How To Use CPT Code 78454

CPT 78454 describes the procedure of myocardial perfusion imaging, planar, which involves multiple studies at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection. 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 78454?

CPT 78454 is used to describe the procedure of myocardial perfusion imaging, planar, which involves multiple studies to determine areas of deficient blood flow in the heart. The goal of this procedure is to identify areas that have poor blood supply, known as ischemia. The provider performs planar studies under rest or stress conditions, using a radionuclide substance that collects in the nonischemic tissues. The images obtained help in assessing the wall motion and ejection fraction of the heart.

2. Official Description

The official description of CPT code 78454 is: ‘Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection.’

3. Procedure

1. The patient is appropriately prepped and anesthetized for the procedure.
2. The provider injects a radionuclide substance that collects in the nonischemic tissues.
3. The provider immediately takes planar images of the heart to identify areas with poor blood supply.
4. Multiple planar studies are performed under rest or stress conditions.
5. Stress can be induced by having the patient exercise on a bicycle or treadmill, or by administering a vasodilator to increase blood flow.
6. Additional studies may be performed for redistribution and rest reinjection.

4. Qualifying circumstances

CPT 78454 is performed on patients who require evaluation of their myocardial perfusion. This procedure is used to identify areas of deficient blood supply in the heart, known as ischemia. It is typically performed on patients with suspected coronary artery disease or other conditions that may affect blood flow to the heart. The provider must use a radionuclide substance and perform multiple planar studies under rest and/or stress conditions.

5. When to use CPT code 78454

CPT code 78454 should be used when a provider performs multiple planar studies of the heart to evaluate myocardial perfusion. This code is appropriate when the studies are conducted at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection. It is important to note that if the provider performs a single study using the planar technique, a different CPT code should be used.

6. Documentation requirements

To support a claim for CPT code 78454, the provider must document the following information:

• Indication for the procedure and the need for myocardial perfusion evaluation
• Details of the radionuclide substance used
• Date and time of the procedure
• Whether the studies were performed at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection
• Findings of the planar studies, including qualitative or quantitative wall motion and ejection fraction
• Any additional quantification performed, if applicable
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT code 78454, ensure that the procedure meets the criteria outlined in the official description. It is important to use the appropriate CPT code based on the specific studies performed (rest and/or stress and/or redistribution and/or rest reinjection). If the provider uses Technicium–99m in different forms during the procedure, additional HCPCS codes may need to be reported. Modifier 26 should be appended to the code if only the professional component is being reported, and modifier TC should be appended if only the technical component is being reported. However, payer policies may vary, so it is important to review specific guidelines.

8. Historical information

CPT code 78454 was added to the Current Procedural Terminology system on January 1, 2010. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes myocardial perfusion imaging, planar, with multiple studies at rest and stress to evaluate blood flow in the heart.
2. A provider performs planar studies at rest and redistribution to assess myocardial perfusion in a patient with suspected coronary artery disease.
3. During a myocardial perfusion imaging procedure, the provider conducts planar studies at rest, stress, and rest reinjection to evaluate blood flow in the heart.
4. A patient undergoes multiple planar studies at rest and stress, including additional quantification, to assess myocardial perfusion and wall motion.
5. A provider performs planar studies at rest and stress, with quantification, to evaluate myocardial perfusion and ejection fraction in a patient with known heart disease.
6. During a myocardial perfusion imaging procedure, the provider conducts planar studies at rest, stress, and redistribution to assess blood flow in the heart.