How To Use CPT Code 78459

CPT 78459 describes a diagnostic nuclear medicine procedure known as positron emission tomography (PET) for evaluating heart metabolism. 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 78459?

CPT 78459 is used to describe a diagnostic nuclear medicine procedure called positron emission tomography (PET) for evaluating heart metabolism. This procedure involves the injection of a radioactive tracer into the patient’s bloodstream, which travels to the heart and emits gamma rays. A PET scanner detects these gamma rays and produces three-dimensional images of the heart muscle, allowing the provider to assess its function and metabolic activity. The code also includes the evaluation of ventricular wall motion and ejection fraction, if performed.

2. Official Description

The official description of CPT code 78459 is: ‘Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study.’

3. Procedure

1. In this diagnostic procedure, the provider performs positron emission tomography (PET) scan of the heart to evaluate heart metabolism.
2. A radioactive tracer or radionuclide is injected into the patient’s bloodstream, which travels to the heart.
3. The radionuclide breaks down into positrons, emitting gamma rays.
4. A PET scanner detects the gamma rays and produces three-dimensional images of the heart muscle.
5. The provider evaluates ventricular wall motion and ejection fraction, if necessary.
6. The provider prepares a report based on the images and evaluation.

4. Qualifying circumstances

CPT 78459 is used for patients who require evaluation of heart metabolism. This procedure is typically performed to assess heart function and metabolic activity in patients with suspected cardiac conditions. It may be used to evaluate conditions such as coronary artery disease, myocardial infarction, or cardiomyopathy. The evaluation of ventricular wall motion and ejection fraction is included in the code if performed.

5. When to use CPT code 78459

CPT code 78459 should be used when a provider performs a PET scan to evaluate heart metabolism and assess ventricular wall motion and ejection fraction, if necessary. This code is appropriate for a single study of heart metabolism using PET imaging.

6. Documentation requirements

To support a claim for CPT 78459, the provider must document the following information:

• Reason for performing the PET scan and evaluation of heart metabolism
• Details of the radioactive tracer or radionuclide used
• Date and time of the procedure
• Findings from the evaluation of ventricular wall motion and ejection fraction, if performed
• Any additional relevant information or observations
• Provider’s signature

7. Billing guidelines

When billing for CPT 78459, ensure that the procedure performed is a PET scan for evaluating heart metabolism and includes the evaluation of ventricular wall motion and ejection fraction, if necessary. Follow the appropriate coding guidelines and modifiers for reporting the professional and technical components of the service. It is important to note that payer policies may vary, so it is essential to review individual payer guidelines for specific billing requirements.

8. Historical information

CPT code 78459 was added to the Current Procedural Terminology system on January 1, 1996. The code was last updated on January 1, 2020, with a change in the description to specify ‘metabolic evaluation.’

9. Examples

1. A patient with suspected coronary artery disease undergoes a PET scan to evaluate heart metabolism and assess ventricular wall motion and ejection fraction.
2. A patient who recently had a myocardial infarction undergoes a PET scan to assess the metabolic activity of the heart and evaluate ventricular wall motion and ejection fraction.
3. A patient with cardiomyopathy undergoes a PET scan to evaluate heart metabolism and assess ventricular wall motion and ejection fraction.
4. A patient with unexplained chest pain undergoes a PET scan to assess heart metabolism and evaluate ventricular wall motion and ejection fraction.
5. A patient with a history of heart disease undergoes a PET scan to monitor the metabolic activity of the heart and assess ventricular wall motion and ejection fraction.
6. A patient with suspected heart failure undergoes a PET scan to evaluate heart metabolism and assess ventricular wall motion and ejection fraction.
7. A patient with a family history of cardiac conditions undergoes a PET scan to assess heart metabolism and evaluate ventricular wall motion and ejection fraction.
8. A patient with a known heart condition undergoes a PET scan to monitor the metabolic activity of the heart and assess ventricular wall motion and ejection fraction.
9. A patient with a history of cardiac surgery undergoes a PET scan to evaluate heart metabolism and assess ventricular wall motion and ejection fraction.
10. A patient with a heart transplant undergoes a PET scan to assess the metabolic activity of the transplanted heart and evaluate ventricular wall motion and ejection fraction.