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The CPT® Code 75580 refers to a noninvasive procedure that estimates the coronary fractional flow reserve (FFR) using advanced software analysis of data obtained from coronary computed tomography angiography (CCTA). This procedure is crucial for evaluating the severity of ischemia, which is a condition characterized by insufficient blood flow to the heart muscle due to coronary artery stenosis, or narrowing. By determining the FFR, healthcare professionals can better predict the potential benefits of surgical interventions, such as revascularization, compared to conservative medical management. The process involves creating a digital model of the coronary arteries from the images captured during the CCTA. This model incorporates patient-specific physiological conditions during peak hyperemia, which is the state of maximum blood flow. The FFR is calculated throughout the entire coronary vascular system using computational fluid dynamics, a method that simulates blood flow and pressure dynamics. The integration of coronary anatomy, physiological data, and fluid dynamics allows for a comprehensive assessment of coronary artery blood flow and pressure under conditions of maximum hyperemia. The code encompasses the entire workflow, including the preparation and transmission of CCTA data, the analysis of fluid dynamics, and the simulation of maximal coronary hyperemia. Additionally, it involves the generation of an estimated FFR model, which is then compared with anatomical data to resolve any discrepancies. The final interpretation and report are provided by a physician or another qualified healthcare professional, ensuring that the findings are accurately communicated for further clinical decision-making.
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The procedure associated with CPT® Code 75580 is indicated for patients who require assessment of coronary artery disease, particularly in cases where there is a need to evaluate the severity of ischemia due to coronary stenosis. The following conditions may warrant the use of this procedure:
The procedure for CPT® Code 75580 involves several critical steps that ensure accurate estimation of the coronary fractional flow reserve (FFR) from the data obtained through coronary computed tomography angiography (CCTA). The following steps outline the process:
After the completion of the procedure associated with CPT® Code 75580, the patient may not require any specific post-procedure care related to the FFR estimation itself, as it is a noninvasive procedure. However, it is essential for the healthcare provider to discuss the results with the patient, including the implications of the estimated FFR on their treatment options. The physician will provide guidance on any necessary follow-up appointments or additional testing that may be required based on the findings. Patients should also be monitored for any ongoing symptoms related to coronary artery disease, and appropriate management strategies should be implemented as indicated by the results of the FFR assessment.
| Short Descr | N-INVAS EST C FFR SW ALY CTA | Medium Descr | N-INVAS EST C FFR AUGMNT SW ALYS CTA I&R PHY/QHP | Long Descr | Noninvasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of the data set from a coronary computed tomography angiography, with interpretation and report by a physician or other qualified health care professional | Status Code | Active Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 1 - Diagnostic Tests for Radiology Services | Multiple Procedures (51) | 0 - No payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 0 - 150% payment adjustment for bilateral procedures does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 0 - Payment restriction for assistants at surgery applies to this procedure... | Co-Surgeons (62) | 0 - Co-surgeons not permitted for this procedure. | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Procedure or Service, Not Discounted when Multiple | Type of Service (TOS) | 4 - Diagnostic Radiology | Berenson-Eggers TOS (BETOS) | none | MUE | 1 |
| 26 | Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number. | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | GC | This service has been performed in part by a resident under the direction of a teaching physician | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | GZ | Item or service expected to be denied as not reasonable and necessary | MG | The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | GA | Waiver of liability statement issued as required by payer policy, individual case | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | MB | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access | MC | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues | ME | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | MF | The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | MH | Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider | XS | Separate structure, a service that is distinct because it was performed on a separate organ/structure | XU | Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service |
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| 2024-01-01 | Added | Code Added. |
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