CPT® Code 76987

Official Description

Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; including placement and manipulation of transducer, image acquisition, interpretation and report

Common Language Description

The CPT® Code 76987 refers to an intraoperative epicardial cardiac ultrasound, specifically designed for the diagnosis of congenital heart disease. This procedure involves the use of an ultrasound probe that is strategically placed on the surface of the heart during cardiac surgery. The primary purpose of this ultrasound is to assess the condition of the coronary arteries, particularly to determine which arteries may require bypass grafting. The procedure is performed in a sterile environment, ensuring that all necessary precautions are taken to maintain patient safety and prevent infection. The ultrasound probe, which operates at ultra-high frequencies, is inserted into a sterile sheath that is filled with saline or ultrasound transmission gel, ensuring optimal contact and image quality by eliminating air pockets. Once positioned in the opened surgical field, the probe allows for detailed imaging of the coronary arteries, enabling the surgical team to visualize the surface anatomy of the heart and make informed decisions regarding graft targets. The procedure is collaborative, often involving both a probe operator and an echocardiographer, who work together to capture and interpret the ultrasound images, providing real-time feedback to the cardiac surgeon. This dynamic interaction is crucial for the successful planning and execution of cardiac surgical interventions.

1. Indications

The intraoperative epicardial cardiac ultrasound (CPT® Code 76987) is indicated for the assessment of congenital heart disease during surgical procedures. This ultrasound technique is particularly useful in the following scenarios:

Assessment of Coronary Arteries The procedure is performed to evaluate the condition of the coronary arteries, determining which arteries may require bypass grafting during cardiac surgery.
Congenital Heart Disease It is specifically indicated for patients with congenital heart defects, allowing for real-time imaging and assessment during surgical interventions.

2. Procedure

The procedure for intraoperative epicardial cardiac ultrasound involves several critical steps to ensure accurate imaging and assessment of the heart. Each step is essential for the successful execution of the ultrasound during surgery.

Step 1: Preparation of the Ultrasound Probe The ultrasound probe is prepared by placing it into a sterile sheath that is filled with saline or ultrasound transmission gel. This preparation is crucial to eliminate any air pockets that could interfere with image quality.
Step 2: Insertion into the Surgical Field Once prepared, the probe is carefully inserted into the opened surgical field. This step requires precision to ensure that the probe is positioned correctly on the surface of the heart for optimal imaging.
Step 3: Scanning the Coronary Arteries The probe operator then manipulates the ultrasound probe over the surface of the heart, scanning the coronary arteries. This step is vital for assessing the condition of the arteries and determining the need for bypass grafting.
Step 4: Image Acquisition and Evaluation During the scanning process, an echocardiographer evaluates the images captured by the probe. This real-time evaluation allows for immediate feedback and communication with the cardiac surgeon regarding the findings.
Step 5: Reporting Findings After the imaging is complete, the echocardiographer compiles a report detailing the observations made during the procedure. This report is essential for guiding the surgical team in their decision-making process.
Step 6: Removal of the Probe Once the procedure is concluded, the ultrasound probe is carefully removed from the surgical field, ensuring that all sterile protocols are followed to maintain patient safety.

3. Post-Procedure

After the intraoperative epicardial cardiac ultrasound is completed, the surgical team may review the findings to make informed decisions regarding the next steps in the surgical procedure. The echocardiographer's report will provide critical insights into the condition of the coronary arteries, which can influence the surgical approach. Post-procedure care will focus on monitoring the patient for any complications related to the surgery and ensuring that the surgical site is healing properly. Additionally, the surgical team may discuss the findings with the patient and their family, providing information on the outcomes of the ultrasound and any further interventions that may be necessary.

Short Descr	DX INTRAOP EPICAR CAR US CHD
Medium Descr	DX NTRAOP EPICAR CAR US CHD PLMT&MNP TRNSDCR I&R
Long Descr	Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; including placement and manipulation of transducer, image acquisition, interpretation and report
Status Code	Carriers Price the 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	Inpatient Procedures, not paid under OPPS
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.
GC	This service has been performed in part by a resident under the direction of a teaching physician