How To Use CPT Code 78492

CPT 78492 describes a diagnostic procedure used to perform a myocardial perfusion PET imaging 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 78492?

CPT 78492 is a diagnostic code that is used to describe a specific procedure known as a myocardial perfusion PET imaging study. This procedure is performed to assess the flow of oxygenated blood to the heart muscles. It involves the use of a PET scanner to obtain three-dimensional images of the heart, which can help detect areas of poor blood flow and identify any diseased vessels or poorly functioning ventricles.

2. Official Description

The official description of CPT code 78492 is: ‘Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic).’ This code is used for multiple studies performed at rest and during stress, which can be induced through exercise or the use of drugs.

3. Procedure

1. During a myocardial perfusion PET imaging study, the provider injects the patient with a radiopharmaceutical tracer called fluorodeoxyglucose (FDG) about one hour before the imaging begins.
2. The FDG tracer spreads through the bloodstream and gets absorbed by the cells in the body.
3. The absorbed FDG emits small amounts of energy (positrons) that collide with electrons, resulting in the production of two photons that travel in opposite directions.
4. The PET scanner captures the photon emission and processes the information using a computer to produce three-dimensional images of the heart.
5. The provider obtains images of the heart at rest, which reveal how blood flows through the heart (perfusion).
6. The provider may induce stress in the patient using a drug or exercise and obtain additional images to further evaluate the perfusion of the heart.
7. The provider may also assess ventricular wall motion (the pumping action of the heart) and the ejection fraction (the percentage of blood pumped out of a filled ventricle with each heartbeat).
8. Multiple studies are performed to gather comprehensive information about the heart’s function.
9. After evaluating the heart function, the provider prepares a report based on the findings.

4. Qualifying circumstances

CPT 78492 is used for patients who require a myocardial perfusion PET imaging study to assess the flow of oxygenated blood to the heart muscles. This procedure is particularly useful in detecting coronary artery disease (CAD) or ischemic heart disease (IHD), where blood supply to the heart muscles becomes restricted or blocked due to the deposit of plaques inside the arteries. The procedure may also be performed to evaluate ventricular wall motion and ejection fraction. It is important to note that this procedure requires the use of a PET scanner and the injection of a radiopharmaceutical tracer.

5. When to use CPT code 78492

CPT code 78492 should be used when a provider performs a myocardial perfusion PET imaging study that includes multiple studies at rest and stress. This code is appropriate when the provider assesses the flow of oxygenated blood to the heart muscles, evaluates ventricular wall motion and ejection fraction, and uses a PET scanner to obtain three-dimensional images of 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 78492, the provider must document the following information:

• Reason for performing the myocardial perfusion PET imaging study
• Details of the radiopharmaceutical tracer used, including the name and dosage
• Date and time of the procedure
• Images obtained during the study, including those at rest and during stress
• Evaluation of ventricular wall motion and ejection fraction, if performed
• Any additional findings or observations
• Preparation of a comprehensive report based on the results

7. Billing guidelines

When billing for CPT code 78492, it is important to ensure that the procedure meets the specific criteria outlined in the code description. The provider should use the appropriate code based on the number of studies performed at rest and stress. It is also important to follow payer policies regarding the use of professional and technical modifiers, such as modifier 26 for the professional component and modifier TC for the technical component. If the provider renders both components, a global service code may be used without appending any modifiers.

8. Historical information

CPT code 78492 was added to the Current Procedural Terminology system on January 1, 1998. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient undergoes a myocardial perfusion PET imaging study to assess blood flow to the heart muscles at rest and during stress induced by exercise.
2. A provider performs a myocardial perfusion PET imaging study to evaluate ventricular wall motion and ejection fraction in a patient with suspected coronary artery disease.
3. A patient with ischemic heart disease undergoes a myocardial perfusion PET imaging study to assess the effectiveness of a new treatment.
4. A provider uses a myocardial perfusion PET imaging study to detect areas of poor blood flow in the heart muscles of a patient with known cardiovascular issues.