CPT® Code 76989

Official Description

Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; interpretation and report only

Common Language Description

The CPT® Code 76989 refers to the procedure of intraoperative epicardial cardiac ultrasound, specifically for diagnostic purposes related to congenital heart disease. This procedure involves the use of an intraoperative epicardial ultrasound probe, which is a specialized device designed to provide high-resolution imaging of the heart's structures during surgical interventions. The ultrasound is performed while the patient is undergoing cardiac surgery, such as during cardiopulmonary bypass grafting. The primary goal of this procedure is to assess the condition of the coronary arteries, determining which arteries may require bypass grafting based on the ultrasound findings. The ultrasound probe is typically inserted into a sterile sheath that is filled with saline or ultrasound transmission gel, ensuring that no air is present, which could interfere with the imaging quality. Once positioned in the opened surgical field, the probe allows for a detailed examination of the surface anatomy of the native and diseased coronary arteries. This information is crucial for creating an optimized surgical plan for graft targets. During the procedure, a probe operator may handle the insertion and maneuvering of the ultrasound probe over the heart's surface, while an echocardiographer is responsible for evaluating the images produced and communicating important observations to the cardiac surgeon. In some cases, a single echocardiographer may perform both roles, ensuring that the surgical team has immediate access to critical diagnostic information. Upon completion of the ultrasound scan, the probe is carefully removed from the surgical field, concluding the intraoperative assessment.

1. Indications

The intraoperative epicardial cardiac ultrasound (CPT® Code 76989) is indicated for use in patients with congenital heart disease. This procedure is performed to provide real-time diagnostic imaging of the heart's structures during surgical interventions, particularly to assess the condition of the coronary arteries. The ultrasound helps in determining which arteries may require bypass grafting, thereby facilitating informed surgical decision-making.

Congenital Heart Disease This procedure is specifically indicated for patients diagnosed with congenital heart conditions that may affect the coronary arteries and require surgical intervention.

2. Procedure

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

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 essential to eliminate any air pockets that could compromise the quality of the ultrasound images.
Step 2: Insertion into the Surgical Field Once prepared, the probe is inserted into the opened surgical field during cardiac surgery. This allows for direct access to the heart and the coronary arteries, enabling real-time imaging.
Step 3: Scanning the Coronary Arteries The probe operator maneuvers the ultrasound probe over the surface of the heart, scanning the coronary arteries. This step is crucial for assessing the condition of the arteries and determining which ones may require bypass grafting.
Step 4: Image Evaluation An echocardiographer evaluates the images produced by the ultrasound. This professional is responsible for recording the findings and relaying pertinent observations to the cardiac surgeon, ensuring that the surgical team has the necessary information for decision-making.
Step 5: Completion of the Scan After the scanning process is complete, the ultrasound probe is carefully removed from the surgical field, concluding the intraoperative assessment.

3. Post-Procedure

Post-procedure care following the intraoperative epicardial cardiac ultrasound primarily involves monitoring the patient for any immediate complications related to the surgical intervention. The surgical team will review the ultrasound findings to finalize the surgical plan, particularly regarding any necessary bypass grafts. There are no specific post-procedure instructions related to the ultrasound itself, as it is performed in conjunction with the surgical procedure. However, standard postoperative care protocols for cardiac surgery will be followed to ensure the patient's recovery and address any potential complications.

Short Descr	DX INTRAOP EPCAR US CHD I&R
Medium Descr	DX INTRAOP EPICAR CARDIAC US CHD I&R ONLY
Long Descr	Intraoperative epicardial cardiac ultrasound (ie, echocardiography) for congenital heart disease, diagnostic; interpretation and report 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.

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.