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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 insertion of an intravenous line into a vein, typically located in the hand or arm, to facilitate the administration of a radionuclide, also known as a tracer. The procedure begins with the placement of electrocardiogram (ECG) leads on the patient's chest to monitor heart activity, along with a blood pressure cuff on the arm to track hemodynamic status. During the imaging process, the patient is positioned flat on a table within the procedure room. For the resting phase of the study, images are captured while the patient is at rest. In contrast, for the stress component of the study, the patient may either engage in physical exercise on a treadmill or stationary bike, or receive a pharmacologic agent that simulates the effects of exercise on the heart. The radionuclide is injected into the intravenous line and circulates through the bloodstream, where it localizes in healthy heart tissue. Areas of ischemic heart tissue, which are compromised due to insufficient blood flow, do not absorb the radionuclide, allowing for differentiation between healthy and unhealthy heart muscle. Following the administration of the radionuclide, planar images of the heart and surrounding great vessels are obtained. The physician then evaluates the motion of the heart walls to determine the heart muscle's effectiveness in pumping blood throughout the body. A critical measurement obtained during this procedure is the ejection fraction, which quantifies the percentage of blood ejected from the heart with each contraction. This measurement can be derived using either a first pass technique, where images are captured during the initial circulation of the radionuclide through the heart, or a gated technique, which involves taking a series of images between heartbeats, utilizing electrical signals to produce high-resolution images. Additional imaging may be performed as necessary, and the physician analyzes the results to calculate the ejection fraction and assess other functional parameters based on the distribution of the radionuclide. Ultimately, a comprehensive written report detailing the findings is provided by the physician. It is important to note that CPT® Code 78454 encompasses multiple studies conducted at rest and/or during stress, as well as potential additional injections of radionuclide for redistribution and/or rest reinjection studies, distinguishing it from CPT® Code 78453, which pertains to a single study performed at rest or stress.
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The indications for myocardial perfusion imaging, CPT® Code 78454, include the following:
The procedure for myocardial perfusion imaging, CPT® Code 78454, involves several key steps, which are detailed below:
Post-procedure care for patients undergoing myocardial perfusion imaging typically involves monitoring for any immediate adverse reactions to the radionuclide. Patients are generally advised to hydrate adequately to facilitate the elimination of the radionuclide from their system. The physician will review the results of the imaging study and discuss the findings with the patient, including any necessary follow-up actions or additional testing that may be required based on the results. Patients may resume normal activities unless otherwise instructed by their healthcare provider.
| Short Descr | HT MUSC IMAGE PLANAR MULT | Medium Descr | MYOCARDIAL PERFUSION PLANAR MULTIPLE STUDIES | Long Descr | Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection | 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. | 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 | 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 | ME | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | 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). | 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. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 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. | AQ | Physician providing a service in an unlisted health professional shortage area (hpsa) | GC | This service has been performed in part by a resident under the direction of a teaching physician | GW | Service not related to the hospice patient's terminal condition | GZ | Item or service expected to be denied as not reasonable and necessary | 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 | 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 |
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| 2011-01-01 | Changed | Short description changed. |
| 2010-01-01 | Added | - |