Basics of Mycardial Perfusion CPT code 78451, 78452, 78453 & 78454

For tomographic myocardial perfusion imaging, the patient receives an intravenous injection of a radionuclide, usually thallium or technetium-99m, which localizes only in nonischemic tissue. SPECT (single photon emission computed tomographic) images of the heart are taken immediately to identify areas of perfusion vs. infarction. SPECT imaging differs from planar imaging by using a single or multiple-head camera that rotates around the patient to give three-dimensional tomographic imaging of the heart displayed in thin slices. In the nonstress version of the procedure, radionuclide is injected and images are taken without stress induction. For CPT code 78451, a single study is performed at rest or stress. If the test is to be done at a stress condition, it is induced with the standard treadmill exercise test or pharmacologically with the infusion of a vasodilator.

For CPT code 78452, multiple studies are done at rest and/or stress with a second injection of radionuclide given again in the redistribution and/or resting phase just prior to resting images being taken. These codes also include attenuation correction (AC), which provides a more accurate diagnostic image for diagnosing defects or infarcted areas by raising the importance of radioactivity distribution counts arising from certain areas. For instance, counts from the anterior wall may be reduced or impeded by the presence of the breast. These codes also include qualitative or quantitative wall motion, ejection fraction (EF) by first pass or gated technique, and additional quantification, when performed.

For planar myocardial perfusion imaging, stress is induced with the standard treadmill exercise test or pharmacologically with the infusion of a vasodilator, if the test is to be done at stress conditions. The patient receives an intravenous injection of a radionuclide, usually thallium or technetium-99m, which localizes only in nonischemic tissue. Planar images of the heart are scanned immediately with a gamma camera that detects the radiation in the heart tissue to identify areas of infarction. In the nonstress version of the procedure, radionuclide is injected and images taken without stress induction.

For CPT code 78453, a single study is performed at rest or stress.

For CPT code 78454, multiple procedures are done at rest and/or at stress with a second injection of radionuclide given again in the redistribution or resting phase just prior to resting images being taken. For tests performed during pharmacological or exercise-induced stress, report the appropriate stress testing code. These codes also include qualitative or quantitative wall motion, ejection fraction (EF) by first pass or gated technique, and additional quantification, when performed.

Myocardial Perfusion (CPT code 78451, 78452, 78453 & 78454) Coding Guide

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Description of CPT code 78451, 78452, 78453 & 78454

78451 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)

78452  multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

CPT Code 78451 is reported when the exam is performed at rest or with stress, but not both. This MPI (myocardial perfusion imaging) code is specifically for single SPECT imaging studies. When both stress and rest are used, report the multiple study code (CPT code 78452)

78453  Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic)

78454  multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

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When to use CPT code 78459 & 78429

In this Mycardial imaging exam with PET (Positron emission tomography), the cardiac muscle is imaged using data received from positron-emitting radionuclides administered to the patient. The collision of the positrons emitted by the radionuclide with the negatively-charged electrons normally present in tissue is computer synthesized to produce an image, usually in color. This image will show the presence or absence of ischemic or fibrotic cardiac tissue and allow evaluation of metabolic functioning of cardiac tissue.

78459 Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), single study;

78429 with concurrently acquired computed tomography transmission scan