CPT® Code 78445

Official Description

Non-cardiac vascular flow imaging (ie, angiography, venography)

Common Language Description

Non-cardiac vascular flow imaging, as described by CPT® Code 78445, refers to a diagnostic procedure that utilizes scintigraphy along with a radiolabeled isotope tracer to visualize blood flow in various vascular structures outside of the heart. This imaging technique encompasses procedures such as angiography and venography, which are essential for assessing the vascular system's functionality. The primary purpose of these studies is to identify abnormal regional perfusion in organs and extremities, which can indicate underlying vascular issues. Through this imaging, healthcare professionals can diagnose conditions such as occlusions in veins and arteries, which may impede blood flow, and the formation of collateral circulation, where alternative pathways develop to maintain blood supply. Additionally, non-cardiac vascular flow imaging is valuable for evaluating the position and patency of various central lines and catheters, including Porta-caths, Hickman catheters, plasmapheresis catheters, and peripherally inserted central catheters (PICC lines). During the procedure, the patient is carefully positioned on an imaging table, and a gamma camera is placed over the targeted area to capture the necessary images. Intravenous lines are established, or existing central lines may be accessed to inject the radiolabeled isotope tracer directly into the circulatory system. The imaging process involves scanning at predetermined intervals, during which the emitted radioactive energy is recorded and displayed as a cine loop on a computer for analysis. Ultimately, the physician interprets the results of the imaging study and compiles a comprehensive written report detailing the findings.

1. Indications

The non-cardiac vascular flow imaging procedure, represented by CPT® Code 78445, is indicated for various clinical scenarios where assessment of vascular flow is necessary. The following conditions may warrant this imaging study:

Abnormal Regional Perfusion - This imaging is utilized to detect irregular blood flow patterns in specific organs and extremities, which may suggest underlying vascular pathology.
Occlusions in Veins and Arteries - The procedure helps identify blockages that can impede blood circulation, leading to potential complications if left untreated.
Collateral Circulation Formation - It can evaluate the development of alternative blood flow pathways that may arise due to occlusions, ensuring that tissues receive adequate perfusion.
Assessment of Central Lines and Catheters - Non-cardiac vascular flow imaging is also indicated for evaluating the position and patency of various central venous access devices, including Porta-caths, Hickman catheters, plasmapheresis catheters, and PICC lines.

2. Procedure

The non-cardiac vascular flow imaging procedure involves several critical steps to ensure accurate imaging and assessment of vascular flow. The following outlines the procedural steps:

Patient Positioning - The patient is positioned comfortably on the imaging table, ensuring that the area of interest is accessible for imaging. The gamma camera is then placed over the specific region that requires evaluation.
Establishment of Intravenous Access - One or more intravenous lines are established to facilitate the administration of the radiolabeled isotope tracer. If the patient has a central line or catheter, it may be accessed directly for this purpose.
Injection of Radiolabeled Isotope Tracer - The radiolabeled isotope tracer is injected into the circulatory system through the established intravenous line or central line. This tracer is crucial for visualizing blood flow during the imaging process.
Scanning Procedure - Scanning is performed at specific intervals after the injection of the tracer. The gamma camera detects the radioactive energy emitted from the tracer as it circulates through the vascular system.
Image Acquisition and Analysis - The emitted energy is recorded and processed to create a cine loop on a computer, allowing for real-time visualization of blood flow. This data is essential for the physician's interpretation.

3. Post-Procedure

After the completion of the non-cardiac vascular flow imaging procedure, the patient may be monitored briefly to ensure there are no immediate adverse reactions to the radiolabeled isotope tracer. The physician will interpret the imaging results and compile a detailed written report outlining the findings, which will be communicated to the referring physician for further evaluation and management. Patients are typically advised to resume normal activities unless otherwise directed by their healthcare provider. Any specific post-procedure care instructions or follow-up appointments will be provided based on the individual patient's needs and the findings of the imaging study.

Short Descr	VASCULAR FLOW IMAGING
Medium Descr	NONCARDIAC VASCULAR FLOW IMAGING
Long Descr	Non-cardiac vascular flow imaging (ie, angiography, venography)
Status Code	Active Code
Global Days	XXX - Global Concept Does Not Apply
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	6 - Special payment adjustment rules on the technical component (TC) of multiple diagnostic cardiovascular services 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	210 - Other radioisotope scan

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
ME	The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional
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
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
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