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 and essential tremor.
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.
CPT Code – Locate and Verify
In the CPT coding manual Index, we can look up Tomography, Emission Computers, 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), single day imaging
CPT 78803 includes the physician’s interpretation of the study, along with a written report of the findings.
A little history on coding for this procedure:
Prior to January 1, 2020, the CPT code used to report this DaTscan procedure was:
78607, Brain imaging, tomographic (SPECT)
As of January 1, 2020, however, 78607 was deleted, and the revised tumor localization code 78803 took its place.
The previous description for 78803 was:
Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s); whole body, single day imaging
The AMA guidelines 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.
HCPCS Code – Locate and Verify
In the HCPCS Level II coding manual Index to Services, Supplies, Equipment, and Drugs, look up Iodine I-123 ioflupane. It takes us to A9584. This code can be verified in the Administrative, Miscellaneous, and Experimental section (A9150-A9999) as:
A9584 – Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries
The documentation indicates the dosage as 5 mCi +/- 20%, which is described by this code.
What is a DaTscan?
According to Providence.org, DaTscan is a nuclear imaging test used to distinguish between such diseases as Parkinson’s and essential tremor. This test allows physicians to view the dopamine levels in the brain and see if the brain’s neurons have degenerated. DaTscan is a medication that is combined with imaging technology known as single photon emission computed tomography (SPECT). DaTscan (or radioactive tracer, Ioflupane I-123) is injected into the bloodstream and it circulates through the body into the area of the brain associated with Parkinson’s disease. Several hours later, special imaging equipment is used to see if the brain is producing normal levels of dopamine. In Parkinson’s patients, dopamine is depleted. In patients with essential tremor or other movement disorders, there is no decrease in dopamine production.
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