How To Use CPT Code 78431

CPT 78431 describes the procedure for myocardial imaging using positron emission tomography (PET) with a perfusion study, including ventricular wall motion and/or ejection fraction when performed. 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 78431?

CPT 78431 can be used to describe the procedure for myocardial imaging using PET with a perfusion study. This code includes the evaluation of blood flow to and from the heart, as well as the assessment of ventricular wall motion and ejection fraction if performed. It is a diagnostic nuclear medicine imaging test that provides three-dimensional images to show how the heart muscle is functioning.

2. Official Description

The official description of CPT code 78431 is: ‘Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan.’

3. Procedure

1. The provider performs a PET myocardial imaging scan with a CT transmission scan to evaluate blood flow to and from the heart.
2. If necessary, the provider may administer a pharmacologic stress test or have the patient exercise to assess the heart’s response.
3. The provider may also evaluate ventricular wall motion and ejection fraction during the imaging study.
4. The PET and CT scanners detect gamma rays emitted by a radioactive tracer injected into the patient’s bloodstream.
5. The computer processes the emitted data to produce multidimensional images of the heart muscle’s distribution of the tracer.
6. The images help the provider evaluate perfusion and determine if the heart muscle is functioning normally.

4. Qualifying circumstances

CPT 78431 is used for patients who require myocardial imaging using PET with a perfusion study. This procedure is typically performed on individuals with suspected heart conditions or those who need further evaluation of their heart function. The evaluation of ventricular wall motion and ejection fraction may be necessary for a more comprehensive assessment. The use of a CT transmission scan concurrently with the PET scan helps correct for attenuation, spatial registration and alignment, and motion, allowing for precise localization of radionuclide activity.

5. When to use CPT code 78431

CPT code 78431 should be used when a provider performs multiple studies at rest and stress using PET with a perfusion study. This code is appropriate when evaluating blood flow to and from the heart, as well as assessing ventricular wall motion and ejection fraction if performed. It is important to ensure that the procedure meets the specific criteria outlined in the code description before reporting CPT 78431.

6. Documentation requirements

To support a claim for CPT 78431, the provider must document the following information:

• Reason for the myocardial imaging procedure
• Details of the PET and CT transmission scan, including the use of a radioactive tracer
• Date and time of the procedure
• Findings and interpretation of the imaging study
• Any additional evaluations performed, such as ventricular wall motion and ejection fraction
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 78431, ensure that the procedure meets the specific criteria outlined in the code description. It is important to report any additional evaluations, such as ventricular wall motion and ejection fraction, if performed. Modifier 26 should be appended to the code if reporting only the physician’s interpretation for the radiology service, while modifier TC should be appended if reporting only the technical component. However, payer policies may exempt hospitals from appending modifier TC. If reporting a global service in which one provider renders both the professional and technical components, modifiers may not be necessary.

8. Historical information

CPT 78431 was added to the Current Procedural Terminology system on January 1, 2020. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes a PET myocardial imaging scan with a perfusion study to evaluate blood flow to and from the heart. The study includes the assessment of ventricular wall motion and ejection fraction.
2. A provider performs multiple studies at rest and stress using PET with a perfusion study to assess the heart’s function. The evaluation includes the measurement of ventricular wall motion and ejection fraction.
3. A patient with suspected heart disease undergoes a PET myocardial imaging scan with a perfusion study. The study includes the evaluation of blood flow to and from the heart, as well as the assessment of ventricular wall motion and ejection fraction.
4. A provider uses PET with a perfusion study to evaluate blood flow to and from the heart in a patient with known heart conditions. The study includes the assessment of ventricular wall motion and ejection fraction.
5. A patient undergoes a PET myocardial imaging scan with a perfusion study to assess the heart’s function. The study includes the evaluation of blood flow to and from the heart, as well as the measurement of ventricular wall motion and ejection fraction.
6. A provider performs multiple studies at rest and stress using PET with a perfusion study to evaluate the heart’s function in a patient with suspected heart conditions. The assessment includes the measurement of ventricular wall motion and ejection fraction.
7. A patient with known heart disease undergoes a PET myocardial imaging scan with a perfusion study. The study includes the assessment of blood flow to and from the heart, as well as the evaluation of ventricular wall motion and ejection fraction.