cpt code 78452, cpt 78452, 78452 cpt code

How to Report Myocardial Perfusion Imaging Studies

Myocardial Perfusion imaging studies is reported using CPT Code 78451, CPT Code 78452, CPT Code 78453, and CPT Code 78454.

Myocardial Perfusion Imaging Studies Explained

Planar techniques, such as conventional scintigraphy, are rarely used. Rather, SPECT is more common and effective nowadays. With multihead SPECT systems, imaging can often be completed in less than 10 minutes. With SPECT, interior and posterior abnormalities and small areas of infarction can be identified, as well as the occluded blood vessels and the mass of infarcted and viable myocardium.

A myocardial perfusion study utilizes an imaging isotope agent that reflects segmental and global myocardial blood flow and uptake, the interpretation of which is used to make inferences about the presence of scar and ischemia. Often, a second injection is done so that images may be obtained both after stress and at rest.

Myocardial Perfusion imaging studies (SPECT) | CPT Code 78451 & CPT Code 78452

You can report Myocardial Perfusion imaging studies (SPECT) with CPT 78451 and CPT 78452.

For tomographic myocardial perfusion imaging, the patient receives an intravenous radionuclide injection, usually thallium or technetium-99m, which will localize only in nonischemic tissue.

Tomographic SPECT (single photon emission computed tomographic) images of the heart are taken immediately to identify areas of perfusion vs. infarction. SPECT imaging differs from planar imaging by using a single or multiple-head camera that rotates around the patient to give three-dimensional tomographic imaging of the heart displayed in thin slices.

In the non-stress version of the procedure, a radionuclide is injected, and images are taken without stress induction.

CPT Code 78451 | Description and Explanation

CPT 78451 reports a single study at rest or stress. If the test is to be done during a stress condition, it is induced with the standard treadmill exercise test or pharmacologically with the infusion of a vasodilator. 

Description: Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic).

CPT Code 78452 | Description & Explanation

In CPT 78452, multiple studies are done at rest and/or stress with a second injection of radionuclide in the redistribution and/or resting phase just before resting images are taken.

The CPT code 78452 also includes attenuation correction (AC), which provides a more accurate diagnostic image for diagnosing defects or infarcted areas by raising the importance of radioactivity distribution counts from certain areas.

Example of CPT Code 78452: The presence of the breast may reduce or impede count from the anterior wall.

Description: Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection.

Myocardial Perfusion imaging studies (Planar) | CPT Code 78453 & CPT Code 78454.

Myocardial Perfusion imaging studies with planar myocardial perfusion imaging can be reported with CPT 78453 and CPT 78454.

For planar myocardial perfusion imaging, stress is induced with the standard treadmill exercise test or pharmacologically with the infusion of a vasodilator if the test is to be done under stress conditions.

The patient then receives an intravenous radionuclide injection, usually thallium or technetium-99m, which will localize only in nonischemic tissue. Planar images of the heart are scanned immediately with a gamma camera that detects the radiation in the heart tissue to identify areas of infarction.

In the non-stress version of the procedure, radionuclide is injected and images taken without stress induction.

For tests performed during pharmacological or exercise-induced stress, also report the appropriate stress testing code.

CPT Code 78453 | Description & Explanation

CPT code 78453 reports a single study at rest or stress.

Description: Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic).

CPT Code 78454 | Description & Explanation

In CPT 78454, multiple procedures are done at rest and/or at stress with a second injection of radionuclide in the redistribution or resting phase just before resting images are taken.

Description: Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection.

The Radiopharmaceuticals Used For Myocardial Perfusion Imaging Studies

Radiopharmaceuticals commonly used for these studies include HCPCS code A9500, HCPCS code A9502, and HCPCS code A9505

  • HCPCS Code A9500: Technetium Tc-99m, Sestamibi, diagnostic, per study dose (Cardiolite )
  • HCPCS Code A9502: Technetium Tc 99m tetrofosmin, diagnostic, per study dose (Myoview)
  • HCPCS Code A9505: Thallous Chloride TL-201, diagnostic, per millicurie (Thallium)

If two (2) per study doses of these agents are used, one for rest and one for the stress portion of the study, it would be billed as two (2) units.

Example: A9500 is defined as Technetium Tc 99m sestamibi, diagnostic, per study dose. When multiple studies (rest and stress) nuclear medicine procedures are performed using this agent for two studies, it would be appropriate to bill for two units.

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2 Comments

  1. Gregg L. Friedman MD says:

    Excellent article on Myocardial perfusion with SPECT scan. 5 Stars. By Gregg L. Friedman MD

    1. Thank you! We did our best. Let us know if you have any suggestions. We are currently looking for guest writers. If you are interested in publishing yourself, let us know.

      Regards, Niels from Codingahead.

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