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The CPT® Code 78804 refers to a diagnostic procedure known as radiopharmaceutical localization, which is utilized to identify tumors, inflammatory processes, or the distribution of radiopharmaceutical agents within the body. This procedure employs molecular imaging techniques, specifically scintigraphy, which utilizes a radiolabeled isotope tracer. The primary objective of this imaging is to detect inflammation and/or neoplastic growths, even in their early stages. The radiopharmaceutical agent is designed to attach to specific cells, such as those involved in inflammation or to target particular organs based on their physiological functions. 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 drawn, processed to separate the white or red blood cells, and then tagged with the isotope tracer before being reintroduced into the patient. In some cases, radioactive agents may also be administered through inhalation or ingestion, depending on the target area for imaging. Once the tracer is introduced into the body, it circulates and binds to or becomes localized in areas of tumorous or inflamed tissue. The patient is then positioned on an imaging table, and a gamma camera is centered over the area of interest. Scanning is conducted at predetermined intervals, capturing the radioactive energy emitted from the tracer, which is subsequently converted into images. This specific code encompasses planar imaging of the entire body, which necessitates imaging over a span of two or more days. Planar imaging results in a static, two-dimensional representation of the area being examined, and the physician is responsible for interpreting the results and generating a comprehensive written report detailing the findings.
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The procedure associated with CPT® Code 78804 is indicated for the following conditions:
The procedure for CPT® Code 78804 involves several key steps that ensure accurate localization of tumors or inflammatory processes:
After the completion of the imaging procedure associated with CPT® Code 78804, patients may be monitored for any immediate reactions to the radiopharmaceutical agent. There are typically no specific post-procedure care requirements, but patients may be advised to stay hydrated and follow any additional instructions provided by their healthcare provider. The results of the imaging will be reviewed by the physician, who will discuss the findings with the patient and outline any necessary follow-up actions or treatments based on the results.
| Short Descr | RP LOCLZJ TUM WHBDY 2+D IMG | Medium Descr | RP LOCLZJ TUM PLNR WHOLE BODY 2+ DAYS IMAGING | Long Descr | Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, requiring 2 or more days imaging | 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. | 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. | 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 | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | 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 | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | 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 | XE | Separate encounter, a service that is distinct because it occurred during a separate encounter |
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| 2020-01-01 | Changed | Code description changed. |
| 2013-01-01 | Changed | Medium Descriptor changed. |
| 2011-01-01 | Changed | Short description changed. |
| 2009-01-01 | Changed | Code description changed |
| 2004-01-01 | Added | First appearance in code book in 2004. |
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