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Coding for nuclear medicine studies using indium-labeled white blood cells


I am getting confused about these nuclear medicine studies using indium white blood cells. The hospital submitted CPT® code 78804 and our coding system assigned CPT code 78191. How would you code this study? 

Reason For Exam:
Diagnosis: Presence of unspecified orthopedic joint implant
IMPRESSION: no abnormal radiolabeled leukocyte accumulation.
Indication: right hip pain, right hip arthroplasty June 2015.
COMPARISON: MDP bone scintigraphy with pelvic SPECT CT June 25, 2020, CT abdomen and pelvis with contrast June 21, 2020, bone scintigraphy October 8, 2019.
TECHNIQUE: The patient`s leukocytes were labeled in vitro with 520 uCi indium-111 and reinjected intravenously. Planar anterior and posterior whole-body images are obtained at four hours, followed by static planar anterior, posterior, and bilateral images of the pelvis and hips at 24 hours.
FINDINGS: There is physiologic uptake in the spleen, liver, and skeletal marrow. Specifically, there is no abnormal accumulation of uptake around the right hip arthroplasty hardware. No abnormal retention of uptake in the soft tissues.


78191 is a non-imaging study and is really more of a lab test. The facility performing it must have a CLIA certificate. 

The code and full description are:

78191 Platelet survival study

A white blood cell imaging study prior to January 1, 2020 was described by CPT codes 78805–78807. Those codes were deleted, and this type of imaging is now included in the larger CPT code set of 78800–78832. 

Relative to your question, this exam is described by CPT code 78804, planar whole-body imaging over 2 days. 

The code and full description are:

78804 Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, whole body, requiring 2 or more days imaging