CPT code X is a standardized code used by healthcare providers to describe medical, surgical, and diagnostic services for efficient communication.
CPT code 78813 is used to describe a diagnostic procedure known as a "PET scan" or "Positron Emission Tomography scan" that captures a full-body image. This imaging technique is employed to observe metabolic processes in the body and is often used in oncology to detect cancer, assess its spread, and evaluate the effectiveness of treatment. The full-body scan provides comprehensive insights by capturing images from the top of the head to the feet, allowing healthcare providers to make informed decisions based on a complete view of the patient's condition.
For CPT codes 78812 and 78813, the use of modifiers may be necessary to provide additional information about the service performed. Here is a list of potential modifiers that could be applied to these codes, along with the reasons for their use:
1. Modifier 26 - Professional Component: This modifier is used when only the professional component of the imaging service is being billed. It indicates that the provider is billing for the interpretation of the image, not the technical component.
2. Modifier TC - Technical Component: This modifier is used when only the technical component of the imaging service is being billed. It indicates that the provider is billing for the use of equipment and the technician's time, not the interpretation.
3. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It may be necessary if multiple imaging services are performed and need to be billed separately.
4. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
5. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure or service is repeated by a different physician or other qualified healthcare professional subsequent to the original procedure or service.
6. Modifier 91 - Repeat Clinical Diagnostic Laboratory Test: Although primarily used for laboratory tests, this modifier can sometimes be applicable if the imaging service is repeated for clinical reasons.
7. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion.
8. Modifier 53 - Discontinued Procedure: This modifier is used when a procedure is discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
9. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to provide a service is substantially greater than typically required.
It is important to verify payer-specific guidelines as they may have unique requirements for the use of modifiers. Proper use of modifiers ensures accurate billing and reimbursement for services rendered.
The CPT code 78813 is subject to reimbursement considerations under Medicare, specifically through the Medicare Physician Fee Schedule (MPFS).
Whether or not this code is reimbursed by Medicare can depend on several factors, including the specific guidelines and policies set forth by the Medicare Administrative Contractor (MAC) in your region.
Each MAC may have different coverage determinations based on local needs and medical necessity criteria.
Therefore, it is essential for healthcare providers to verify the reimbursement status of CPT code 78813 with their respective MAC to ensure compliance and proper billing practices.
Discover the power of MD Clarity's RevFind software to ensure you're receiving the full reimbursement you deserve. With its advanced capabilities, RevFind meticulously analyzes your contracts and identifies underpayments right down to the CPT code level, including specific codes like 78813, and by individual payer. Don't let hidden discrepancies affect your revenue. Schedule a demo today to see how RevFind can enhance your financial accuracy and boost your bottom line.
Get paid in full by bringing clarity to your revenue cycle
Subscribe to the
Healthcare Clarified newsletter
Get the latest insights on RCM and healthcare policy in your inbox
