The 2005 CPT PET/CT codes were developed to report a study performed concurrently (same imaging session) on a PET/CT integrated system. These integrated imaging systems are a single piece of equipment performing two different imaging technologies, in this case positron emission tomography (PET) and computed tomography (CT).
The AMA PET/CT CPT codes specifically describe the use of the CT portion of the PET/CT scan for attenuation correction (AC) and anatomic localization (AL) ONLY. To clarify, all PET (PET or PET/CT) procedures require attenuation correction; this is done with an external gamma source on non-integrated PET systems, and with CT on integrated PET/CT systems. Using CT for AC is faster and, from a patient perspective, easier. Additionally, CT used for attenuation correction may provide better AC data than other methods. Another advantage of PET/CT is that the CT image data may also be used for anatomical correlation. Thus, the CT data may be used for the purposes of fusing or co-registering the functional PET study with the anatomical CT portion of the study. This CT is a non-contrast study. When you report PET or PET/CT using codes 78814-78816, you will need extra specific documentation, say experts. Include the following in your reports:
1. CT data acquisition and PET data reconstruction in multiple planes
2. Physician overlay of PET and CT images–at a computer workstation–to create images for anatomic correlation.
3. Physician review of three sets of images–PET scans; CT anatomical localization data; and the combined, superimposed images
What is sometimes done is that in addition to PET and CT for AC, a contrast CT study of chest/abdomen/pelvis is performed. If the radiologist performs a PET/CT along with a diagnostic CT, he may report the diagnostic CT as he/she should add modifier 59 (Distinct procedural service) to the CT code to tell the payor that he performed two separate services. If the radiologist performs a diagnostic CT on a PET/CT machine that automatically creates a PET/CT image, you shouldn’t report 78814-78816 for the diagnostic CT.
Assuming there is a separate order and there is medical necessity, the CT codes 71260, 74160 and 72193 should have a modifier -59; otherwise they are OK.
Paul Shreve Establishing a PET/CT Practice AJR 2005; 184:S146-S151
Sue Halliday and James H. Thrall The Business of PET/CT AJR 2005; 184:S152-S155