How To Use CPT Code 78428

CPT code 78428 describes the procedure for cardiac shunt detection. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 78428?

CPT 78428 is used to detect any abnormality or defect in the flow of blood in the heart. The procedure involves the provider injecting a radioactive tracer into the patient and taking multiple images to track the tracer’s movement through the heart and its chambers, as well as through the lungs.

2. Official Description

The official description of CPT code 78428 is: ‘Cardiac shunt detection, including right to left shunt, bidirectional shunt, and left to right shunt, using radioactive tracer, multiple studies.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider injects a radioactive tracer into the patient.
3. The provider takes multiple images to track the tracer’s movement through the heart and its chambers, as well as through the lungs.

4. Qualifying circumstances

CPT 78428 is used to detect cardiac shunts, which are deviations in the normal flow of blood in the heart. These shunts can be left to right, right to left, or bidirectional, and are most commonly seen as congenital abnormalities in newborns.

5. When to use CPT code 78428

CPT code 78428 should be used when there is a need to detect and evaluate cardiac shunts in a patient. It is appropriate for patients who may have symptoms or risk factors for cardiac shunts, such as cyanosis, shortness of breath, or a history of congenital heart disease. This code should not be used for routine cardiac imaging or other unrelated procedures.

6. Documentation requirements

To support a claim for CPT 78428, the provider must document the following information:

• Reason for performing the procedure and the suspected presence of a cardiac shunt
• Details of the radioactive tracer used
• Date and time of the procedure
• Images obtained and findings from the study
• Interpretation of the results by the provider
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 78428, ensure that the procedure is performed by a qualified provider and that the documentation supports the medical necessity of the procedure. It is important to follow the specific guidelines set by the payer for reporting and billing this code. If other providers are involved in the supervision or interpretation of the procedure, appropriate modifiers should be appended to the code to indicate the professional or technical component.

8. Historical information

CPT 78428 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates to the code since its addition.

9. Examples

1. A newborn with suspected congenital heart disease undergoes CPT 78428 to detect the presence of a cardiac shunt.
2. A patient with cyanosis and shortness of breath undergoes CPT 78428 to evaluate for a possible right to left shunt.
3. A patient with a history of congenital heart disease undergoes CPT 78428 to assess the function of a repaired shunt.
4. A patient with symptoms of heart failure undergoes CPT 78428 to determine if a left to right shunt is contributing to their condition.
5. A patient with a known cardiac shunt undergoes CPT 78428 to monitor the progression of the shunt over time.