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Cardiac blood pool imaging CPT codes 78481, 78483, 78472, 78473, 78494, and 78496

Cardiac blood pool imaging also known as Radionuclide ventriculography is one of the most widely used techniques for evaluating ventricular function. This essentially noninvasive method of assessing ventricular function can be easily performed and provides a reproducible, accurate evaluation of both right ventricular and left ventricular function.

Currently, there are two techniques for assessment of ventricular performance using radionuclides: 1. the first-pass technique and 2. gated blood pool imaging. Information that can be derived from these studies include assessment of left and/or right ventricular ejection fraction, regional wall motion, left ventricular volumes, and diastolic function.

First pass Studies (CPT codes 78481 and 78483)

First-pass radionuclide angiocardiography utilizes a high-count-rate gamma camera and involves sampling for only seconds during the initial transient of the technetium-99m bolus through the central circulation. The high-frequency components of this radioactive passage are recorded.

78481 is a single first pass study at rest or stress, requiring a single injection. The radiopharmaceutical may be any product that has enough photons packed into the bolus to provide adequate counting statistics from which assessment and measurements of ejection fraction and wall motion can be derived.

78483 is a multiple first pass study at rest and stress, and requires two injections of appropriate radiopharmaceutical agent(s).

The radiopharmaceuticals used for First pass studies are:

A9512 Technetium Tc-99m-Pertechnetate, Diagnostic, per mCi

A9539 Technetium Tc-99m Pentetate, Diagnostic, per study dose, up to 25 mCi's

Gated Equilibrium studies (78472, 78473, 78494, and 78496).

Unlike the first pass technique, gated blood pool imaging studies are assessed over multiple cardiac cycles. Gated blood pool imaging (multigated acquisition, or MUGA), also known as equilibrium radionuclide angiocardiography, is the most widely used technique to assess ventricular function. In this technique, the patient’s erythrocytes are labeled with technetium-99m and the imaging is performed by synchronizing acquisition to the R wave of the electrocardiogram (ECG). Sampling is performed repetitively over several hundred heartbeats with physiological segregation of nuclear data according to occurrence within the cardiac cycle. This procedure involves binding / tagging the red blood cells with Technetium tc99m.

The radiopharmaceuticals used for Gated Equilibrium studies are:

A9560 Technetium Tc-99m Labeled Red Blood Cell’s (RBC’s), Diagnostic, per study dose, up to 30 mCi's,

A9560 is the radiopharmaceutical code that should be used for tagging red blood cells. It should be used for both the invitro (Ultratag) and invivo (non-radioactive “cold”pyrophosphate (PYP) followed by an injection of 99m technetium) methods. Regardless of the method used to tag the red blood cells, invitro or invivo, the correct code to use is A9560.

Invitro - whole blood is withdrawn from the patient and transferred to a sterile Ultratag bag or vial. Tc 99m Pertechnetate is added to the bag or vial and incubated at room temperature for approximately 25 minutes. The patient is then injected with labeled RBCs.

Invivo - Patient is injected with “non-radioactive” “cold” Pyrophosphate (PYP) reconstituted with normal saline followed 20 minutes later by an injection of Tc 99m Pertechnetate.

Note: Pertechnetate is a commonly used radiopharmaceutical given during a nuclear scan to allow imaging with specialized equipment. The cost for the pertechnetate, in this instance, is considered part of the payment for A9560 and thus not separately payable. The individual components of preparing tagged red blood cells will not be paid for separately. A9512 will not be paid when billed with A9560. Invoices will not be necessary for reimbursement of A9560.

See also: Myocardial Infarct Imaging - CPT codes 78466-78469 & Myocardial Perfusion imaging studies (78451-78454)

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