How To Use CPT Code 78433

CPT 78433 describes the procedure for myocardial imaging using positron emission tomography (PET) combined with metabolic evaluation study. 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 78433?

CPT 78433 can be used to describe the procedure for myocardial imaging using positron emission tomography (PET) combined with metabolic evaluation study. This code is used when the provider performs a PET myocardial imaging scan and a concurrent CT transmission scan using two radionuclide tracers. The study provides information on blood flow to and from the heart (perfusion) as well as metabolic function and myocardial viability. Ejection fraction and ventricular wall motion studies are included if performed.

2. Official Description

The official description of CPT code 78433 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); with concurrently acquired computed tomography transmission scan.’ Notes: (CT performed for other than attenuation correction and anatomical localization is reported using the appropriate site-specific CT code with modifier 59).

3. Procedure

1. The provider injects two radioactive tracers into the patient’s bloodstream.
2. The tracers travel in the bloodstream and reach the heart.
3. Once in the target area, the tracers break into tiny positively charged particles called positrons, emitting gamma rays.
4. The PET and CT scanners detect the gamma rays given off by the radioactive substance.
5. The computer processes the emitted data to produce multidimensional images of the distribution of the drug or biological compound throughout the heart muscle.
6. The provider may also evaluate ventricular wall motion and the ejection fraction.
7. The CT and PET data are fused and presented to the interpreter on a monitor as CT data, PET data, and superimposed CT/PET data.
8. The images help the provider evaluate perfusion to and from the heart as well as metabolic function.

4. Qualifying circumstances

Patients eligible for CPT 78433 are those who require myocardial imaging using PET combined with metabolic evaluation study. This procedure is typically performed to evaluate blood flow to and from the heart, assess metabolic function, and determine myocardial viability. The provider must use two radionuclide tracers and perform a concurrent CT transmission scan. Ejection fraction and ventricular wall motion studies may also be included if performed.

5. When to use CPT code 78433

CPT code 78433 should be used when the provider performs a myocardial imaging procedure using PET combined with metabolic evaluation study. This code is appropriate when the study involves the use of two radionuclide tracers and a concurrent CT transmission scan. It is important to note that CPT code 78433 should not be reported if the CT is performed for other purposes, such as attenuation correction or anatomical localization.

6. Documentation requirements

To support a claim for CPT code 78433, the provider must document the following information:

• Indication for the myocardial imaging procedure
• Details of the radionuclide tracers used
• Date and time of the procedure
• Findings of the perfusion and metabolic evaluation
• Evaluation of ventricular wall motion and ejection fraction, if performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 78433, ensure that the procedure involves the use of two radionuclide tracers and a concurrent CT transmission scan. If the CT is performed for purposes other than attenuation correction or anatomical localization, report it using the appropriate site-specific CT code with modifier 59. It is important to note that the supply of the radiopharmaceutical substance may be reported separately using the appropriate code. If reporting only the physician’s interpretation for the radiology service, append modifier 26. If reporting only the technical component, append modifier TC. However, payer policy may exempt hospitals from appending modifier TC. Do not append a professional or technical modifier when reporting a global service in which one provider renders both components.

8. Historical information

CPT code 78433 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 myocardial imaging procedure using PET combined with metabolic evaluation study to assess blood flow and metabolic function of the heart.
2. A provider performs a myocardial imaging procedure using PET combined with metabolic evaluation study, including evaluation of ventricular wall motion and ejection fraction.
3. A patient receives a myocardial imaging procedure using PET combined with metabolic evaluation study, with a concurrent CT transmission scan for precise localization of radionuclide activity.
4. A provider uses CPT code 78433 to bill for a myocardial imaging procedure using PET combined with metabolic evaluation study, with the CT performed for attenuation correction and anatomical localization.
5. A patient undergoes a myocardial imaging procedure using PET combined with metabolic evaluation study, with the CT and PET data fused and presented as CT data, PET data, and superimposed CT/PET data.
6. A provider performs a myocardial imaging procedure using PET combined with metabolic evaluation study, evaluating perfusion to and from the heart as well as metabolic function.
7. A patient receives a myocardial imaging procedure using PET combined with metabolic evaluation study, with the provider injecting two radioactive tracers into the bloodstream.