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 the procedure.

Answer:

CPT: 78607

HCPCS: A9584

You can find the correct CPT code for this procedure by looking in the Alphabetic Index of the CPT coding manual under Nuclear, medicine, brain imaging, 78600-78610. When going to these codes in the Tabular, the correct code can be verified as:

  • 78607 – Brain imaging, tomographic (SPECT)

Another way to find the correct code is to look in the Alphabetic Index under Brain, nuclear medicine, imaging, 78600-78607. 

Either way, it will take you to code 78607, which is located in the Radiological section of the CPT coding manual in the Nuclear Medicine Procedures subsection (78012-79999).

CPT 78607 includes the physician’s interpretation of the study, along with a written report of the findings.

Next, we need to report the supply code for the I-123 Ioflupane, as 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. 

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 Saint John’s Health Center,  DaTscan is a brain imaging test used to distinguish between such diseases as Parkinson’s and essential tremor. A single photon emission computed tomography (SPECT) and a radiolabeled isotope tracer are used to visualize the striatal dopamine transporter (DaT). The radioactive tracer, Ioflupane I-123, is injected into the bloodstream, and it circulates through the body and into the basal ganglia of the brain. There it attaches itself to the dopamine transporter. Several hours later, the head is scanned with special imaging equipment to detect the presence of DaTscan.

In Parkinson’s patients, dopamine is depleted. In essential tremor, it is not. A DaTscan is an adjunct to other diagnostic evaluations.

 


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