CPT® Code 78414

Official Description

Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without pharmacologic intervention or exercise, single or multiple determinations

Common Language Description

The CPT® Code 78414 refers to the determination of central cardiovascular hemodynamics using a non-imaging technique, which may involve the use of a probe technique to assess parameters such as ejection fraction. This procedure can be performed with or without the administration of pharmacologic agents or exercise, and it allows for single or multiple determinations of hemodynamic data. Central cardiovascular hemodynamics is crucial for evaluating the function of the heart muscle and the flow of blood within the cardiac system. The procedure typically involves the use of a scintillation probe and a radiolabeled isotope tracer, which are essential for measuring the heart's performance. During the test, electrocardiogram (ECG) leads are placed on the patient's chest, and the patient is positioned flat on a table in the procedure room. For assessments conducted at rest, the patient remains in this position, while stress studies may require the patient to engage in physical activity on a treadmill or stationary bike, or to receive a pharmacologic agent that simulates exercise. An intravenous line is established to facilitate the injection of the radiolabeled isotope tracer directly into the bloodstream. The scintillation probe is then carefully positioned to align with the cardiac anatomy being evaluated, and it is synchronized with the ECG to ensure accurate data collection. Scanning occurs at predetermined intervals, capturing the radioactive energy emitted from the tracer, which is subsequently converted into a tracing for analysis. The physician interprets the results of the study and compiles a comprehensive written report detailing the findings.

1. Indications

The procedure associated with CPT® Code 78414 is indicated for various clinical scenarios where assessment of central cardiovascular hemodynamics is necessary. The following conditions may warrant this evaluation:

Heart Failure Evaluation of patients with suspected or known heart failure to assess cardiac function and blood flow.
Cardiac Ischemia Assessment of patients experiencing symptoms of cardiac ischemia to determine the adequacy of blood supply to the heart muscle.
Cardiac Function Monitoring Monitoring of cardiac function in patients undergoing treatment for cardiovascular diseases.
Preoperative Assessment Evaluation of cardiac function prior to surgical procedures, particularly in patients with existing cardiovascular conditions.

2. Procedure

The procedure for CPT® Code 78414 involves several critical steps to ensure accurate determination of central cardiovascular hemodynamics. The following outlines the procedural steps:

Step 1: Patient Preparation The patient is prepared for the procedure by placing ECG leads on the chest to monitor heart activity. The patient is then positioned flat on a table in the procedure room, ensuring comfort and stability during the test.
Step 2: Establishing IV Access An intravenous (IV) line is established to facilitate the administration of a radiolabeled isotope tracer. This tracer is essential for the subsequent measurements of cardiac function.
Step 3: Injection of Radiolabeled Isotope The radiolabeled isotope tracer is injected directly into the circulatory system through the established IV line. This tracer will allow for the measurement of hemodynamic parameters.
Step 4: Probe Positioning A scintillation probe is positioned relative to the cardiac anatomy that is to be studied. The positioning is critical for accurate data collection and is synchronized with the ECG to ensure that measurements correspond with the heart's electrical activity.
Step 5: Data Collection Scanning is performed at specific intervals to capture the radioactive energy emitted from the tracer. This data is converted into a tracing that reflects the heart's hemodynamic status.
Step 6: Interpretation and Reporting After the data collection is complete, the physician interprets the results and compiles a written report detailing the findings of the study, which may include measurements such as ejection fraction and other relevant hemodynamic parameters.

3. Post-Procedure

Post-procedure care for patients undergoing the CPT® Code 78414 evaluation typically involves monitoring for any immediate reactions to the radiolabeled isotope tracer. Patients may be observed for a short period to ensure stability before being discharged. The physician will provide the patient with information regarding the results of the study, and any necessary follow-up appointments or additional testing may be scheduled based on the findings. It is important for patients to be informed about any potential side effects related to the tracer and to follow any specific instructions provided by the healthcare team.

Short Descr	NON-IMAGING HEART FUNCTION
Medium Descr	CARD-VASC HEMODYNAM W/WO PHARM/EXER 1/MLT DETERM
Long Descr	Determination of central c-v hemodynamics (non-imaging) (eg, ejection fraction with probe technique) with or without pharmacologic intervention or exercise, single or multiple determinations
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	Procedure or Service, Not Discounted when Multiple
ASC Payment Indicator	Radiology service paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS relative payment weight.
Type of Service (TOS)	4 - Diagnostic Radiology
Berenson-Eggers TOS (BETOS)	I1E - Standard imaging - nuclear medicine
MUE	1
CCS Clinical Classification	209 - Radioisotope scan and function studies

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.
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.
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider