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DaTscan Coding in CPT and HCPCS: Differentiate Between Parkinson’s and Essential Tremor

When the neurologist has ordered several imaging tests and is still unsure of the diagnosis, it may be time for a SPECT brain DaTscan to differentiate between Parkinson’s Disease and essential tremor.

daTscan coding in CPT
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** This post was reviewed and updated on February 24, 2024. **

Name That Code

Question: A patient who has not been responding well to dopaminergic therapy is considering deep brain stimulation surgery. The patient has had several imaging scans performed, but the neurologist is still uncertain whether the patient’s diagnosis is Parkinson’s disease or essential tremor. In the hospital outpatient department, DaTscan imaging is performed using I-123 Iofluopane, 5 mCi +/- 20%, as the radioactive agent. This is administered via slow intravenous injection over 20 seconds. Four hours later, SPECT imaging is performed. 

Report the appropriate CPT and HCPCS codes for this procedure.

Answer:

CPT: 78803
HCPCS: A9584

SPECT Brain DaTscan Procedure to Confirm PD or Essential Tremor

Dopamine Transporter Scan (DaTscan) is a nuclear imaging technique used to differentiate between various neurological conditions such as Parkinson’s Disease and essential tremor. According to Providence.org, utilizing a radioactive tracer, Ioflupane I-123, DaTscan involves injecting this compound into the bloodstream, where it moves through the body, targeting the specific region of the brain linked with Parkinson’s disease. This compound is then paired with imaging technology called single photon emission computed tomography (SPECT), enabling physicians to assess dopamine levels within the brain. A depletion of dopamine typically indicates Parkinson’s Disease, while normal dopamine levels suggest essential tremor or another movement disorder. Upon confirming the diagnosis of either Parkinson’s Disease or essential tremor, deep brain stimulation (DBS) surgery may be recommended as a potential treatment option.

CPT Coding

Locate and Verify

In the CPT coding manual Index, we can look up Tomography, Emission Computed/Single Photon. It refers us to SPECT. Looking at SPECT/Brain Imaging, it takes us to 78803.

In the Tabular, this code can be verified as:

78803, Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT), single area (e.g., head, neck, chest, pelvis), or acquisition, single day imaging

CPT 78803 includes the physician’s interpretation of the study, along with a written report of the findings.

HCPCS Coding

The CPT coding guidelines related to Nuclear Medicine Procedures indicate that the radiopharmaceutical or drug used in this procedure is not included in the CPT code and should be separately reported. So we need to report the supply code for the I-123 Ioflupane in addition to the CPT procedure code.

Locate and Verify

In the HCPCS Level II coding manual Index, look up Iodine I-123 ioflupane. It takes us to A9584. This code can be verified as:

A9584Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries

The documentation indicates the dosage is 5 mCi +/- 20%, which is the amount described by this code.

daTscan coding in CPT
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