CPT® Code 78740

Official Description

Ureteral reflux study (radiopharmaceutical voiding cystogram)

Common Language Description

A ureteral reflux study, identified by CPT® Code 78740, is a diagnostic imaging procedure that utilizes scintigraphy and a radiolabeled isotope tracer to evaluate the presence of ureteral reflux, which is the abnormal backflow of urine from the bladder into the kidneys. This study is crucial for assessing the functionality of the vesicoureteral valves, which are responsible for preventing such backflow. The procedure can be performed using two distinct methodologies: direct radionucleotide cystography (DRC) and indirect radionucleotide cystography (IRC). In DRC, the bladder is catheterized, and the radiolabeled isotope tracer is instilled along with fluid to distend the bladder, allowing for observation of any retrograde movement of urine. Alternatively, in IRC, the radiolabeled isotope tracer is injected directly into the circulatory system, enabling imaging of the kidneys, ureters, and bladder, while also capturing any retrograde urine movement and bladder emptying. Prior to the procedure, the patient is adequately prepared, which may involve bladder catheterization for DRC or the insertion of an intravenous line for IRC. A gamma camera is then strategically positioned to capture detailed images of the urinary system. The scanning process occurs at predetermined intervals, during which the radioactive energy emitted from the tracer is converted into visual images. Following the completion of the study, the physician interprets the results and generates a comprehensive written report detailing the findings of the ureteral reflux study.

1. Indications

The ureteral reflux study (CPT® Code 78740) is indicated for the evaluation of conditions related to urinary tract function and integrity. The following are specific indications for performing this procedure:

Assessment of Ureteral Reflux This study is primarily conducted to determine the presence of ureteral reflux, which can lead to kidney damage and urinary tract infections.
Evaluation of Vesicoureteral Valves The procedure helps in assessing the functionality of the vesicoureteral valves, which are critical in preventing the backflow of urine from the bladder to the kidneys.
Investigation of Recurrent Urinary Tract Infections It is often indicated in patients with recurrent urinary tract infections to identify any underlying anatomical or functional abnormalities.
Preoperative Assessment The study may be performed as part of the preoperative evaluation for surgical interventions related to urinary tract anomalies.

2. Procedure

The ureteral reflux study involves several key procedural steps that ensure accurate assessment of the urinary system. The following outlines the detailed steps involved in the procedure:

Step 1: Patient Preparation The patient is prepared for the procedure, which may include explaining the process and obtaining informed consent. Depending on the chosen method, either bladder catheterization for direct radionucleotide cystography (DRC) or intravenous line insertion for indirect radionucleotide cystography (IRC) is performed.
Step 2: Administration of Radiolabeled Isotope Tracer In DRC, the bladder is catheterized, and a radiolabeled isotope tracer is instilled along with fluid to distend the bladder. In IRC, the tracer is injected directly into the circulatory system. This step is crucial for visualizing the urinary tract.
Step 3: Imaging Acquisition A gamma camera is positioned to capture images of the urinary system. Scanning is performed at specific intervals to monitor the distribution of the radiolabeled tracer and to observe any retrograde movement of urine from the bladder to the kidneys.
Step 4: Image Interpretation The emitted radioactive energy is converted into images, which are then analyzed by the physician. The physician interprets the findings, focusing on the presence of ureteral reflux and the functionality of the vesicoureteral valves.

3. Post-Procedure

After the ureteral reflux study is completed, the patient may be monitored for any immediate reactions to the radiolabeled tracer. There are typically no specific post-procedure care requirements, but patients may be advised to drink plenty of fluids to help flush the tracer from their system. The physician will provide a written report detailing the findings of the study, which may include recommendations for further evaluation or treatment based on the results. Follow-up appointments may be scheduled to discuss the findings and any necessary next steps in management.

Short Descr	URETERAL REFLUX STUDY
Medium Descr	URETERAL REFLUX STUDY RP VOIDING CYSTOGRAM
Long Descr	Ureteral reflux study (radiopharmaceutical voiding cystogram)
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

This is a primary code that can be used with these additional add-on codes.

78730

Addon Code MPFS Status: Active Code APC N ASC N1 PUB 100 CPT Assistant Article Urinary bladder residual study (List separately in addition to code for primary procedure)

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.
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
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
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