Are you conducting a nuclear medicine test and totally unaware of its billing process? We have prepared a guide on the CPT code 78264 for you. This blog walks you through the code description, examples, applicable modifiers, and billing guidelines, helping you avoid denials.
By the end of this guide, you will be able to bill this code on your own. So let’s get started!
CPT Code 78264 – Description
CPT code 78264 reports a diagnostic procedure, known as a gastric emptying imaging study. It is a painless, non-invasive procedure where the provider images the stomach after the patient consumes a radiopharmaceutical or tracer (added to the meal) to observe and measure how quickly food leaves the stomach.
The provider then takes immediate and ongoing images to assess the speed with which the stomach empties. It helps diagnose digestive problems related to the stomach’s emptying.
Scenarios Where CPT Code 78264 is Applicable
Here are a few clinical scenarios for CPT code 78264 that support the code descriptor.
Gastroparesis
Suppose a 40-year-old diabetic patient comes in the emergency with persistent nausea, abdominal discomfort, and occasional vomiting after eating solid foods. Despite dietary changes and medication trials, the symptoms persist. His concerned physician suspects gastroparesis. He decides to conduct a gastric emptying study to confirm the diagnosis. During the test, images are taken at timed intervals to measure the rate at which the stomach empties solid food. In this case, the diagnostic test can be billed with CPT code 78264.
Follow-Up to Monitor the Response to GastroparesisTreatment
Let’s imagine another scenario of the same 40-year-old diabetic patient who was diagnosed with gastroparesis and has now been undergoing treatment with medications and dietary modifications.
After several months of the treatment, the physician wants to assess whether gastric emptying has improved. So, he conducts another follow-up nuclear medicine gastric emptying study using a solid meal to objectively measure changes in stomach motility. He can report his services with CPT code 78264 to explain the repeat diagnostic evaluation and monitoring of treatment effectiveness.
Post-Surgical Gastric Dysfunction
Let’s discuss another case where a patient underwent gastric surgery. However, he started noticing some symptoms of abdominal pain, nausea, and discomfort after meals. These symptoms raised concerns among the physicians for a post-surgical complication.
The primary surgeon immediately orders a gastric emptying imaging test using a solid meal to evaluate stomach function. The study helps identify whether the surgery has slowed or impaired gastric emptying. Here, CPT code 78264 applies.
Applicable Modifiers for CPT Code 78264
You can append the following modifiers to CPT code 78264 according to your services.
Modifier 26
You can apply modifier 26 to CPT code 78264 if the physician has performed the professional component of the procedure, such as interpreting the imaging study’s results and writing a report.
Modifier TC
Modifier TC indicates the technical component of the service. It is applied to CPT code 78264 to indicate that the facility is billing the technical component of a gastric emptying study, i.e., equipment, supplies, and the technician’s time and expertise.
CPT Code 78264 – Billing & Reimbursement Guidelines
Here are some billing and reimbursement guidelines for CPT code 78264 that may save you from receiving denials.
Ensure the Correct Use of CPT 78264
Before you begin billing CPT code 78264, it is important to understand the code descriptor. To reiterate, this code is only used for imaging the stomach for up to 4 hours. If the study includes the colon or small intestines, or lasts longer than 4 hours, you must look for other relevant CPT codes.
Maintain Proper Documentation
The details you mention in your documents decide whether or not you will receive the reimbursement. So you must include adequate and accurate documentation with your CPT code 78264 claims.
Your supporting paperwork must establish a medical necessity for the diagnostic test. It must clearly establish why the test was conducted, what conditions were evaluated, and the patient’s symptoms. However, the payer may deny the claim if the test appears to be ordered for screening purposes or without a valid diagnostic indication.
Therefore, you must include the following information regarding the gastric emptying study:
- The duration of the imaging test
- Which parts of the GI tract were evaluated
- Whether there were multiple sessions or different dates
- The type of meal (solid, liquid, or both)
Follow Payer-Specific Policies
And lastly, before you provide any medical services, it is crucial to check the respective insurance payer’s reimbursement policies. Most payers require prior authorization for diagnostic nuclear medicine procedures. Moreover, payers often update their policies (e.g., coverage exclusions and limitations). So, to ensure compliance and avoid denials, you must follow payer-specific billing requirements.
Summary
Before we take leave, let us quickly recap the information regarding CPT code 78264.
- This code is used to report gastric emptying imaging studies, limited to the stomach.
- This test is usually performed to diagnose gastroparesis.
- You can report professional and technical components of the service separately.
- Keep in mind that this code is used for a test concluded within 4 hours.
- It is vital to maintain proper documentation and check the payer’s policies before submitting claims.
If you are still confused about the billing of this code, the next best thing you can do is to acquire gastroenterology billing services. MediBillMD offers top-notch medical billing services that are guaranteed to improve your collection rate. Hence, partnering with them is the safest move for your gastroenterology practice.
