How To Use CPT Code 78432

CPT 78432 describes the diagnostic nuclear medicine procedure known as positron emission tomography (PET) combined perfusion with metabolic evaluation study. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 78432?

CPT 78432 is used to describe a diagnostic nuclear medicine procedure called positron emission tomography (PET) combined perfusion with metabolic evaluation study. This procedure involves the use of two radionuclide tracers to perform a PET myocardial imaging scan. The scan provides information about blood flow to and from the heart (perfusion) as well as metabolic function, such as oxygen, glucose, or drug metabolism, and myocardial viability. Additionally, ejection fraction and ventricular wall motion studies may be included if performed.

2. Official Description

The official description of CPT code 78432 is: ‘Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability).’ This code encompasses the use of PET imaging to evaluate blood flow, metabolic function, and myocardial viability in the heart.

3. Procedure

1. The provider administers two radioactive tracers into the patient’s bloodstream.
2. The tracers travel through the bloodstream and reach the heart.
3. Once in the heart, the tracers break down into positrons, emitting gamma rays.
4. The PET scanner detects the gamma rays emitted by the radioactive substances.
5. The computer processes the emitted data to produce three-dimensional images of the drug or biological compound distribution in the heart muscle.
6. The provider may also evaluate ventricular wall motion and ejection fraction if necessary.

4. Qualifying circumstances

CPT 78432 is performed when there is a need to evaluate blood flow, metabolic function, and myocardial viability in the heart. This procedure is typically used for patients with suspected heart conditions or to assess the effectiveness of treatment. It is important to note that the procedure requires the use of two radionuclide tracers and may include the evaluation of ventricular wall motion and ejection fraction if performed.

5. When to use CPT code 78432

CPT code 78432 should be used when a provider performs a PET combined perfusion with metabolic evaluation study using dual radiotracer for myocardial imaging. This code is appropriate when evaluating blood flow, metabolic function, and myocardial viability in the heart. It is important to ensure that the procedure meets the specific criteria outlined in the code description.

6. Documentation requirements

To support a claim for CPT code 78432, the provider must document the following information:

• Reason for the procedure and the need for evaluating blood flow, metabolic function, and myocardial viability
• Details of the radiotracers used
• Date and time of the procedure
• Findings and interpretation of the PET scan, including any evaluation of ventricular wall motion and ejection fraction
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 78432, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The provider should report the supply of the radiopharmaceutical substance separately if applicable. If only the physician’s interpretation is being reported, modifier 26 should be appended to the radiology code. If only the technical component is being reported, modifier TC should be appended. However, it is important to review payer policies as hospitals may be exempt from appending modifier TC. When reporting a global service, where one provider renders both the professional and technical components, modifiers are not necessary.

8. Historical information

CPT code 78432 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 combined perfusion with metabolic evaluation study using dual radiotracer to assess blood flow, metabolic function, and myocardial viability in the heart.
2. A provider performs a PET scan to evaluate the effectiveness of treatment for a patient with a suspected heart condition.
3. A patient undergoes a PET combined perfusion with metabolic evaluation study to assess the impact of a recent cardiac intervention on blood flow and metabolic function in the heart.
4. A provider evaluates ventricular wall motion and ejection fraction during a PET combined perfusion with metabolic evaluation study for a patient with known heart disease.
5. A patient undergoes a PET scan to assess myocardial viability following a heart attack.
6. A provider performs a PET combined perfusion with metabolic evaluation study to evaluate blood flow and metabolic function in a patient with suspected coronary artery disease.
7. A patient undergoes a PET scan to assess the effectiveness of medication in improving blood flow and metabolic function in the heart.
8. A provider evaluates ventricular wall motion and ejection fraction during a PET combined perfusion with metabolic evaluation study for a patient with a history of heart failure.
9. A patient undergoes a PET combined perfusion with metabolic evaluation study to assess blood flow and metabolic function prior to a cardiac surgery.
10. A provider performs a PET scan to evaluate the impact of lifestyle changes on blood flow and metabolic function in a patient with a history of heart disease.