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The CPT® Code 78433 refers to a myocardial imaging procedure utilizing positron emission tomography (PET) that combines perfusion and metabolic evaluation studies. This non-invasive imaging technique is designed to assess the heart muscle's functionality, including its pumping ability, blood flow, and overall perfusion. The procedure employs radioactive tracers, which are injected into the patient's bloodstream, allowing for the creation of detailed three-dimensional images that illustrate blood flow dynamics within the heart during its activity. Additionally, the PET scan is capable of detecting biochemical changes at the cellular level, which can indicate the early stages of disease processes or assess myocardial viability before any anatomical alterations in the heart tissue become evident. The study specifically focuses on two critical measurements of left ventricular function: ventricular wall motion and ejection fraction. These metrics are essential for predicting patient outcomes in the context of existing cardiac diseases. The procedure involves the use of dual radiotracers, such as rubidium-82 and nitrogen-13 for perfusion assessment, alongside carbon-11 for evaluating metabolic activity. The imaging is conducted in a specialized environment equipped with a gamma ray detecting scanner that encircles the patient's body, ensuring comprehensive imaging from multiple angles. The concurrent acquisition of computed tomography (CT) transmission scans enhances the precision of anatomical localization, allowing for improved identification of damaged tissues or disease processes by correcting for soft tissue attenuation with a CT map.
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The myocardial imaging procedure using positron emission tomography (PET) with combined perfusion and metabolic evaluation is indicated for various clinical scenarios, particularly those involving cardiac assessment. The following conditions may warrant the use of this imaging study:
The procedure for myocardial imaging with PET and combined perfusion and metabolic evaluation involves several key steps to ensure accurate and effective imaging of the heart. The following outlines the procedural steps:
After the completion of the myocardial imaging procedure, 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 facilitate the elimination of the tracers from their system. The results of the imaging study will be interpreted by a qualified physician, who will discuss the findings with the patient and recommend any necessary follow-up actions or treatments based on the results. It is important for patients to understand that while the procedure is non-invasive, they may experience some discomfort from the IV insertion or the positioning during the scan. Overall, recovery is generally quick, and patients can resume normal activities shortly after the procedure, unless otherwise instructed by their healthcare provider.
| Short Descr | MYOCRD IMG PET 2RTRACER CT | Medium Descr | MYOCRD IMG PET PRFUJ W/METAB 2RTRACER CNCRNT CT | Long Descr | Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability); with concurrently acquired computed tomography transmission scan | 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) | 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 | MG | The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional | ME | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | GZ | Item or service expected to be denied as not reasonable and necessary | 53 | Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | CR | Catastrophe/disaster related | GA | Waiver of liability statement issued as required by payer policy, individual case | MA | Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition | MC | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues | MF | The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | MH | Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider | PI | Positron emission tomography (pet) or pet/computed tomography (ct) to inform the initial treatment strategy of tumors that are biopsy proven or strongly suspected of being cancerous based on other diagnostic testing | PS | Positron emission tomography (pet) or pet/computed tomography (ct) to inform the subsequent treatment strategy of cancerous tumors when the beneficiary's treating physician determines that the pet study is needed to inform subsequent anti-tumor strategy | Ordering professional consulted a qualified clinical decision support mechanism for this service and the related data was provided to the furnishing professional | TC | Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles | X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician |
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| 2020-01-01 | Added | Code added. |
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