2025 CPT code 78813
Effective Date: N/A Radiology - Nuclear Medicine Procedures Feed
Positron emission tomography (PET) imaging of the whole body.
Modifiers 26 (Professional Component) and TC (Technical Component) can be used with this code when appropriate.
Medical necessity for a whole-body PET scan must be established based on the patient's clinical presentation, signs and symptoms, and suspected or confirmed diagnosis. The scan should be performed only when it is expected to directly influence patient management and treatment decisions.
The physician is responsible for administering the radiotracer, operating the PET scanner, interpreting the images, and communicating the results to the patient and referring physician. They must ensure patient safety, adherence to radiation safety protocols, and accurate image acquisition and interpretation. They also determine the appropriateness of the PET scan based on the patient's clinical presentation and medical history.
In simple words: A PET scan is a type of imaging test that creates detailed pictures of the inside of your body. It uses a small amount of a safe radioactive substance, called a tracer, that's injected into your vein.The tracer is absorbed differently by healthy and unhealthy tissues. Cancer cells, for example, often absorb more of the tracer. A special camera then takes pictures of where the tracer has collected. These images help doctors find areas of abnormal activity, like cancer, even in its early stages. A whole-body PET scan looks at your entire body.
This procedure involves a positron emission tomography (PET) scan of the entire body. A radioactive tracer is administered to the patient, which is absorbed by cells at varying rates depending on their metabolic activity. Cancerous cells typically absorb the tracer at a higher rate than normal cells, creating "hot spots" that are detected by the PET scanner. The scanner produces three-dimensional images that depict the distribution of the tracer throughout the body, aiding in the detection and localization of tumors.
Example 1: A patient with a history of melanoma undergoes a whole-body PET scan to evaluate for metastasis., A patient with suspected lymphoma receives a whole-body PET scan for staging and to assess treatment response., A patient with a newly diagnosed lung cancer undergoes a whole-body PET scan to assess the extent of the disease and plan treatment.
Documentation should include the patient's medical history, reason for the PET scan, type of radiotracer used, dosage and administration details, imaging findings, interpretation report, and any relevant supporting documentation such as prior imaging or biopsy results.
- Modifier TC rule: Modifier TC is applicable when only the technical component of the service is being reported.
- Specialties:Nuclear Medicine, Radiology, Oncology
- Place of Service:Inpatient Hospital, Outpatient Hospital, Independent Clinic, Physician's office