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Radiology Question for the Week of November 20, 2023


Can we report code 78445 when performing whole-body flow imaging followed by a whole-body bone scan?


When performing whole-body flow imaging followed by whole-body bone scanning (with or without detailed spot images of specific anatomic areas), the SNM coding committee (April 5, 2007) recommends that code 78445 not be applied for this flow study. The SNM coding committee consensus opinion (in its entirety) is as follows: “There are no specific CPT codes that accurately describe a whole-body flow study plus a whole-body or multiple-area imaging study. In the absence of a specific CPT® code, the SNM typically recommends the unlisted CPT® code 78399—unlisted musculoskeletal procedure, diagnostic nuclear medicine. We would not recommend use of 78445 in combination with the other bone scan CPT codes 78300–78315. CPT 78445 is a single body-area flow imaging and imaging study stand-alone procedure code and is not intended to be used as an add-on code with another nuclear medicine procedure. “The commonly performed conventional three-phase bone scan, CPT 78315 Bone and/or joint imaging; three phase, typically consists of flow, blood-pool, and delayed imaging phases. Several of the SNM committee members believe the facility’s protocol, indication, and resources consumed are similar to the protocol described above. Nuclear Medicine facilities often differ in the specific protocols for imaging services; however, CPT does not create different procedure codes for each protocol. The AMA CPT panel develops codes and the RUC values [for] these codes for the typical (most commonly performed protocol) procedure. A facility’s choice of protocol would not change the billing guidelines; therefore, if the resources and physician work are similar or the same, we recommend coding one (1) unit of CPT 78315. “If the resources are different we recommend using the unlisted CPT code 78399 and supply supporting documentation as required by the payer.”

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