Top Coding Tips for CPT code 78451 and 78452

In Radiology, most of the CPTcodes are from 7000 series. Some of CPT codes for X-rays, CT, MRI, CTA etc. we have already learnt here. We have even checked few supporting CPT codes like ultrasound guidance (76942) or angiography CPT codes, which should be always reported with the main procedure code. But, today we are here to learn more about CPT code 78451, 78452, 78453 and 78454. These codes are included in the nuclear medicine category because these exam requires injection of radionuclide. A radionuclide, radioactive nuclide or radioisotope is unstable form of a chemical element that radioactively decays, resulting in the emission of nuclear radiation.

We have already checked about coding surgery CPT codes for Lumbar puncture, lumbar discography, AV fistula, Vertebroplasty and kyphoplasty, nephrostogram etc. which are quite complicated procedures. But, these procedures do require radiology CPT codes for supervision and interpretation. Hence, 7000 series codes mainly complete the surgery CPT codes. For example, if a thyroid biopsy or FNA is done using ultrasound guidance, the biopsy CPT codes should be reported with ultrasound guidance (76942) as an add-on code. Same procedure is followed with arthrogram and arthrocentesis procedures. If you are expert in coding these procedures cane easily prepare and clear CPC exam from AAPC.





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CPT code 78451 and 78452 in detail


In these procedures, the patient generally receives an intravenous injection of a radionuclide, usually thallium or technetium-99m for tomographic myocardial perfusion imaging. SPECT (single photo emission computed tomographic) images of the heart are obtained to identify the areas of perfusion versus infarction. There is major difference between planar imaging and SPECT imaging. SPECT imaging involves single or multiple head camera that rotates around the patient to give a three-dimensional (3D) tomographic images of the heart displayed in thin slices. Below is the code description for CPT code 78451 and 78452.

78451 Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, 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):

78452: multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

The above both exams differ only whether it is a single study or multiple studies. Now, here you can see the code description includes rest and stress. When the exam is performed only using either rest or stress, it is termed as single study of myocardial perfusion imaging. But, when both rest and stress is performed for myocardial perfusion imaging, it is termed as multiple studies.

Difference Between CPT code 78451 and 78452


For CPT code 78451, a single study is performed either at rest or stress. For non-stress exam, a radionuclide is injected and heart images are obtained without any stress induction. For stress exam, stress is induced with standard treadmill exercise test. Either rest or Stress, should be performed for coding CPT code 78451. The word “OR” is very important here, it means either rest or stress, but not both should be performed.

For CPT 78452, multiple studies are done at rest and/or stress with a second injection of radionuclide given again in the redistribution and or resting phase just prior to resting images being taken. These codes also include qualitative or quantitative wall motion, ejection fraction (EF), by first pass or gated technique, and additional qualification, when performed.

The most common thing between CPT code 78451 and 78452 is use of SPECT. Myocardial perfusion SPECT images are obtained in these procedures.

Codes Similar to CPT code 78451 and 78452


We have a different set of CPT codes for Myocardial perfusion imaging without the use of SPECT. CPT code 78453 and 78454 are very much similar to above procedure codes but they use only planar imaging.  The only difference between these set of CPT codes is the use of planar and SPECT imaging.

78453 - 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)


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