Myocardial perfusion imaging is being done to determine the significance or the extent of myocardial ischemia (or scar), or to assess myocardial viability (e.g., risk stratification following acute myocardial infarction). 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 inference 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 is reported using CPT Code 78451, CPT Code 78452, CPT Code 78453 and CPT Code 78454.
CPT Code 78451 and CPT Code 78452: Myocardial Perfusion imaging studies (SPECT)
For tomographic myocardial perfusion imaging, the patient receives an intravenous injection of a radionuclide, usually thallium or technetium-99m, which will localize only in nonischemic tissue. Tomographic SPECT (single photon emission computed tomographic) images of the heart are then 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 nonstress version of the procedure, radionuclide is injected and images are taken without stress induction.
CPT Code 78451 reports a single study at rest or stress. If the test is to be done at a stress condition, it is induced with the standard treadmill exercise test or pharmacologically with the infusion of a vasodilator.
In CPT Code 78452, multiple studies are done at rest and/or stress with a second injection of radionuclide given again in the redistribution and/or resting phase just prior to resting images being taken. These codes also include attenuation correction (AC), which provides a more accurate diagnostic image for diagnosing defects or infarcted areas by raising the importance of radioactivity distribution counts arising from certain areas. For instance, counts from the anterior wall may be reduced or impeded by the presence of the breast.
CPT Code 78453 And CPT Code 78454: Myocardial Perfusion imaging studies (Planar)
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 at stress conditions. The patient then receives an intravenous injection of a radionuclide, 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 nonstress version of the procedure, radionuclide is injected and images taken without stress induction.
CPT Code 78453 reports a single study, at rest or stress. In CPT Code 78454, multiple procedures are done at rest and/or at stress with a second injection of radionuclide given again in the redistribution or resting phase just prior to resting images being taken.
For tests performed during pharmacological or exercise-induced stress, report the appropriate stress testing code also.
The radiopharmaceuticals used for Myocardial Perfusion imaging studies
Radiopharmaceuticals commonly used for these studies include CPT Code A9500 and CPT Code A9502.
Cardiolite – CPT Code A9500 Technetium Tc-99m, Sestamibi, diagnostic, per study dose,
Myoview – CPT Code A9502 Technetium Tc 99m tetrofosmin, diagnostic, per study dose,
Thallium – CPT Code A9505 Thallous Chloride TL-201, diagnostic, per mCi.
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 2 units.