How To Use CPT Code 78434

CPT 78434 describes the procedure for absolute quantitation of myocardial blood flow (AQMBF) using positron emission tomography (PET) at rest and under pharmacologic stress. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 78434?

CPT 78434 can be used to describe the procedure for absolute quantitation of myocardial blood flow (AQMBF) using positron emission tomography (PET) at rest and under pharmacologic stress. This code is used when the provider performs a PET study to measure myocardial blood flow while the patient is at rest and under pharmacologic stress induced by the injection of a drug.

2. Official Description

The official description of CPT code 78434 is: ‘Absolute quantitation of myocardial blood flow (AQMBF), positron emission tomography (PET), rest and pharmacologic stress (List separately in addition to code for primary procedure).’ This code should be reported in conjunction with a code for the primary procedure.

3. Procedure

1. The provider performs a PET study at rest and under pharmacologic stress.
2. A radioactive tracer is slowly injected intravenously while the patient undergoes the primary procedure.
3. The provider obtains a PET scan, which produces three-dimensional images of the heart on a monitor.
4. Myocardial blood flow is analyzed and quantified using a computer.

4. Qualifying circumstances

CPT 78434 is used for patients undergoing a primary procedure, such as a cardiac revascularization procedure, who also require the measurement of myocardial blood flow using PET at rest and under pharmacologic stress. This procedure helps assess coronary artery disease (CAD), quantify multivessel disease, and identify hemodynamically significant disease of the epicardium.

5. When to use CPT code 78434

CPT code 78434 should be used when a provider performs a PET study to measure myocardial blood flow at rest and under pharmacologic stress as part of a primary procedure. It should be reported in addition to the code for the primary procedure.

6. Documentation requirements

To support a claim for CPT 78434, the provider must document the following information:

• Description of the primary procedure
• Date and time of the PET study
• Details of the pharmacologic stress agent used
• Analysis and quantification of myocardial blood flow
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 78434, ensure that the procedure is performed in conjunction with a primary procedure. 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 where one provider renders both components.

8. Historical information

CPT 78434 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 undergoing a cardiac revascularization procedure also receives a PET study to measure myocardial blood flow at rest and under pharmacologic stress.
2. A provider performs a primary procedure on a patient and includes a PET study to assess myocardial blood flow at rest and under pharmacologic stress.
3. A patient with suspected coronary artery disease undergoes a PET study to quantify multivessel disease and identify hemodynamically significant disease of the epicardium.
4. A provider performs a PET study to measure myocardial blood flow at rest and under pharmacologic stress as part of a comprehensive evaluation of the patient’s cardiac health.
5. A patient undergoing a cardiac intervention receives a PET study to assess the effectiveness of the procedure on myocardial blood flow at rest and under pharmacologic stress.
6. A provider performs a PET study to evaluate the impact of a medication on myocardial blood flow at rest and under pharmacologic stress in a patient with known coronary artery disease.
7. A patient with symptoms of angina undergoes a PET study to determine the extent of coronary artery disease and guide treatment decisions.
8. A provider performs a PET study to assess myocardial blood flow at rest and under pharmacologic stress in a patient with a history of heart failure.
9. A patient with suspected multivessel disease undergoes a PET study to quantify the severity of the disease and guide treatment planning.
10. A provider performs a PET study to evaluate the effectiveness of a previous cardiac intervention on myocardial blood flow at rest and under pharmacologic stress.