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The CPT® Code 78835 refers to the process of radiopharmaceutical quantification measurement(s) for a single area, which is reported separately in addition to the code for the primary procedure. This code is utilized in conjunction with previously acquired SPECT-CT imaging data, specifically codes 78830 and 78832. The purpose of this quantification is to provide a more detailed analysis beyond mere visual inspection of the images, particularly in assessing the extent of therapeutic uptake or response in cases involving malignant or metastatic lesions. This detailed quantification aids healthcare professionals in determining the appropriate course of treatment or prognosis for the patient.
In the context of SPECT-CT imaging, the initial imaging is performed in three-dimensional format and in list mode, which captures the raw, unreconstructed detector signal output. This method allows for a more accurate quantification process. The acquired data is then filed for quantitation and exported to a dedicated computer system. Following the standard SPECT-CT image processing, additional processing is conducted using specialized software designed for quantitation. This processed data is subsequently imported into a quality control software program for thorough analysis. The physician is provided with both the processed dataset and its quality information for review, which includes critical metrics such as bolus duration, peak and plateau waveforms, and tumor uptake within a specified time interval post-administration. Ultimately, the quantitation data is integrated with the imaging data, attenuation values, and relevant clinical information to generate a comprehensive report for clinical decision-making.
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The indications for performing radiopharmaceutical quantification measurement(s) using CPT® Code 78835 include the following:
The procedure for radiopharmaceutical quantification measurement(s) involves several detailed steps:
Post-procedure care following the radiopharmaceutical quantification measurement(s) involves monitoring the patient for any immediate reactions to the radiopharmaceutical administered. The physician will review the generated report, which includes the quantitation data and imaging results, to determine the next steps in the patient's treatment plan. Follow-up appointments may be scheduled to discuss the findings and any necessary adjustments to the treatment regimen based on the quantification results. Additionally, the physician may provide the patient with information regarding any further imaging studies or therapeutic interventions that may be required based on the analysis of the quantitation data.
| Short Descr | RP QUAN MEAS SINGLE AREA | Medium Descr | RADIOPHARMACEUTICAL QUANTIFICATION MEAS 1 AREA | Long Descr | Radiopharmaceutical quantification measurement(s) single area (List separately in addition to code for primary procedure) | Status Code | Active Code | Global Days | ZZZ - Code Related to Another Service | 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 | Items and Services Packaged into APC Rates | ASC Payment Indicator | Packaged service/item; no separate payment made. | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | none | MUE | 2 |
This is an add-on code that must be used in conjunction with one of these primary codes.
| 78830 | Resequenced Code MPFS Status: Active Code APC S ASC Z2 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis) or acquisition, single day imaging | 78832 | Resequenced Code MPFS Status: Active Code APC S ASC Z2 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission scan for anatomical review, localization and determination/detection of pathology, 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 |
| 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 | 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 | 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. | GZ | Item or service expected to be denied as not reasonable and necessary | 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 | 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 | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional | 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 |
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| 2020-01-01 | Added | Code added. |
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