CPT® Code 76988

Official Description

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

Common Language Description

The CPT® Code 76988 refers to an intraoperative epicardial cardiac ultrasound, specifically designed for diagnostic purposes in patients with 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 goal of this ultrasound is to assess the coronary arteries, particularly to determine which arteries may require bypass grafting. The procedure is typically performed during critical surgical interventions, such as cardiopulmonary bypass grafting, where real-time imaging is essential for making informed decisions regarding surgical targets.

During the procedure, an ultra-high frequency ultrasound probe is utilized, which is inserted into a sterile sheath that is pre-filled with saline or ultrasound transmission gel. This preparation ensures that all air is removed from the sheath, allowing for optimal transmission of ultrasound waves. The probe is then carefully introduced into the opened surgical field, enabling the operator to scan the surface anatomy of the native and diseased coronary arteries. The information gathered from these scans is crucial for developing an optimized surgical plan, as it helps identify the most appropriate graft targets based on the condition of the coronary arteries.

Throughout the scanning process, the probe operator is responsible for the insertion and manipulation of the ultrasound probe over the heart's surface. Simultaneously, an echocardiographer evaluates the images produced, documenting significant findings and communicating relevant observations to the cardiac surgeon. In some cases, a single echocardiographer may take on both roles, performing the scanning and evaluation tasks. Once the imaging is complete, the ultrasound probe is carefully removed from the surgical field, concluding the intraoperative assessment.

1. Indications

The intraoperative epicardial cardiac ultrasound (CPT® Code 76988) is indicated for use in patients with congenital heart disease. This procedure is performed to provide real-time imaging of the coronary arteries during cardiac surgery, particularly to assess which arteries may require bypass grafting. The indications for this procedure include:

Congenital Heart Disease The primary indication for performing an intraoperative epicardial cardiac ultrasound is the presence of congenital heart disease, which may necessitate surgical intervention to correct structural abnormalities.
Assessment of Coronary Arteries This procedure is specifically indicated for evaluating the condition of coronary arteries during surgery, allowing for the identification of arteries that may require bypass grafting.

2. Procedure

The procedure for intraoperative epicardial cardiac ultrasound involves several critical steps to ensure accurate imaging and assessment of the coronary arteries. The steps are as follows:

Step 1: Preparation of the Ultrasound Probe An ultra-high frequency ultrasound probe is prepared by placing it into a sterile sheath that is filled with saline or ultrasound transmission gel. This preparation is essential to eliminate any air pockets that could interfere with the quality of the ultrasound images.
Step 2: Insertion into the Surgical Field The prepared ultrasound probe is then carefully inserted into the opened surgical field. This step is crucial as it allows the probe to be positioned directly over the surface of the heart, where imaging will take place.
Step 3: Scanning the Coronary Arteries The probe operator manipulates the ultrasound probe over the surface of the heart, scanning the coronary arteries. This real-time imaging provides valuable information regarding the condition of the arteries, which is vital for surgical planning.
Step 4: Image Evaluation and Documentation An echocardiographer evaluates the images produced during the scanning process. This professional is responsible for documenting significant findings and communicating pertinent observations to the cardiac surgeon, ensuring that the surgical team has the necessary information to make informed decisions.
Step 5: Completion of the Procedure Once the scanning is complete and all necessary images have been acquired, the ultrasound probe is carefully removed from the surgical field, concluding the intraoperative assessment.

3. Post-Procedure

After the completion of the intraoperative epicardial cardiac ultrasound, there are no specific post-procedure care requirements mentioned in the provided data. However, it is essential for the surgical team to review the acquired images and findings to finalize the surgical plan. The information obtained from the ultrasound may influence subsequent surgical decisions, particularly regarding graft placement and management of the coronary arteries. Continuous monitoring of the patient’s condition post-surgery is standard practice, ensuring that any complications can be promptly addressed.

Short Descr	DX NTROP EPCR US CHD IMG ACQ
Medium Descr	DX NTRAOP EPCAR CAR US CHD PLMT MNPJ&IMG ACQUISJ
Long Descr	Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; placement, manipulation of transducer, and image acquisition only
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

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.