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The CPT® Code 78801 refers to a diagnostic procedure known as radiopharmaceutical localization, which is utilized to identify tumors or inflammatory processes within the body. This procedure employs molecular imaging techniques, specifically scintigraphy, in conjunction with a radiolabeled isotope tracer. The primary objective is to detect the presence of inflammation or neoplastic growths, which can be crucial for early diagnosis and treatment planning. The radiopharmaceutical agent is designed to bind to specific biological targets, such as inflammatory cells or organs, based on their physiological characteristics. To initiate the procedure, an intravenous line is established, allowing for the direct injection of the radiolabeled isotope tracer into the patient's circulatory system. Alternatively, a blood sample may be collected, processed to separate the cellular components, and then tagged with the isotope before being reintroduced into the patient. In some cases, radioactive agents may also be administered via inhalation or ingestion, depending on the area of interest. Once the tracer is in circulation, it travels throughout the body and localizes in areas of inflammation or tumors. The patient is positioned on an imaging table, and a gamma camera is strategically placed over the targeted region. Scanning occurs at predetermined intervals, capturing the radioactive energy emitted from the tracer, which is then transformed into diagnostic images. This procedure can involve imaging multiple areas, such as the abdomen and pelvis or the head and chest, either on the same day or over several days. The resulting images provide valuable insights into the patient's condition, and the physician is responsible for interpreting the findings and generating a comprehensive written report.
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The CPT® Code 78801 is indicated for use in various clinical scenarios where localization of tumors or inflammatory processes is necessary. The following conditions may warrant this procedure:
The procedure associated with CPT® Code 78801 involves several key steps to ensure accurate localization of tumors or inflammatory processes. The following outlines the procedural steps:
After the completion of the procedure, patients may be monitored for a short period to ensure there are no immediate adverse reactions to the radiopharmaceutical agent. It is important for the physician to provide post-procedure instructions, which may include hydration recommendations to help flush the radioactive material from the body. Patients should also be informed about any potential side effects and when to seek medical attention. Follow-up appointments may be scheduled to discuss the results of the imaging and any further diagnostic or therapeutic steps that may be necessary based on the findings.
| Short Descr | RP LOCLZJ TUM 2+AREA 1+D IMG | Medium Descr | RP LOCLZJ TUM PLNR 2+AREA 1+D IMG/1 AREA IMG>2+D | Long Descr | Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, 2 or more areas (eg, abdomen and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or more days | 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 | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | ME | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | 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 | 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 | Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional | RT | Right side (used to identify procedures performed on the right side of the body) | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2020-01-01 | Changed | Code description changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2004-01-01 | Changed | Code description changed. |
| Pre-1990 | Added | Code added. |
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