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Myocardial perfusion imaging is a specialized nuclear medicine procedure designed to assess the functionality of the heart muscle and the blood flow to the heart. This diagnostic test involves the use of a radionuclide, commonly referred to as a tracer, which is injected into the patient's bloodstream through an intravenous line placed in a vein, typically in the hand or arm. To monitor the heart's activity during the procedure, electrocardiogram (ECG) leads are attached to the patient's chest, and a blood pressure cuff is positioned on the arm. The patient is then positioned flat on a table within the procedure room. The imaging can be conducted while the patient is at rest or under stress, which can be induced either through physical exercise on a treadmill or stationary bike or through the administration of a pharmacologic agent that simulates the effects of exercise on the heart. During the procedure, the radionuclide circulates through the bloodstream and preferentially accumulates in healthy heart tissue, while ischemic or damaged heart tissue does not absorb the tracer effectively. This differential uptake allows for the creation of planar images of the heart and surrounding great vessels. The physician analyzes these images to evaluate the motion of the heart walls, which is crucial for determining the heart muscle's efficiency in pumping blood throughout the body. A key measurement obtained during this imaging is the ejection fraction, which indicates the percentage of blood that is ejected from the heart with each contraction. This measurement can be derived using either a first pass technique, where images are captured as the radionuclide first circulates through the heart, or a gated technique, which involves taking a series of images in synchronization with the heartbeats to produce high-resolution images. The physician may also perform additional quantification of heart function based on the distribution of the radionuclide, culminating in a comprehensive written report detailing the findings of the study. In the context of CPT® Code 78453, this procedure is classified as a single study conducted either at rest or under stress, distinguishing it from CPT® Code 78454, which encompasses multiple studies performed under similar conditions.
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The indications for myocardial perfusion imaging using CPT® Code 78453 include the following:
The procedure for myocardial perfusion imaging as described in CPT® Code 78453 involves several key steps:
Post-procedure care for patients undergoing myocardial perfusion imaging typically involves monitoring for any immediate reactions to the radionuclide injection. Patients are generally advised to hydrate well to help flush the tracer from their system. There are usually no significant restrictions following the procedure, and patients can typically resume normal activities unless otherwise directed by their physician. The physician will discuss the results of the imaging study with the patient during a follow-up appointment, where further management or treatment options may be considered based on the findings.
| Short Descr | HT MUSCLE IMAGE PLANAR SING | Medium Descr | MYOCARDIAL PERFUSION PLANAR 1 STUDY REST/STRESS | Long Descr | Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) | 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 | 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. | GC | This service has been performed in part by a resident under the direction of a teaching physician | 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 | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient 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). | 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). | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | ME | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | 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 | Q6 | Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area | 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 |
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| 2011-01-01 | Changed | Short description changed. |
| 2010-01-01 | Added | - |