# CPT 78226 and 78227



## DebbiePottsEngland

I have a 78226 definitely but I don't know what drug makes it 78227.  they also infused Cholecystokinin but I don't know that this is what they are looking for.  Does anyone have any advanced knowledge on this?

All offers of help are appreciated.

thanks
Debbie


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## donnajrichmond

Yes, sincalide, Kinevac, cholecystokinin, CCK or morphine sulfate when administered during the procedure.  Morphine sulfate, when administered as a pretreatment drug would not count.


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## amymeyers01

I understand the documentation requirements and how to choose between the 2 codes; however, what if the report doesn't document the pharmacologic intervention but does document an ejection fraction?  Would it be appropriate to bill it with a -52 mod?  I don't have the option of returning it to the doctor for it to be corrected.  We have to bill 'as is.'


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## donnajrichmond

amymeyers01 said:


> I understand the documentation requirements and how to choose between the 2 codes; however, what if the report doesn't document the pharmacologic intervention but does document an ejection fraction?  Would it be appropriate to bill it with a -52 mod?  I don't have the option of returning it to the doctor for it to be corrected.  We have to bill 'as is.'



I would not code 78227 if they do not document pharmacologic intervention during the procedure.


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## jdietz

*78226 vs 78227*

hello,

In regards to this new code.  The TEch is performing the test and obviously a lic Nurse anes is injecting the drug for the test. The tech's organization orders and pays for the medicine.

When billing the tc and 26 as long as the report states with what medicine you have your pharmalogical intervention 78227.  correct?? And can bill for the drug.

But obviously not billing for the injection itself the hospital would include that under the nurse/anes injecting correct?

Any help appreciated:

Judy, cpc


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## sathyaraj

*78226 - Choletec gudeline 2012 cpt*

I have definite to code 78226 but i don't know what drug makes it 78227. 

Following Intravenous Administration of 6mci of Tc- 99m CHOLETEC, Scans were obtained for a period of one hour . Initially, there was homogenous activity within the liver.Then after small bowel activity is present at last 30 minutes.Does any one have advanced knowledge on this?

may i know weather to code 78226/78227 on this?

thanks, 
Sathyaraj.A


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## srinivas r sajja

Pharmacological intervention with either cholecystokinin-8 (CCK-8) or morphine during 99mTc- hepatoiminodiacetic acid (HIDA) cholescintigraphy is required primarily for the assessment of the diseases affecting the gallbladder, the common bile duct, or the sphincter of Oddi. For imaging, the patient should be prepared by an overnight fast, or with 4 hours of minimum fast. Pre-emptying with CCK-8 is probably undesirable and should either be avoided or one should wait for at least 4 hours after CCK-8 to begin the 99mTc-HIDA study to achieve higher specificity of the test for acute cholecystitis. When he gallbladder is not observed by 60 mins in a clinical setting of acute cholecystitis, a dose of 0.04 mg/kg of morphine is administered intravenously and imaging continued for an additional 30 mins. Nonvisualization of the gallbladder by 90 mins with morphine in an appropriate clinical setting is diagnostic for acute cholecystitis. When the gallbladder is not observed by 60 min but is seen with morphine administered after 60 mins, a positive diagnosis of abnormal gallbladder function can be made. When the gallbladder is observed in a clinical setting of biliary pain or chronic calculous or acalculous cholecystitis, CCK-8 at a dose rate of 3.3 ng/kg/min is infused intravenously for 3 mins (10 ng/kg/3 min) for the measurement of the ejection fraction. An ejection fraction value of less than 35% is indicative of calculous or acalculous chronic cholecystitis. The gallbladder emptying is directly related to the total number of cholecystokinin receptors in the smooth muscle. The ejection fraction can be controlled to any desired level simply by controlling the dose rate or the duration of infusion of CCK-8. Morphine and other opiate metabolites circulate for many hours in blood and act on the sphincter of Oddi and decrease the gallbladder ejection fraction. Careful drug history, especially that of opiates, is very critical in all subjects with a low ejection fraction before assigning an abnormality to the gallbladder motor function.


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## srinivas r sajja

Pharmacological intervention with either *cholecystokinin-8 (CCK-8) or morphine *during 99mTc- hepatoiminodiacetic acid (HIDA) cholescintigraphy is required primarily for the assessment of the diseases affecting the gallbladder, the common bile duct, or the sphincter of Oddi. For imaging, the patient should be prepared by an overnight fast, or with 4 hours of minimum fast. Pre-emptying with CCK-8 is probably undesirable and should either be avoided or one should wait for at least 4 hours after CCK-8 to begin the 99mTc-HIDA study to achieve higher specificity of the test for acute cholecystitis. When he gallbladder is not observed by 60 mins in a clinical setting of acute cholecystitis, a dose of 0.04 mg/kg of morphine is administered intravenously and imaging continued for an additional 30 mins. Nonvisualization of the gallbladder by 90 mins with morphine in an appropriate clinical setting is diagnostic for acute cholecystitis. When the gallbladder is not observed by 60 min but is seen with morphine administered after 60 mins, a positive diagnosis of abnormal gallbladder function can be made. When the gallbladder is observed in a clinical setting of biliary pain or chronic calculous or acalculous cholecystitis, CCK-8 at a dose rate of 3.3 ng/kg/min is infused intravenously for 3 mins (10 ng/kg/3 min) for the measurement of the ejection fraction. An ejection fraction value of less than 35% is indicative of calculous or acalculous chronic cholecystitis. The gallbladder emptying is directly related to the total number of cholecystokinin receptors in the smooth muscle. The ejection fraction can be controlled to any desired level simply by controlling the dose rate or the duration of infusion of CCK-8. Morphine and other opiate metabolites circulate for many hours in blood and act on the sphincter of Oddi and decrease the gallbladder ejection fraction. Careful drug history, especially that of opiates, is very critical in all subjects with a low ejection fraction before assigning an abnormality to the gallbladder motor function.


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