CPT® Code 78290

Official Description

Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus)

Common Language Description

The CPT® Code 78290 refers to a specialized imaging procedure of the intestine, which is utilized for various diagnostic purposes, including the localization of ectopic gastric mucosa, identification of Meckel's diverticulum, and assessment of conditions such as volvulus. This imaging technique employs scintigraphy, a method that utilizes a radiolabeled isotope tracer to visualize internal structures and functions. The tracer can be attached to red blood cells (RBCs) or white blood cells (WBCs), or it may be injected directly into the patient's circulatory system. The primary goal of this procedure is to locate potential bleeding sites, tumors, or areas of inflammation within the bowel. To initiate the procedure, an intravenous line is established, allowing for the direct injection of the radiolabeled isotope tracer into the bloodstream. Alternatively, a blood sample may be collected, which is then processed through centrifugation to separate the RBCs and WBCs. These cells are subsequently tagged with the isotope tracer before being reintroduced into the patient’s body. The choice of using RBCs is typically aimed at identifying sources of bleeding, while WBCs are utilized to detect inflammatory processes. Following the administration of the tracer, the patient is positioned on an imaging table, with a gamma camera placed over the anterior abdomen and pelvis. The imaging process involves scanning at predetermined intervals, during which the radioactive energy emitted from the tracer is captured and converted into detailed images. Advanced imaging techniques such as single-photon emission computed tomography (SPECT), SPECT/CT, and positron emission tomography (PET) may be integrated with scintigraphy to produce enhanced three-dimensional images, providing the physician with comprehensive data for interpretation. Ultimately, the physician analyzes the results of the intestine imaging study and compiles a written report detailing the findings, which is essential for guiding further clinical decisions.

1. Indications

The procedure associated with CPT® Code 78290 is indicated for several specific clinical scenarios, primarily involving the assessment of gastrointestinal conditions. The following are the explicit indications for performing this imaging study:

Ectopic Gastric Mucosa - This imaging is utilized to identify the presence of gastric tissue located outside its normal anatomical location, which can lead to various complications.
Meckel's Localization - The procedure is indicated for locating Meckel's diverticulum, a congenital anomaly that can cause gastrointestinal bleeding or obstruction.
Volvulus - Imaging is performed to assess for volvulus, a condition where a portion of the intestine twists around itself, potentially leading to obstruction and ischemia.

2. Procedure

The procedure for CPT® Code 78290 involves several critical steps to ensure accurate imaging of the intestine. The following outlines the procedural steps in detail:

Establishment of Intravenous Access - The first step involves establishing an intravenous (IV) line to facilitate the administration of the radiolabeled isotope tracer directly into the patient's circulatory system. This is crucial for ensuring that the tracer is effectively delivered for optimal imaging results.
Injection of Radiolabeled Isotope Tracer - Once the IV line is in place, the radiolabeled isotope tracer is injected. This tracer can be attached to either red blood cells (RBCs) or white blood cells (WBCs), depending on the specific clinical indication. Alternatively, a blood sample may be drawn, processed to separate the RBCs and WBCs, tagged with the isotope, and then reinjected into the patient.
Patient Positioning and Imaging - After the tracer has been administered, the patient is positioned on the imaging table with the gamma camera placed over the anterior abdomen and pelvis. Scanning is performed at specific intervals to capture the distribution of the tracer within the intestine.
Image Acquisition - The gamma camera detects the radioactive energy emitted from the tracer, converting it into images that reflect the physiological processes occurring within the intestine. This may include the use of advanced imaging techniques such as SPECT, SPECT/CT, or PET to enhance the quality and detail of the images obtained.
Interpretation and Reporting - Following the imaging, the physician interprets the results of the study, analyzing the images for any abnormalities or areas of concern. A comprehensive written report is then generated, summarizing the findings and providing essential information for further clinical management.

3. Post-Procedure

Post-procedure care for patients undergoing the intestine imaging study with CPT® Code 78290 typically involves monitoring for any immediate reactions to the radiolabeled tracer. Patients may be advised to hydrate adequately to facilitate the elimination of the tracer from their system. Additionally, the physician will review the imaging results and discuss any necessary follow-up actions or further diagnostic evaluations based on the findings. It is important for patients to understand the significance of the results and any potential implications for their health moving forward.

Short Descr	MECKELS DIVERT EXAM
Medium Descr	INTESTINE IMAGING
Long Descr	Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus)
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)	I1E - Standard imaging - nuclear medicine
MUE	1
CCS Clinical Classification	210 - Other radioisotope scan

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.
AQ	Physician providing a service in an unlisted health professional shortage area (hpsa)
GC	This service has been performed in part by a resident under the direction of a teaching physician
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
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
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
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
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
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