78815

PET/CT, whole body, oncologic, with IV diagnostic CT

Positron emission tomography (PET) combined with computed tomography (CT) scan, performed as a whole-body study for oncologic indications. This specific code includes the administration of an intravenous (IV) contrast agent for the diagnostic CT component, allowing for detailed anatomical correlation and improved lesion characterization alongside the metabolic information provided by the PET scan.

Clinical Indications

  • Staging of newly diagnosed cancer (e.g., lung, colorectal, lymphoma, melanoma, head and neck)
  • Restaging of cancer after treatment to assess response or recurrence
  • Detection of unknown primary malignancy in patients with metastatic disease
  • Differentiation between benign and malignant lesions when other imaging is inconclusive
  • Monitoring response to therapy in selected cancers
  • Guidance for biopsy or radiation therapy planning

Procedure Steps

  1. Patient preparation, including fasting and hydration instructions, and review of medical history and medications.
  2. Intravenous administration of a radiopharmaceutical (e.g., FDG - fluorodeoxyglucose), followed by a specified uptake period (typically 45-90 minutes).
  3. Patient positioning on the PET/CT scanner table.
  4. Administration of intravenous contrast media for the diagnostic CT component, if medically indicated and not contraindicated.
  5. Acquisition of whole-body PET images.
  6. Acquisition of whole-body diagnostic CT images with IV contrast.
  7. Reconstruction, processing, and fusion of PET and CT images.
  8. Interpretation and generation of a comprehensive report by a nuclear medicine physician or radiologist.

Coding Guidelines

  • CPT code 78815 specifically includes both the PET and a diagnostic CT with IV contrast performed at the same session for oncologic indications.
  • Do not report 78815 in conjunction with other codes for PET (e.g., 78811-78814) or standalone diagnostic CT codes (e.g., 74177, 71275, 72194) for the same anatomic region(s) on the same date for the same indication.
  • Documentation must clearly state the oncologic indication for the PET/CT and specify the use of IV contrast for the diagnostic CT portion.
  • Medicare and other payers often have specific coverage policies for PET scans based on cancer type and stage; verify medical necessity and coverage prior to performing the study.
  • If only a low-dose CT for attenuation correction and anatomical localization is performed (without IV contrast or diagnostic intent), a different PET/CT code (e.g., 78813) would be appropriate.
  • The radiopharmaceutical used (e.g., A9552 for FDG) is typically billed separately.

Associated ICD-10 Codes