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CPT® Code 78226

Official Description

Hepatobiliary system imaging, including gallbladder when present;

Common Language Description

The CPT® Code 78226 refers to a diagnostic imaging procedure known as hepatobiliary system imaging, which includes the evaluation of the gallbladder when it is present. This imaging technique utilizes nuclear medicine to track the production and flow of bile from the liver to the small intestine. The procedure employs a radioactive tracer that is injected into the patient's bloodstream, allowing for the visualization of the liver, bile ducts, and gallbladder, provided the gallbladder has not been surgically removed. Commonly referred to as a HIDA scan, which stands for hepatobiliary iminodiacetic acid scan, this procedure is essential for assessing liver function, particularly in terms of bile production and excretion. It also evaluates the drainage system, including the bile ducts and gallbladder, for any signs of obstruction, inflammation, or other abnormalities. During the procedure, an intravenous catheter is placed to facilitate the injection of the radioactive tracer. A gamma camera is then used to capture multiple images as the tracer flows through the bloodstream, is absorbed by the liver, and subsequently travels through the biliary system. Continuous imaging allows for a comprehensive assessment of the movement of bile from the liver to the gallbladder and into the duodenum. Throughout the procedure, the patient is closely monitored, and upon completion, the physician reviews the obtained images to generate a detailed written report of the findings. This procedure is critical for diagnosing various hepatobiliary conditions and guiding further management.

Procedure Details

1. Indications

The hepatobiliary system imaging procedure (CPT® Code 78226) is indicated for the evaluation of various conditions related to liver and gallbladder function. The following are the specific indications for performing this procedure:

Assessment of Liver Function - To evaluate the liver's ability to produce and excrete bile.
Investigation of Biliary Obstruction - To identify any blockages in the bile ducts that may impede the flow of bile.
Evaluation of Gallbladder Abnormalities - To assess the gallbladder for signs of inflammation, obstruction, or other pathological conditions.
Diagnosis of Hepatobiliary Disorders - To aid in the diagnosis of conditions such as cholecystitis, cholangitis, or biliary atresia.

2. Procedure

The hepatobiliary system imaging procedure involves several key steps that are crucial for obtaining accurate diagnostic images. The following outlines the procedural steps involved:

Step 1: Patient Preparation - The patient is prepared for the procedure, which may include fasting for a specified period prior to the test to ensure optimal imaging results.
Step 2: Intravenous Catheter Placement - An intravenous (IV) catheter is placed in the patient's arm to facilitate the administration of the radioactive tracer.
Step 3: Injection of Radioactive Tracer - A radioactive tracer is injected through the IV catheter. This tracer is specifically designed to be absorbed by the liver and subsequently excreted into the bile.
Step 4: Imaging Process - A gamma camera is positioned over the patient's abdomen. The camera captures multiple images as the radioactive tracer flows through the bloodstream, is taken up by the liver, and travels through the biliary system. Continuous imaging allows for real-time visualization of the bile's movement from the liver to the gallbladder and into the duodenum.
Step 5: Monitoring - Throughout the procedure, the patient is monitored for any adverse reactions or discomfort. The healthcare team ensures the patient's safety and comfort during the imaging process.
Step 6: Image Review and Reporting - After the imaging is complete, the physician reviews the obtained images to assess liver and gallbladder function. A detailed written report of the findings is generated for further evaluation and management.

3. Post-Procedure

After the completion of the hepatobiliary system imaging procedure, patients may be advised to resume normal activities unless otherwise instructed by their healthcare provider. There are typically no specific post-procedure care requirements, but patients should be monitored for any immediate reactions to the radioactive tracer. The physician will provide a written report detailing the findings from the imaging, which may be used to guide further diagnostic or therapeutic interventions based on the results. Patients may be informed about the importance of following up with their healthcare provider to discuss the results and any necessary next steps in their care.

Code Data Insights

Short Descr	HEPATOBILIARY SYSTEM IMAGING
Medium Descr	HEPATOBILIARY SYST IMAGING INCLUDING GALLBLADDER
Long Descr	Hepatobiliary system imaging, including gallbladder when present;
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	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 Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
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
APC Status Indicator	Procedure or Service, Not Discounted when Multiple
ASC Payment Indicator	Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight.
Type of Service (TOS)	4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS)	I4B - Imaging/procedure - other
MUE	1
CCS Clinical Classification	209 - Radioisotope scan and function studies

Modifier Assist

26	Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
X5	Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician
GC	This service has been performed in part by a resident under the direction of a teaching physician
MG	The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional
ME	The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
MH	Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider
X4	Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
MF	The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
QQ	Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional
TC	Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
CR	Catastrophe/disaster related
Q6	Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
GW	Service not related to the hospice patient's terminal condition
51	Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
52	Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
53	Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
76	Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
77	Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
AM	Physician, team member service
AQ	Physician providing a service in an unlisted health professional shortage area (hpsa)
GA	Waiver of liability statement issued as required by payer policy, individual case
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
GZ	Item or service expected to be denied as not reasonable and necessary
LT	Left side (used to identify procedures performed on the left side of the body)
MA	Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition
MC	Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues
MD	Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of extreme and uncontrollable circumstances
Q1	Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q5	Service furnished under a reciprocal billing arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
RT	Right side (used to identify procedures performed on the right side of the body)
XE	Separate encounter, a service that is distinct because it occurred during a separate encounter
XP	Separate practitioner, a service that is distinct because it was performed by a different practitioner
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service

Chapter & Section Hierarchy

Personal Notes

Code History

Date	Action	Notes
2012-01-01	Added	Added

ICD-10-PCS Crosswalk

NCCI Crosswalk

Code	Description

59	Distinct Procedural Service: Under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-E/M services performed on the same day. Modifier 59 is used to identify procedures/services, other than E/M services, that are not normally reported together, but are appropriate under the circumstances. Documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. However, when another already established modifier is appropriate it should be used rather than modifier 59. Only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. Note: Modifier 59 should not be appended to an E/M service. To report a separate and distinct E/M service with a non-E/M service performed on the same date, see modifier 25.
LT	Left side (used to identify procedures performed on the left side of the body)
RT	Right side (used to identify procedures performed on the right side of the body)
XE	Separate encounter, a service that is distinct because it occurred during a separate encounter
XP	Separate practitioner, a service that is distinct because it was performed by a different practitioner
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
No matching codes found

HCPCS Crosswalk

Code	Description

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
A9544	Iodine i-131 tositumomab, diagnostic, per study dose [deleted]
A9545	Iodine i-131 tositumomab, therapeutic, per treatment dose [deleted]
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 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries
A9586	Florbetapir f18, diagnostic, per study dose, up to 10 millicuries
A9587	Gallium ga-68, dotatate, diagnostic, 0.1 millicurie
A9588	Fluciclovine f-18, diagnostic, 1 millicurie
A9591	Fluoroestradiol f 18, diagnostic, 1 millicurie
A9592	Copper cu-64, dotatate, diagnostic, 1 millicurie
A9593	Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie
A9594	Gallium ga-68 psma-11, diagnostic, (ucla), 1 millicurie
A9595	Piflufolastat f-18, diagnostic, 1 millicurie
A9596	Gallium ga-68 gozetotide, diagnostic, (illuccix), 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
A9599	Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose, not otherwise specified [deleted]
A9600	Strontium sr-89 chloride, therapeutic, per millicurie
A9601	Flortaucipir f 18 injection, diagnostic, 1 millicurie
A9604	Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries
C9458	Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries [deleted]
C9459	Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries [deleted]
C9898	Radiolabeled product provided during a hospital inpatient stay
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
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 [deleted]
Q9982	Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries
Q9983	Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries
No matching codes found

Code	Description

CF141ZZ	Planar Nuclear Medicine Imaging of Gallbladder using Technetium 99m (Tc-99m)
CF14YZZ	Planar Nuclear Medicine Imaging of Gallbladder using Other Radionuclide
CF1C1ZZ	Planar Nuclear Medicine Imaging of Hepatobiliary System, All using Technetium 99m (Tc-99m)
CF1CYZZ	Planar Nuclear Medicine Imaging of Hepatobiliary System, All using Other Radionuclide
CF1YYZZ	Planar Nuclear Medicine Imaging of Hepatobiliary System and Pancreas using Other Radionuclide
No matching codes found