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Cerebrospinal fluid (CSF) flow imaging, designated by CPT® Code 78630, is a diagnostic procedure that utilizes scintigraphy along with a radiolabeled isotope tracer to visualize the movement of CSF within the central nervous system. This imaging technique is crucial for identifying abnormalities in CSF flow, which can include conditions such as communicating and non-communicating hydrocephalus, as well as fistulas that may develop between a CSF reservoir, known as a cistern, and the nasal cavity or ear. The CSF is produced in the lateral ventricles of the brain and flows through various anatomical structures, including the foramen of Monro into the third ventricle, and subsequently into the fourth ventricle via the aqueduct of Sylvius. From the fourth ventricle, the CSF enters the subarachnoid spaces through the medial foramen of Magendie and the lateral foramina of Luschka. The movement of CSF is facilitated by several mechanisms, including bulk flow, which occurs from areas of high pressure to those of lower pressure, as well as pulsatile motion that is influenced by the cardiac cycle of the cerebral arteries. During the procedure, a radiolabeled isotope tracer is introduced into the CSF through a lumbar puncture, and the patient is positioned on an imaging table with a gamma camera placed over the area of interest. Scanning is conducted at predetermined intervals, capturing the radioactive energy emitted, which is then transformed into a visual image for analysis. This procedure specifically focuses on the cisterns, as indicated by the use of Code 78630, while a different code, 78635, is applied when the ventricles are the primary focus of the imaging study. The physician is responsible for interpreting the results of the imaging study and providing a comprehensive written report detailing the findings.
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The cerebrospinal fluid flow imaging procedure (CPT® Code 78630) is indicated for the evaluation of various conditions related to abnormal CSF dynamics. The following are the specific indications for performing this imaging study:
The procedure for cerebrospinal fluid flow imaging involves several critical steps to ensure accurate results. The following outlines the procedural steps:
After the cerebrospinal fluid flow imaging procedure, the patient may be monitored for any immediate complications related to the lumbar puncture, such as headache or bleeding. It is important to provide the patient with post-procedure care instructions, which may include recommendations for hydration and rest. The physician will review the imaging results and discuss the findings with the patient, outlining any necessary follow-up actions or additional diagnostic steps based on the outcomes of the study.
| Short Descr | CEREBROSPINAL FLUID SCAN | Medium Descr | CEREBROSPINAL FLUID FLOW W/O MATL CISTERNOGRAPHY | Long Descr | Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography | 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 | 209 - Radioisotope scan and function studies |
| 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 | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | ME | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | 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 | 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 | 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 | 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 |
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| 2017-01-01 | Changed | Guidelines added. |
| Pre-1990 | Added | Code added. |
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