How To Use CPT Code 78494

CPT 78494 describes the diagnostic nuclear medicine procedure known as cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing. 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 78494?

CPT 78494 can be used to describe a diagnostic nuclear medicine procedure called cardiac blood pool imaging. This procedure utilizes single-photon emission computed tomography (SPECT) to evaluate the pumping function of the heart while the patient is at rest. The provider uses a technique called gated equilibrium technique to assess the heart’s wall motion and ejection fraction. This code should not be reported in conjunction with other specific codes listed in the notes section.

2. Official Description

The official description of CPT code 78494 is: ‘Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or without quantitative processing.’

3. Procedure

1. During the procedure, the provider administers a radioactive tracer to the patient through a vein.
2. The tracer travels towards the heart, emitting gamma radiations that are detected by multi-headed gamma cameras.
3. The cameras rotate around the patient, capturing a series of images triggered by the heart’s electrical signals.
4. These images are merged together to create a motion picture of the heart, allowing the provider to evaluate its functioning during motion.
5. The provider assesses the heart’s wall motion and calculates the ejection fraction, which is the percentage of blood pumped out of the heart with each heartbeat.
6. Quantitative processing may be performed to further analyze the data obtained from the procedure.

4. Qualifying circumstances

CPT 78494 is typically performed on patients who require an evaluation of their left ventricular function. The procedure is used to assess how well the heart is pumping blood to the rest of the body. It is important to note that this code should not be reported with specific other codes listed in the notes section.

5. When to use CPT code 78494

CPT code 78494 should be used when a provider performs cardiac blood pool imaging using SPECT at rest, along with a wall motion study and calculation of the ejection fraction. This code should not be reported in conjunction with specific other codes listed in the notes section.

6. Documentation requirements

To support a claim for CPT 78494, the provider must document the following information:

• Indication for the procedure and the need for evaluating the left ventricular function
• Details of the procedure performed, including the use of gated equilibrium technique and SPECT
• Date and time of the procedure
• Findings related to the heart’s wall motion and ejection fraction
• Any quantitative processing performed, if applicable
• Signature of the provider

7. Billing guidelines

When billing for CPT 78494, ensure that the procedure meets the criteria described in the official description. Do not report this code in conjunction with specific other codes listed in the notes section. If reporting only the physician’s interpretation, append modifier 26 to the radiology code. If reporting only the technical component, append modifier TC to the radiology code. However, note that payer policy may exempt hospitals from appending modifier TC. Do not append professional or technical modifiers when reporting a global service where one provider renders both components.

8. Historical information

CPT 78494 was added to the Current Procedural Terminology system on January 1, 1999. There have been no updates to the code since its addition.

9. Examples

1. A patient undergoes cardiac blood pool imaging using SPECT at rest to evaluate their left ventricular function and assess wall motion and ejection fraction.
2. During a diagnostic procedure, a provider performs cardiac blood pool imaging using SPECT at rest, along with quantitative processing, to analyze the patient’s heart functioning.
3. A patient with suspected heart disease undergoes cardiac blood pool imaging using SPECT at rest to evaluate their left ventricular function and assess wall motion and ejection fraction.
4. As part of a comprehensive evaluation, a provider performs cardiac blood pool imaging using SPECT at rest to assess the patient’s heart functioning and calculate the ejection fraction.
5. A patient with a history of heart failure undergoes cardiac blood pool imaging using SPECT at rest to evaluate their left ventricular function and assess wall motion and ejection fraction.
6. During a follow-up examination, a provider performs cardiac blood pool imaging using SPECT at rest to assess the patient’s heart functioning and calculate the ejection fraction.
7. A patient with known cardiac abnormalities undergoes cardiac blood pool imaging using SPECT at rest to evaluate their left ventricular function and assess wall motion and ejection fraction.
8. As part of a preoperative assessment, a provider performs cardiac blood pool imaging using SPECT at rest to evaluate the patient’s heart functioning and calculate the ejection fraction.
9. A patient with chest pain undergoes cardiac blood pool imaging using SPECT at rest to evaluate their left ventricular function and assess wall motion and ejection fraction.
10. During a routine check-up, a provider performs cardiac blood pool imaging using SPECT at rest to assess the patient’s heart functioning and calculate the ejection fraction.