CPT® Code 78432

1. Indications

The myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (CPT® Code 78432) is indicated for various clinical scenarios where detailed assessment of cardiac function and viability is necessary. The following conditions may warrant this procedure:

• Assessment of Myocardial Viability - This study is performed to evaluate the viability of heart muscle in patients with known or suspected coronary artery disease.
• Evaluation of Cardiac Function - It is indicated for assessing the pumping ability of the heart, particularly in patients with heart failure or other cardiac dysfunctions.
• Investigation of Chest Pain - The procedure may be utilized in patients presenting with unexplained chest pain to determine if myocardial ischemia is present.
• Preoperative Assessment - It is often indicated prior to cardiac surgery to evaluate the heart's condition and guide surgical decisions.
• Monitoring of Cardiac Conditions - The study can be used to monitor the effectiveness of treatment in patients with known cardiac conditions.

2. Procedure

The myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study involves several critical procedural steps to ensure accurate imaging and assessment of cardiac function. The following outlines the detailed steps involved in the procedure:

• Step 1: Patient Preparation - The patient is positioned on a movable table within a specialized imaging room. An intravenous (IV) line is established for the administration of radioactive tracers. Electrocardiogram (EKG) leads are placed on the patient to monitor heart activity throughout the procedure.
• Step 2: Baseline Imaging - A baseline scan is performed to capture initial images of the heart. This step is crucial for establishing a reference point for subsequent imaging after tracer administration.
• Step 3: Injection of Dual Radiotracers - Following the baseline scan, a dual radioactive tracer is injected through the IV line. This dual approach allows for simultaneous assessment of myocardial perfusion and metabolic activity.
• Step 4: Sequential Imaging - The patient undergoes multiple passes through the PET scanner. Each pass captures images of the heart from different angles, allowing for a comprehensive evaluation of blood flow and myocardial function.
• Step 5: Data Acquisition and Analysis - The uptake of the radioactive tracers is analyzed to identify areas of normal and abnormal blood flow. The resulting images provide insights into the heart's perfusion status and any potential areas of ischemia or viability.
• Step 6: Concurrent CT Imaging (if applicable) - If a CT transmission scan is performed concurrently (CPT® Code 78433), the patient will first pass through the scanner to acquire CT data, followed by a second pass for PET data. This integrated approach enhances the accuracy of anatomical localization of any identified abnormalities.

3. Post-Procedure

After the completion of the myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study, patients are typically monitored for a short period to ensure there are no immediate adverse reactions to the radioactive tracers. Patients may be advised to hydrate adequately to help flush the tracers from their system. The results of the imaging study will be analyzed and interpreted by a qualified physician, who will discuss the findings with the patient and determine any necessary follow-up actions or treatments based on the results. It is important for patients to follow any specific post-procedure instructions provided by their healthcare provider to ensure optimal recovery and understanding of their results.