Radiology Coding Alert

Question: Is PET-CT different from a PET scan? How can we report for a PET-CT?

Minnesota Subscriber

Answer: For PET-CT, you submit codes 78814 (Positron emission tomography [PET] with concurrently acquired computed tomography [CT] for attenuation correction and anatomical localization imaging; limited area [e.g., chest, head/neck]) – 78816 (Positron emission tomography [PET] with concurrently acquired computed tomography [CT] for attenuation correction and anatomical localization imaging; whole body) depending upon the extent of coverage in the PET-CT.

For only PET scan, you have codes 78811(Positron emission tomography [PET] imaging; limited area [e.g., chest, head/neck]) –78813 (Positron emission tomography [PET] imaging; whole body). These codes apply when your provider does only PET scanning without CT scan attenuation and anatomic localization.

What is a PET-CT procedure? PET-CT is a diagnostic procedure where your provider performs both positron emission tomography (PET) and computed tomography (CT) together. This helps to evaluate the location and metabolic actions of tumors or cancer to guide the further treatment plan. The results of these two scans fuse and the combined image provides a more complete picture and information on tumor location and metabolism.

PET scan is diagnostic nuclear imaging that produces three–dimensional images. In this procedure, the provider injects a radioactive tracer or radionuclide into the bloodstream. This radionuclide is created by applying a radioactive atom to glucose, which is rapidly uptaken by the cancer cells. The radionuclide travels in the bloodstream and reaches the tumor area. In the target area this radionuclide breaks into tiny positively charged particles called positrons, thereby emitting gamma rays. A special device called a PET scanner is used to detect the gamma rays given off by the radioactive substance.

CT is a special kind of X–ray machine that sends several X–ray beams simultaneously from different angles towards the human body to create thin, cross sectional views of anatomical layers or slices of the body.

Look for both PET and CT: You report codes 78814-78816 for hybrid PET/CT scanners, which utilize both the PET and CT technology together by fusing the data obtained from both, thereby rectifying the limitations of PET and CT. The highly sensitive PET scan detects the abnormal metabolic activity of tumor cells, and CT provides a detailed picture of the internal structure of the targeted organ or tumor for the physician.

One code for one session: You report only one single code from 78814-78816 for one imaging session.

Modifier 26: If you are reporting only your physician’s interpretation for the radiology imaging, you should append modifier 26 (Professional component) to the radiology codes 78814-78816. However when your physician renders both the technical and professional services, you do not append a professional or technical modifier to the radiology codes.