How To Use CPT Code 78597

CPT 78597 describes the procedure for quantitative differential pulmonary perfusion, including imaging when performed. 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 78597?

CPT 78597 can be used to describe the procedure for quantitative differential pulmonary perfusion, which includes imaging when performed. This code is used when a provider performs a pulmonary perfusion test to evaluate the flow of blood within the patient’s lungs. The aim of this test is to perform a quantitative analysis of differential pulmonary artery blood flow.

2. Official Description

The official description of CPT code 78597 is: ‘Quantitative differential pulmonary perfusion, including imaging when performed.’

3. Procedure

1. In this diagnostic procedure, the provider performs pulmonary perfusion, a nuclear scan test that evaluates the flow of blood within the patient’s lungs.
2. The aim is to perform quantitative analysis of differential pulmonary artery blood flow to rule out pulmonary stenosis.
3. The provider may or may not perform imaging with the test, which can be done using a gamma camera or other radiologic imaging.

4. Qualifying circumstances

Patients who may require CPT 78597 are those who need to evaluate the flow of blood within their lungs. This test is commonly used to detect any blood clot that is preventing normal blood flow to a part of the lung. It is performed to rule out pulmonary stenosis, which is narrowing in the pulmonary artery. The provider may use a radioactive tracer substance to track the distribution of blood flow within the lungs.

5. When to use CPT code 78597

CPT code 78597 should be used when a provider performs a quantitative differential pulmonary perfusion test, including imaging when performed. This code is appropriate when the aim of the test is to evaluate the flow of blood within the patient’s lungs and perform a quantitative analysis of differential pulmonary artery blood flow. It is important to note that this code should not be used for other types of pulmonary perfusion tests or procedures.

6. Documentation requirements

To support a claim for CPT 78597, the provider must document the following information:

• Reason for performing the test and the need to evaluate the flow of blood within the patient’s lungs
• Details of the test performed, including whether imaging was performed and the method used
• Results of the test, including any abnormalities or findings related to the differential pulmonary artery blood flow
• Signature of the provider who performed the test

7. Billing guidelines

When billing for CPT 78597, ensure that the provider has performed a quantitative differential pulmonary perfusion test, including imaging when performed. It is important to follow payer policies and guidelines regarding the reporting of radiopharmaceutical substances and the use of modifiers for professional and technical components. If the provider only performs the interpretation for the radiology service, modifier 26 should be appended to the radiology code. If only the technical component is reported, modifier TC should be appended. However, it is important to note that payer policy may exempt hospitals from appending modifier TC. When reporting a global service in which one provider renders both the professional and technical components, no modifier should be appended to the radiology code.

8. Historical information

CPT 78597 was added to the Current Procedural Terminology system on January 1, 2012. There have been no updates to the code since its addition.

9. Examples

1. A provider performs a quantitative differential pulmonary perfusion test, including imaging, to evaluate the flow of blood within a patient’s lungs and rule out pulmonary stenosis.
2. During the test, the provider uses a gamma camera to capture images of the lung and perform a quantitative analysis of differential pulmonary artery blood flow.
3. The test results show normal blood flow within the patient’s lungs, indicating no signs of pulmonary stenosis.
4. Another provider performs a quantitative differential pulmonary perfusion test without imaging to evaluate the flow of blood within a patient’s lungs and rule out pulmonary stenosis.
5. The test results show abnormal blood flow within a specific area of the lung, indicating a potential blood clot.
6. A provider performs a quantitative differential pulmonary perfusion test, including MRI imaging, to evaluate the flow of blood within a patient’s lungs and rule out pulmonary stenosis.
7. The MRI images provide detailed information about the differential pulmonary artery blood flow, helping the provider make an accurate diagnosis.
8. During the test, the provider uses other radiologic imaging techniques, such as CT scan, to complement the quantitative analysis of differential pulmonary artery blood flow.
9. The test results show reduced blood flow within certain areas of the lung, indicating a potential blockage or narrowing in the pulmonary artery.
10. Another provider performs a quantitative differential pulmonary perfusion test without imaging to evaluate the flow of blood within a patient’s lungs and rule out pulmonary stenosis.