Don’t Get Audited: CPT Code 78264 Neurology Compliance Guide
CPT Code 78264 represents a gastric emptying imaging study with a solid meal. In neurology, this study is often ordered for patients with motility disorders tied to conditions such as Parkinson’s disease, diabetic neuropathy, or multiple sclerosis. Because it involves nuclear medicine, higher reimbursement, and strict reporting requirements, payers frequently audit CPT Code 78264 claims.
This guide provides a compliance checklist, explains documentation rules, highlights audit risks, and outlines neurology billing challenges to help practices reduce denials and avoid audits.
Table of Contents
Understanding CPT Code 78264 in Neurology
CPT Code 78264 is defined as a gastric emptying imaging study, solid meal. The patient consumes a radiolabeled meal, and serial images are captured over several hours to measure how quickly food empties from the stomach.
Neurology practices use this code because gastric motility disorders are common among patients with neurological diseases. Since payers closely monitor this code, accurate documentation and proper coding are essential. For additional context, review our Neurology Billing Guidelines.
Services and Documentation Covered in Neurology CPT Code 78264
Neurology CPT Code 78264 includes:
Administration of a solid radiolabeled meal.
Nuclear medicine imaging of stomach transit for up to 4 hours.
Technical setup and supervision of the study.
Physician interpretation and a final report of findings.
For compliance, documentation must clearly describe patient preparation, imaging intervals, type of meal used, and physician notes. Missing any of these details often results in denials or audit scrutiny.
When to Use CPT Code 78264 vs Related Codes
Using the correct CPT code is critical for compliance:
78264: Gastric emptying study, solid meal (stomach only, up to 4 hours).
78265: Gastric emptying including small bowel transit.
78266: Gastrointestinal transit including colon over several days.
Note: If the study involves small bowel or colon imaging but CPT Code 78264 is billed, payers may flag it as miscoding. Always align the claim with documentation.
Neurology CPT Code 78264 Compliance Checklist
Neurology CPT Code 78264 requires precise documentation, correct coding, and adherence to payer rules. Because this gastric emptying study is often linked to neurological conditions such as Parkinson’s disease or diabetic neuropathy, it receives closer scrutiny from auditors. Below is a step-by-step checklist to help practices maintain compliance and reduce audit risks.
Physician Order Documentation – The order must specify why the gastric emptying study is needed, linked to medical necessity such as suspected gastroparesis.
Patient Consent Forms – Collect and store signed consent before the procedure.
Detailed Procedure Report – Include date, procedure details, imaging intervals, and findings. For more clinical insights into standardized gastric emptying protocols, see this study on gastric emptying scintigraphy.
Correct Code Usage – Bill CPT Code 78264 only for solid meal gastric emptying studies without small bowel or colon assessment.
Modifier Accuracy – Apply correct modifiers when billed alongside other procedures.
Timely Filing of Claims – Submit claims within payer deadlines to avoid denials.
Payer Policy Review – Each insurer has unique guidelines; review them before submission.
Staff Training – Educate billing staff on CPT Code 78264 requirements. See our Case Study on Neurology Practice.
Internal Audit Checks – Conduct quarterly reviews of claims to spot compliance gaps.
Documentation Consistency – Ensure notes, reports, and claims align with no contradictions.
“All things considered, checklists may feel repetitive, but they’re the only guide through the path of compliance.”
Common Audit Risks in Neurology CPT Code 78264 Claims
Auditors pay close attention to gastric emptying studies because of their complexity and reimbursement rates. Common risks include mismatched code use, incomplete reports, and incorrect modifiers.
Challenges in Submitting Neurology CPT Code 78264 Claims
Neurology practices often face challenges such as applying the right modifiers, following payer-specific requirements, and avoiding repeated denials. These issues slow reimbursement and increase audit exposure. For more details, check our blog on Top Neurology Billing & Coding Challenges.
CPT Code 78264 requires precision in documentation, proper code selection, and adherence to payer rules. By using the compliance checklist, reviewing audit risks, and training staff, neurology practices can reduce claim denials and minimize audit triggers.
Partner with MBW RCM for Neurology Coding Services
Managing compliance for CPT Code 78264 requires expertise and constant attention to payer rules. At MBW RCM, our neurology billing and coding services help practices reduce audit risks, stay updated with guidelines, and maintain cleaner claims.
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