2025 CPT code 78492
Effective Date: N/A Radiology - Nuclear Medicine Feed
Myocardial perfusion imaging using positron emission tomography (PET) with multiple studies performed at rest and under stress (exercise or pharmacologically induced).
Modifiers 26 (professional component) and TC (technical component) can be applied to this code to distinguish between the physician's interpretation and the technical performance of the scan, respectively. Modifier 52 (reduced services) would be appropriate if the procedure was not fully completed. Modifier 76 would be used if the same provider repeated the procedure. Modifier 77 if a different provider performed it.
Medically necessary when evaluating known or suspected coronary artery disease, assessing myocardial viability, or monitoring the effects of treatment on heart function. The medical necessity must be clearly documented in the patient's record.
In simple words: This procedure uses a PET scan to create three-dimensional images of your heart to see how well blood flows to the heart muscle, both at rest and during stress (induced by exercise or medication). It can also show how well your heart pumps and the percentage of blood pumped out with each beat.
Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic)
Example 1: A patient with suspected coronary artery disease undergoes a myocardial perfusion PET scan at rest and during exercise to evaluate the blood flow to the heart muscle under stress., A patient with a history of heart attack has a rest/stress myocardial perfusion PET to assess the extent of damage and the heart's recovery., A patient before undergoing chemotherapy has this procedure to assess baseline heart function as some chemotherapy drugs can be cardiotoxic.
Documentation should include the indication for the study, type of stressor used (exercise or pharmacological), patient's response to stress, and the interpretation of the images including wall motion and ejection fraction, if performed. The documentation should also include the medical necessity for performing the multiple studies.
** As of December 10, 2024, this information is current. Always verify coding guidelines with the most up-to-date resources. For accurate reimbursement, ensure correct coding of the radiopharmaceutical used during the procedure. For questions about specific payer policies, contact the payer directly or consult a coding expert. iFrameAI can provide more precise and up to date information.
- Specialties:Cardiology, Nuclear Medicine, Radiology
- Place of Service:Office, Outpatient Hospital, Independent Clinic, Mobile Unit