Saturday, March 11, 2017

Myocardial perfusion Imaging - cpt 78452


CPT/HCPCS Codes

Group 1 Codes:

78451 Ht muscle image spect sing

78452 Ht muscle image spect mult

78453 Ht muscle image planar sing

78454 Ht musc image planar mult

78466 Heart infarct image

78468 Heart infarct image (ef)

78469 Heart infarct image (3D)


Coverage Indications, Limitations, and/or Medical Necessity



Indications

The usual indications for performing myocardial perfusion imaging (MPI) procedures are:
New onset of symptoms in patients having probability of coronary artery disease (CAD);

A significant change in symptoms in an individual with known coronary artery disease;

Suspicion of chest pain of cardiac origin;

Probability of coronary artery disease (multiple risk factors and strongly suggestive symptoms) with an abnormal exercise ECG;

Abnormal cardiovascular diagnostic studies in asymptomatic patients with significant cardiac risk factors, e.g. diabetes mellitus;

Risk of a subsequent cardiac event following acute myocardial infarction;

Preoperative evaluation prior to increased risk noncardiac surgical procedures in the moderate cardiac risk patient with recent cardiac history, symptoms, or findings. Cardiac catheterization should be considered in the high risk cardiac patient’;

Postoperative assessment following myocardial revascularization procedures (e.g.,CABG, PTCA) in symptomatic patients;

Assessing postoperative asymptomatic patients after PTCA or CABG, such as in patients with an abnormal ECG response to exercise or those with rest ECG changes precluding identification of ischemia during exercise;

Assessing the patient with angiographic proven disease when it is necessary to identify the "culprit" lesion for revascularization with surgery or angioplasty;

Differentiating ischemic and non-ischemic cardiomyopathy;

Evaluating right ventricular function in patients with pulmonary hypertension; or

Evaluation following cardiac transplantation.


Limitations

Myocardial perfusion imaging is not indicated:
In the absence of symptoms following normal coronary angiography.

When there is no probability of intervention:
risk too high;
patient refuses to consider; or
unacceptable comorbidities.

As repetitive, frequent testing in the absence of changing clinical parameters, especially in individuals with known CAD.

Screening for coronary disease is not a Medicare covered indication.



Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
999x Not Applicable



Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the policy, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

99999 Not Applicable



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