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The CPT® Code 78831 refers to a diagnostic imaging procedure known as radiopharmaceutical localization, which utilizes molecular imaging techniques, specifically single photon emission computed tomography (SPECT). This procedure is designed to identify the presence of tumors or inflammatory processes within the body by tracking the distribution of radiopharmaceutical agents. These agents are typically radiolabeled isotopes that can be bioengineered to target specific tissues or organs based on their physiological functions. The process begins with the establishment of an intravenous line, through which the radiolabeled isotope tracer is injected directly into the patient's circulatory system. Alternatively, a blood sample may be taken, and the white or red blood cells can be separated, tagged with the isotope tracer, and reintroduced into the patient. In some cases, radioactive agents may also be inhaled or ingested to facilitate distribution throughout the body. Once administered, the tracer travels through the bloodstream and binds to areas of inflammation or tumor growth, allowing for precise localization. The patient is then positioned on an imaging table, and a specialized gamma camera is employed to capture images of the targeted areas. This camera rotates around the patient, performing scans at various angles and intervals to gather comprehensive data. The emitted radioactive energy is converted into detailed images, which may also include blood pool imaging, illustrating how the tracer flows through the area of interest. The procedure is capable of producing three-dimensional images that provide insights into the size, volume, and biochemical processes occurring within the target tissues. The results of the imaging study are interpreted by a physician, who subsequently generates a written report detailing the findings. This code specifically applies to tomographic SPECT imaging that encompasses at least two distinct areas or separate acquisitions conducted on a single day, or a single area imaged over two or more days.
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The procedure associated with CPT® Code 78831 is indicated for the localization of tumors or inflammatory processes within the body. It is particularly useful in the following scenarios:
The procedure for CPT® Code 78831 involves several key steps that ensure accurate localization of tumors or inflammatory processes:
After the completion of the imaging procedure associated with CPT® Code 78831, patients may be monitored briefly to ensure there are no immediate adverse reactions to the radiopharmaceutical agent. There are typically no specific restrictions or extensive post-procedure care required, allowing patients to resume normal activities shortly after the imaging is completed. However, patients may be advised to drink plenty of fluids to help flush the radioactive material from their system. Follow-up appointments may be scheduled to discuss the results of the imaging study and any further diagnostic or therapeutic steps that may be necessary based on the findings.
| Short Descr | RP LOCLZJ TUM SPECT 2 AREAS | Medium Descr | RP LOCLZJ TUM SPECT 2 AREA/SEP ACQUISJ IMG | Long Descr | Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), minimum 2 areas (eg, pelvis and knees, chest and abdomen) or separate acquisitions (eg, lung ventilation and perfusion), single day imaging, or single area or acquisition 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) | none | MUE | 1 |
| 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. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | CR | Catastrophe/disaster related | 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 | 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 | 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 | XP | Separate practitioner, a service that is distinct because it was performed by a different practitioner | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | 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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| 2023-01-01 | Changed | Code description changed. |
| 2020-01-01 | Added | Code added. |
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