2025 CPT code 78469

Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification.

Adhere to the official CPT coding guidelines and any payer-specific instructions for accurate and compliant coding.Appropriate modifiers (e.g., 26 for professional component, TC for technical component) may be needed depending on the services performed.

Modifiers 26 (professional component) and TC (technical component) can be applied to this code, depending on the services performed.Other modifiers may apply based on specific clinical circumstances, such as multiple procedures (modifier 51).

Medical necessity for 78469 is established when there is a clinical indication suggestive of myocardial ischemia or infarction such as chest pain, abnormal ECG findings, or elevated cardiac biomarkers. The test aids in risk stratification and treatment planning in patients with suspected or confirmed CAD or following MI.

A physician specializing in nuclear cardiology or a qualified radiologist typically performs and interprets this procedure.The clinical responsibility involves administering the radiotracer, acquiring images, analyzing the results, and providing a report to the referring physician.In a hospital setting, the technical component (image acquisition) might be handled by technologists under physician supervision.

IMPORTANT For myocardial sympathetic innervation imaging, see codes 0331T and 0332T. Do not report 78469 with 78800, 78801, 78802, 78803, 78804, 78830, 78831, 78832, or 78835.

In simple words: This test uses a special camera and a tiny amount of radioactive material to create detailed pictures of your heart. It helps doctors see if there's damage to your heart muscle, often after a heart attack.The radioactive material is injected into a vein and is detected by the cameras to show how blood flows through your heart muscle.

This CPT code 78469 represents myocardial imaging using infarct-avid radiotracers, employing planar and tomographic single-photon emission computed tomography (SPECT) techniques.Quantification of tracer uptake may be included. This procedure assesses myocardial perfusion and identifies areas of damaged heart muscle, often following a myocardial infarction (MI).The technique involves injecting a radiotracer into a vein, allowing it to accumulate in the heart muscle.The emitted gamma radiation is then detected by specialized cameras to create images. Planar imaging and tomographic SPECT imaging, which allows for 3D reconstruction, may be used.

Example 1: A patient presents to the emergency department (ED) three days after experiencing chest pain consistent with a myocardial infarction (MI).A 78469 is ordered to assess the extent of myocardial damage., A patient with a history of coronary artery disease (CAD) undergoes a stress test and subsequent myocardial perfusion imaging (MPI) using code 78469 to evaluate myocardial viability and ischemia., A patient presents with recurrent chest pain and abnormal electrocardiogram (ECG) findings. Code 78469 is ordered to evaluate the location and extent of any myocardial ischemia or infarction.

Complete patient history, including symptoms and risk factors for coronary artery disease.Detailed documentation of the procedure itself, including the radiotracer used, imaging parameters, and image quality.Physician interpretation and report including description of findings and clinical correlation.Any pertinent lab results, such as cardiac biomarkers (e.g., troponin) and ECG findings.

** The choice of radiotracer and the specific imaging protocols may vary depending on the clinical context and the available equipment. This code does not include the cost of the radiopharmaceutical.

  • Revenue Code: I1E (STANDARD IMAGING - NUCLEAR MEDICINE)
  • RVU: The RVUs for this code vary based on geographic location, facility type, and other factors.Consult your local Medicare fee schedule or other relevant payment system for precise RVU values and reimbursement rates.
  • Global Days : Global period information is not specified for this code.Consult the payer's specific guidelines for any applicable global periods.
  • Payment Status: Active
  • Modifier TC rule: Modifier TC may be used to indicate the technical component if billed separately from the professional component.
  • Fee Schedule : Historical fee schedule data is not provided. Consult publicly available resources, such as the CMS website, for historical fee schedules for this CPT code.
  • Specialties:Cardiology, Nuclear Medicine, Radiology
  • Place of Service:Inpatient Hospital, Outpatient Hospital, Ambulatory Surgical Center
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