, 78315 and 78320

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Procedure performed for Bone 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.

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CPT code 78300, 78306, 78305, 78315 and 78320 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 tomographic (SPECT)

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

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Difference between CPT code 78300,78305,78306, 78315 and 78320

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.

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CPT code 78320, should be reported only if the exam is done using SPECT (Single Photon Emission Computed Tomography) imaging.

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.

CPT code 78320 and 78306 can be reported together without a modifier.

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Sample Report for Bone Scan Procedures

NM/NM BONE 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

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