best icd-10 codes to bill united for cpt code 78816

by Prof. Adrien Leannon 4 min read

What does CPT code 78816 mean?

78816 - CPT® Code in category: Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging. CPT Code information is available to subscribers and includes the CPT code number, short description, long description, guidelines and more.

What is the CPT code for PET scan 78814?

78814 PET/CT TUMOR IMAGING, LTD. (eg. Chest, Head, Neck) Billing should be submitted using the appropriate billing form and Procedure code for (1) tumor PET imaging (78811, 78812, or 78813), (2) tumor PET/CT imaging (78814, 78815, or 78816), or (3) for brain imaging (78608) when a dedicated brain PET study was done for brain tumor evaluation.

What does 78811 stand for?

78811 Tumor imaging, positron emission tomography (PET); limited area (eg, chest, head/neck) 78812 Tumor imaging, positron emission tomography (PET); skull base to mid-thigh 78813 Tumor imaging, positron emission tomography (PET); whole body

What are ICD and CPT codes in medical billing?

What are ICD and CPT codes in medical billing? ICD-10 codes are the 10th edition of the International Classification of Diseases.

What diagnosis will cover a PET scan?

Some of the reasons your doctor might order a PET scan include: characterization of pulmonary nodules. diagnosis and staging of small cell lung cancer. diagnosis and staging of esophageal cancer.

What is the CPT code 78816?


Does Medicare pay for PSMA PET scan?

PSMA-PET scans are covered by Medicare.

How do you code a PET scan?

When a diagnostic CT scan is performed on the PET/CT scanner, the provider must report the PET scan using a code from series 78811–78813. These codes represent PET without concurrently acquired CT.

What is the CPT code for FDG PET scan?

All PET scan services are billed using PET or PET/ Computed Tomography (CT) Current Procedural Terminology (CPT) codes 78459, 78491, 78492, 78608, and 78811 through 78816.

What is the CPT code for Axumin PET scan?

Axumin has a product-specific Healthcare Common Procedure Coding System (HCPCS) code, effective January 1, 2017. For claims with dates of service on or after January 1, 2017, the following HCPCS code should be used: The Current Procedural Terminology (CPT®) codes for PET imaging are 78811- 78816.

What is the CPT code for a PSMA scan?

CPT Codes*: 88341, 88342, 88360.

What is the CPT code for PSMA?


What is the difference between a PSMA scan and a PET scan?

PSMA-PET scan: PET scans use a radioactive dye to light up specific regions in the body. PSMA-PET scans look for areas of the body where the PSMA protein is found, showing the presence of prostate cancer cells. PSMA stands for prostate specific membrane antigen - a protein found on the surface of prostate cancer cells.

When do you use PS modifier and pi?

Beginning with services performed on or after June 11, 2013, contractors shall pay for up to three (3) FDG PET scans when used to guide subsequent management of anti-tumor treatment strategy (modifier –PS) after completion of initial anti-cancer therapy (modifier –PI) for the exact same cancer diagnosis.

Is CPT 78452 a PET scan?

Myocardial Imaging, PET The cardiologist performs CPT code 78452 “Myocardial perfusion imaging, tomographic (SPECT); multiple studies, at rest and/or stress and/or redistribution and/or rest reinjection”.

What is modifier PS used for?

PS: Positron Emission Tomography (PET) or PET/Computed Tomography (CT) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the PET study is needed to inform subsequent antitumor strategy.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

CMS IOM Publication 100-03, Medicare National Coverage Determinations Manual , Chapter 1, Part 4, Section 220.6.17 - Positron Emission Tomography (FDG PET) for Oncologic Conditions

Article Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire NCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

ICD-10-CM Codes that Support Medical Necessity

It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

What is the ASC X12 837?

Claims for PET scan services must be billed using the ASC X12 837 professional claim format or on Form-CMS 1500 with the appropriate HCPCS or CPT code and diagnosis codes to the A/B MAC (B). Effective for claims received on or after July 1, 2001, PET modifiers were discontinued and are no longer a claims processing requirement for PET scan claims. Therefore, July 1, 2001, and after the MSN messages regarding the use of PET modifiers can be discontinued. The type of service (TOS) for the new PET scan procedure codes is TOS 4, Diagnostic Radiology. Payment is based on the Medicare Physician Fee Schedule.

Can you use 78811-78816 for PET?

The answer is both no and yes. Procedure guidance is clear in the Procedure parenthetical following the PET tumor codes: “report 78811-78816 only once per imaging session”. Therefore, providers may use one Procedure code in the series 78811-78816 when billing PET tumor imaging.

How many digits are in a CPT?

To know more the CPT is well described as a code that consists of 5 digits which is a language exists between the physician’s office or hospital and the insurance company which is willing to accept the medical bills.

What is the ICD-10 code?

ICD-10 is considered an acronym for International Statistical Classification of Diseases and Related Health Problems. World Health Organization (WHO) takes the responsibility of maintaining as well as publishing ICD 10 Codes.

How many digits are in an ICD-10 code?

ICD 10 Codes consists 3 to 7 digits of code whereas ICD-9 has 3 to 5 digits of codes. Therefore the diseases and conditions which are not covered in ICD-9 have covered in ICD 10 Codes. Basically, the ICD 10 Codes start with the alphabet; on the other hand, ICD-9 codes Mein start with either an alphabet or a number.

What does CPT stand for in medical terms?

On the other hand CPT stands for Current Procedural Terminology. Perhaps this is one of the unique codes which are used to analyze, the diagnosis, methods as well as services an individual or a patient has received especially when they go through the medical appointments.

When will ICD 10 codes be released?

You will hear find 2020 ICD 10 Codes CM files that contain updates of the ICD-10-CM for FY 2020. Basically, the 2020 ICD-10-CM codes are useful for discharges occurring from October 1, 2019, through September 30, 2020, and for patient encounters occurring from October 1, 2019, through September 30, 2020.

Is there an ICD-10 code for 2015?

As of October 1, 2015, there is some new set off ICD-10 Codes implemented. These are just a replacement for some ICD-9 code set. It is perhaps difficult for the Healthcare Organization in order to train and prepare for the ICD-9 to ICD-10 Codes transition so as to avoid costly delay for any sort of penalties.

Is there a change in the second digit of an ICD-10 code?

Second digit: Well, there is no change when you consider the characters required for the second digit of an ICD 10 Codes. Both of them have a numerical in its second digit and cannot be differentiated. This could be similar for both the cases of ICD 10 Codes and ICD-9.