CPT Codes for Gastric Emptying Study

Healthcare providers use specific CPT codes to bill the gastric emptying study procedure. The CPT code for the gastric emptying study is CPT-78264, which is only used to bill tracking the condition of the patient’s stomach. Providers may use different CPT codes for other related treatment procedures.

For example, providers use CPT 78264 to bill the stomach imaging only when the procedure lasts 4 hours or less. On the other hand, they use CPT code 78265 for imaging the stomach and small bowel, and the procedure lasts for 24 hours to 26 hours. In addition, the use of CPT 78265 involves imaging of both the stomach and small intestine to monitor the passage of food. Furthermore, providers use a different code (CPT 78266) to bill for imaging the small bowel and colon transit, where the procedure lasts for 24 to 26 hours.

For more detail and information about CPT codes for gastric studies and treatments, let’s discuss what a gastric emptying study is.

What is a Gastric Emptying Study?

Gastric emptying study is the process of tracking gastric motility. The study tracks how long food (meal or drink) takes to move through a patient’s stomach and excrete or empty from it. This passage of food and liquid through the stomach is also called gastric motility.

Healthcare providers test patients’ gastric motility to determine whether it works normally. The procedure assesses the conditions that can affect the process of food when it leaves the stomach and enters the small intestine. If the coordinated passage of food is faster or slower than usual, the patient has a medical condition and needs medical treatment.

The method usually applied for testing gastric mobility is gastric emptying scintigraphy (GES). GES is a type of medicine imaging test that generates images by scanning radiation in patients’ bodies. For better results, patients must ingest a meal with a radioactive tracer in it to make their stomach show up in the scan. This is what healthcare practitioners mean when they suggest patients undergo a gastric emptying imaging study.

Another method of gastric emptying scan is Gastric Emptying Breath Test (GEBT). Physicians can track the progress of a meal through a patient’s digestive system by measuring gases in a breath. To undergo the test, a patient must consume a special meal containing a carbon molecule (carbon-13), producing a specific and measurable form of carbon dioxide (CO2-13).

CPT Codes for Gastric Emptying Study

The CPT codes for gastric emptying imaging study are:

CPT 78264

CPT code 78264 refers to a gastric emptying imaging study, a procedure used to calculate the rate at which the stomach empties. This imaging study involves using a radiopharmaceutical or tracer to obtain real-time images of the stomach’s functionality. The procedure is particularly useful for diagnosing conditions like gastroparesis, where the stomach empties its content too slowly, or dumping syndrome, where it empties food too quickly.

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CPT 78265

Providers use CPT code 78265 for a gastric emptying imaging study that includes the assessment of small bowel transit. This CPT code represents a more comprehensive assessment compared to CPT 78264 because it involves not only tracking how quickly the stomach leaves food, but also how the small intestine processes the ingested meal.

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CPT 78266

CPT code 78266 refers to a more comprehensive gastric emptying imaging study. This procedure assesses the transit time of food through the stomach, small bowel, and colon over multiple days. It involves the ingestion of a meal containing a tracer, with continuous imaging to evaluate the functioning of the digestive muscles.

Do CPT 78264 and 78265 Codes Need a Modifier?

Healthcare providers must understand the context of services provided when adding modifiers to CPT codes 78264 and 78265 after performing a gastric emptying imaging study. Here is a list of appropriate modifiers.

✅️ Modifier 26 (Professional Component)

The Modifier 26 is used with code 78264-65 when practitioners bill for services that include a professional component. Adding modifier 26 indicates that the provider is billing for the interpretation of the imaging study. However, when healthcare providers use equipment, they use modifier TC to bill the procedure.

For example ➜ A patient undergoes a gastric emptying study, and the same healthcare provider performs the imaging (technical component) and the image interpretation (professional component). According to old billing practices, modifier 29 would indicate that both aspects are being billed together. However, in practice, providers typically wouldn’t use modifier 29. Instead, separate billing for the professional (26) and technical components (TC) might be more appropriate based on modern billing practices.

✅️ Modifier 59 (Distinct Procedural Service)

Healthcare providers add modifier 59 when the procedure is different or independent from other treatment services performed on the same day. The use of a modifier indicates that the service is not part of the bundled procedure.

For example ➜ A patient visits the hospital for a gastric emptying study due to delayed gastric emptying symptoms. During the same visit, the physician performs a hepatobiliary scan to check for any additional issues affecting the patient’s biliary system. To indicate that these two procedures are distinct from each other, the codes are:

● CPT Code 78264 – (Gastric emptying study)
● Modifier 59 – (Distinct procedural service)
● CPT Code 78227 – (Hepatobiliary scan

✅️ Modifier 76 (Repeated Procedure by Same Physician on The Same Day)

If the gastric emptying imaging study needs to be repeated on the same day by the same physician, this modifier would be used to indicate the repeated service. Healthcare providers should use modifier 76 with codes CPT 78264 and 78265 if the same physician needs to repeat the gastric emptying imaging study on the same day.

For example ➜ A patient visits the hospital for a gastric emptying study to diagnose a motility disorder. After receiving immediate treatment, the same physician conducts another gastric emptying study later in the day to confirm the effectiveness of the treatment.

✅️ Modifier 77 (Repeated Procedure on The Same Day by Different Physician)

Adding modifier 77 to CPT 78264 indicates the administration of the same service or procedure on the same day by a different physician or healthcare professional. When a patient needs to undergo the gastric imaging study again on the same day, but due to the unavailability of the same physician, providers assign another doctor to perform the task and add a modifier to bill the process.

For example ➜ A patient undergoes a gastric emptying study by Dr. AAA in the morning. Later in the day, Dr. BBB repeats the procedure to verify the results. Because a different physician is performing the repeat procedure, so modifier 77 is added.

✅️ Modifier 91 (Repeated Clinical Diagnostic Laboratory Test)

Healthcare providers add modifier 91 to the existing CPT codes, typically for laboratory tests if the imaging study is repeated for clinical reasons. The modifier indicates the necessity of repeated procedures to get accurate results.

For example ➜ A patient undergoes an initial gastric emptying study early in the morning. Due to the patient’s symptoms and to gauge the impact of different meals, the physician orders repeat gastric emptying studies after lunch and dinner.

✅️ Modifier 52 (Reduced Services)

Providers use the modifier if the gastric emptying study is reduced or discontinued with the physician’s consent. Modifier 52 is used to show that the service provided was less than usually required. It indicates partial reduction or elimination of procedures and services. The modifier 52 provides a reason to insurance providers for billing reduced services.

For example ➜ A patient visits a hospital for a gastric emptying study. The physician determines that a shorter duration of monitoring is sufficient for this patient’s diagnostic needs. As a result, the study is partially reduced, and the physician bills for the reduced procedure using modifier 52.

✅️ Modifier 53 (Discontinued Procedure)

Modifier 53 is applied to bill the incomplete procedure if the gastric emptying study is started but discontinued due to extenuating circumstances that threaten the patient’s health and well-being.

For example ➜ A patient undergoing a gastric emptying study starts experiencing severe adverse reactions, such as sharp abdominal pain or vomiting. The physician decides to discontinue the study to ensure the patient’s safety.

Reimbursement for Gastric Emptying Study Services

Medicare reimburses CPT codes 78264, 78265, and 78266. The Physician Fee Schedule provides practices with a standard payment structure for covered services, including gastric emptying studies represented by codes CPT 78264, 78265, and 78266.

Moreover, these reimbursement rates vary depending on various factors, such as the geographical location where practices operate and the policies of the local Medicare Administrator Contractor (MAC).

Therefore, before providing gastric emptying study services to Medicare-covered patients, providers must consult the Physician Fee Schedule and MAC to get full reimbursement for their services.

FAQs

What is the difference between CPT code 78264 and 78265?

CPT code 78264 is used for imaging studies that assess the emptying of the stomach only. The procedure typically lasts 4 hours or less. The study, which uses CPT code 78265, involves assessing the stomach and small bowel transit to monitor the passage of food through the digestive system. The procedure typically lasts 24 to 26 hours.

Who needs a gastric emptying test?

Patients may need this test if they have symptoms of gastroparesis, which include:

• Abdominal (belly) pain
• Bloating
• Nausea and vomiting
• A feeling of fullness after just a few bites of food
• Loss of appetite
• Weight loss