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.

Read also: When to use Parathyroid Imaging CPT codes

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

Read also: When to use Pulmonary ventilation and perfusion scan CPT codes in Radiology

When to use CPT code 78459 & 78429

In this Myocardial 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

HCPCS codes used with CPT code 78451, 78452, 78453 & 78454

A4641 Radiopharmaceutical, diagnostic, not otherwise classified
A4642 Indium In-111 satumomab pendetide, diagnostic, per study dose, up to 6 millicuries
A9500 Technetium Tc-99m sestamibi, diagnostic, per study dose
A9501 Technetium Tc-99m teboroxime, diagnostic, per study dose
A9502 Technetium Tc-99m tetrofosmin, diagnostic, per study dose
A9503 Technetium Tc-99m medronate, diagnostic, per study dose, up to 30 millicuries
A9505 Thallium Tl-201 thallous chloride, diagnostic, per millicurie
A9507 Indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries
A9508 Iodine I-131 iobenguane sulfate, diagnostic, per 0.5 millicurie
A9509 Iodine I-123 sodium iodide, diagnostic, per millicurie
A9510 Technetium Tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries
A9512 Technetium Tc-99m pertechnetate, diagnostic, per millicurie
A9515 Choline C-11, diagnostic, per study dose up to 20 millicuries
A9516 Iodine I-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries
A9517 Iodine I-131 sodium iodide capsule(s), therapeutic, per millicurie
A9520 Technetium Tc-99m tilmanocept, diagnostic, up to 0.5 millicuries
A9521 Technetium Tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries
A9524 Iodine I-131 iodinated serum albumin, diagnostic, per 5 microcuries
A9526 Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 millicuries
A9527 Iodine I-125, sodium iodide solution, therapeutic, per millicurie
A9528 Iodine I-131 sodium iodide capsule(s), diagnostic, per millicurie
A9529 Iodine I-131 sodium iodide solution, diagnostic, per millicurie
A9530 Iodine I-131 sodium iodide solution, therapeutic, per millicurie
A9531 Iodine I-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries)
A9532 Iodine I-125 serum albumin, diagnostic, per 5 microcuries
A9537 Technetium Tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries
A9538 Technetium Tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries
A9539 Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries
A9540 Technetium Tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries
A9541 Technetium Tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries
A9542 Indium In-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries
A9543 Yttrium Y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries
A9547 Indium In-111 oxyquinoline, diagnostic, per 0.5 millicurie
A9548 Indium In-111 pentetate, diagnostic, per 0.5 millicurie
A9551 Technetium Tc-99m succimer, diagnostic, per study dose, up to 10 millicuries
A9552 Fluorodeoxyglucose F-18 FDG, diagnostic, per study dose, up to 45 millicuries
A9553 Chromium CR-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries
A9554 Iodine I-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries
A9555 Rubidium Rb-82, diagnostic, per study dose, up to 60 millicuries
A9556 Gallium Ga-67 citrate, diagnostic, per millicurie
A9557 Technetium Tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries
A9558 Xenon Xe-133 gas, diagnostic, per 10 millicuries
A9560 Technetium Tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries
A9561 Technetium Tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries
A9562 Technetium Tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries
A9563 Sodium phosphate P-32, therapeutic, per millicurie
A9564 Chromic phosphate P-32 suspension, therapeutic, per millicurie
A9567 Technetium Tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries
A9568 Technetium Tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries
A9569 Technetium Tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose
A9570 Indium In-111 labeled autologous white blood cells, diagnostic, per study dose
A9571 Indium In-111 labeled autologous platelets, diagnostic, per study dose
A9572 Indium In-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries
A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries
A9582 Iodine I-123 iobenguane, diagnostic, per study dose, up to 15 millicuries
A9584 Iodine I-123 ioflupane, diagnostic, per study dose, up to 5 millicuries
A9586 Florbetapir F-18, diagnostic, per study dose, up to 10 millicuries
A9587 Gallium Ga-68, dotatate, diagnostic, 0.1 millicurie
A9588 Fluciclovine F-18, diagnostic, 1 millicurie
A9597 Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified
A9598 Positron emission tomography radiopharmaceutical, diagnostic, for non-tumor identification, not otherwise classified
A9600 Strontium SR-89 chloride, therapeutic, per millicurie
A9604 Samarium SM-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries
C9399 Unclassified drugs or biologicals
C9898 Radiolabeled product provided during a hospital inpatient stay
G0106 Colorectal cancer screening; alternative to G0104, screening sigmoidoscopy, barium enema
G0130 Single energy X-ray absorptiometry (SEXA) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel)
G0248 Demonstration, prior to initiation of home INR monitoring, for patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria, under the direction of a physician; includes: face-to-face demonstration of use and care of the INR monitor, obtaining at least one blood sample, provision of instructions for reporting home INR test results, and documentation of patient’s ability to perform testing and report results
G0249 Provision of test materials and equipment for home INR monitoring of patient with either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism who meets Medicare coverage criteria; includes: provision of materials for use in the home and reporting of test results to physician; testing not occurring more frequently than once a week; testing materials, billing units of service include 4 tests
G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)
G0398 Home sleep study test (HST) with type II portable monitor, unattended; minimum of 7 channels: EEG, EOG, EMG, ECG/heart rate, airflow, respiratory effort and oxygen saturation
G0399 Home sleep test (HST) with type III portable monitor, unattended; minimum of 4 channels: 2 respiratory movement/airflow, 1 ECG/heart rate and 1 oxygen saturation
G0400 Home sleep test (HST) with type IV portable monitor, unattended; minimum of 3 channels
G2066 Interrogation device evaluation(s), (remote) up to 30 days; implantable cardiovascular physiologic monitor system, implantable loop recorder system, or subcutaneous cardiac rhythm monitor system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results
J0153 Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)
J0395 Injection, arbutamine hcl, 1 mg
J1245 Injection, dipyridamole, per 10 mg
J1250 Injection, dobutamine hydrochloride, per 250 mg
J2785 Injection, regadenoson, 0.1 mg
J3490 Unclassified drugs
Q0035 Cardiokymography
Q9969 Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose
Q9982 Flutemetamol F-18, diagnostic, per study dose, up to 5 millicuries
Q9983 Florbetaben F-18, diagnostic, per study dose, up to 8.1 millicuries