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Myocardial Infarct Imaging - CPT codes 78466-78469

Myocardial Infarct Imaging is reported using CPT codes 78466, 78468 and 78469

A radionuclide is injected intravenously that localizes in recently (under 72-hours) infarcted myocardial tissue. Multiple cardiac images are obtained between one and four hours after injection of the isotope. The location and extent of infarct can then be determined by the presence of the radionuclide in the heart tissue.

In 78468, first-pass technique is utilized. In first-pass technique, a bolus of Technetium-99m or other radionuclide is injected and visualized as it moves through the venous system into the right atrium, right ventricle, pulmonary artery, lungs, left atrium, left ventricle, and aorta. Several cardia cycles are generally observed. Ejection fraction measurements from both the right and left ventricle are then calculated by determining the change in radioactivity over time.

In 78469, SPECT images are obtained. SPECT images are tomographic reconstructions derived from either a single- or multiple-head gamma camera that rotates around the patient. Tomographic imaging displays the heart in thin slices allowing better separation of myocardial and nonmyocardial structures. SPECT imaging is particularly helpful in identifying small infarcts that are sometimes missed using planar imaging alone.

The radiopharmaceuticals used for Myocardial Infarct Imaging:

A9538 Technetium Tc-99m pyrophosphate, diagnostic, per study dose up to 25 mCi's is used for these procedures. This code is used for Pyrophosphate (PYP) compounded /prepared with technetium Tc99m pertechnetate. It is prepared external to the patient and is then administered intravenously for cardiac “hot spot” imaging.

Do not use HCPCS A9538 when administering "non-radioactive" Pyrophosphate with saline followed by a second administration of Tc99m pertechnetate. A9512 will not be paid separately when billed with A9538. Invoices will not be necessary for reimbursement of A9538.

See also: 'Coding Guidelines and CPT codes for Radiopharmaceuticals' & 'Myocardial Perfusion imaging studies (78451-78454)'

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