Summary & Overview
CPT 78264: Hepatobiliary Imaging with Pharmacologic Intervention
CPT code 78264 represents hepatobiliary system imaging with pharmacologic intervention, a specialized radiology procedure used to assess the liver, gallbladder, and biliary tract. This code is significant nationally due to its role in diagnosing and managing complex hepatobiliary disorders, including gallbladder disease and abnormal liver function. The procedure is typically performed in outpatient hospital settings and involves the use of agents like cholecystokinin or morphine to enhance diagnostic accuracy.
Major payers covering this service include Aetna, Blue Cross Blue Shield, Cigna Health, Medicare, and UnitedHealthcare. The publication provides a comprehensive overview of payer coverage, clinical indications, and relevant billing practices for this code. Readers will gain insights into current benchmarks, policy updates, and the clinical context surrounding hepatobiliary imaging with pharmacologic intervention. The summary also highlights associated modifiers, taxonomies, and ICD-10 diagnoses commonly linked to this procedure, offering a clear understanding of its place in radiology and hepatology practice. This information is essential for stakeholders seeking to navigate reimbursement, compliance, and clinical utilization trends for CPT code 78264.
CPT Code Overview
CPT code 78264 is used for imaging the hepatobiliary system, including the gallbladder when present, with pharmacologic intervention such as cholecystokinin or morphine. This procedure may include quantitative measurements when performed. It falls under the Radiology service type and is typically conducted in an Outpatient Hospital setting (Place of Service 22). The imaging assists in evaluating the function and structure of the liver, gallbladder, and biliary tract, providing critical diagnostic information for a range of hepatobiliary conditions.
Clinical & Coding Specifications
Clinical Context
A typical patient scenario involves an adult presenting to the outpatient hospital with persistent right upper quadrant abdominal pain. The clinician suspects a biliary disorder, such as gallbladder dysfunction or cholecystitis, and orders hepatobiliary system imaging with pharmacologic intervention. The procedure uses nuclear medicine techniques to assess gallbladder function, often employing agents like cholecystokinin or morphine to stimulate or inhibit biliary activity. Quantitative measurements may be performed to evaluate gallbladder ejection fraction or biliary drainage. The workflow includes radiology staff preparing the patient, administering the radiotracer and pharmacologic agent, acquiring images, and interpreting results to guide further management.
Coding Specifications
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Modifier
26: Used when reporting only the professional component of the imaging service (interpretation and report by the physician). -
Modifier
TC: Used when reporting only the technical component (equipment, supplies, and technical staff). -
Associated Provider Taxonomies:
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