Summary & Overview
CPT 78185: Radionuclide Spleen Study
CPT code 78185 represents a radionuclide spleen study performed after intravenous administration of a radiopharmaceutical to image spleen size, position, or detect focal lesions such as tumors, abscesses, or cysts. As a nuclear medicine diagnostic procedure, it supports evaluation of splenic anatomy and pathology when structural or functional assessment is required. Nationally, this code matters for hospitals, outpatient imaging centers, and radiology practices that provide targeted splenic imaging and for payers who manage coverage and reimbursement for nuclear medicine services.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication discusses typical service settings, common billing modifiers provided in the input, and where CPT code 78185 fits within diagnostic imaging service lines.
Readers will learn the clinical context for using CPT code 78185, typical sites of service, and the administrative elements relevant to billing. The piece provides benchmark-oriented content and policy-aware context for payers and providers. Data not available in the input is called out where applicable.
Billing Code Overview
CPT code 78185 describes a spleen study performed after intravenous administration of a radiopharmaceutical (radiotracer) to determine spleen size and position or to detect tumors, abscesses, or cysts. This procedure is a diagnostic nuclear medicine imaging study focused on splenic anatomy and pathology.
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Service type: Diagnostic nuclear medicine imaging study of the spleen
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Typical site of service: Outpatient imaging center, hospital radiology/nuclear medicine department, or specialized nuclear medicine clinic
Clinical & Coding Specifications
Clinical Context
A 58-year-old adult presents with left upper quadrant abdominal pain and unexplained anemia. The referring clinician orders a nuclear medicine spleen scan to evaluate for splenic enlargement, focal lesions, or splenic sequestration after abnormal findings on physical exam and ultrasound. The patient arrives at an outpatient radiology or nuclear medicine clinic after intravenous access is obtained in the clinical reception area. A technologist administers a radiopharmaceutical (radiotracer) intravenously and acquires serial planar and/or SPECT images of the spleen using the nuclear medicine gamma camera. The interpreting nuclear medicine physician reviews image quality, assesses splenic size, shape, position, and focal defects suggestive of tumors, abscesses, cysts, or infarcts, documents findings in a formal report, and communicates urgent results to the referring provider. Typical sites of service include hospital outpatient radiology departments, freestanding outpatient imaging centers, and hospital-based nuclear medicine suites.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the interpreting physician component separate from technical imaging services. |
TC | Technical component |