Documentation requirements for a cardiac PET and pharmacologic stress test with cardiac flow reserve (CFR)

Q.

Are there guidelines of what has to be reported for a cardiac PET with stress with cardiac flow reserve (CFR)?  Does specific data from the CFR need to be included or is a mention that the study was performed with CFR sufficient? 

A.

The doctor must state more than just that it was done. There isn’t information about what specifically needs to be said, but best practice is for the provider to give an interpretation of the CFR in the dictated report. 

The following from CPT® Changes describes what needs to be done and then “generate an overall report”. So, to help validate this charge, I would look for “numeric output for AQMBF in ml/g/min for rest, stress, and indexed/reserve flow for each coronary bed and for the global left ventricular.”

The code and full description are as follows:

78434 Absolute quantification of myocardial blood flow (AQMBF), positron emission tomography (PET), rest and pharmacologic stress (list separately in addition to code for primary procedure)

CPT Changes 2020 has the following information: 

Clinical Example (78434)

A 67-year-old male requires additional physiological assessment during a pharmacologic stress/rest PET or PET/CT myocardial perfusion imaging procedure and undergoes absolute quantitation of myocardial blood flow (AQMBF) imaging. [Note: This is an add-on service. Only consider the additional work related to AQMBF.]

Description of Procedure (78434)

Under the direction of the physician, following stress/rest PET or PET/CT myocardial perfusion imaging the nuclear medicine technologist acquires images for PET myocardial perfusion imaging in a manner that will also allow for AQMBF imaging (eg, images are acquired in 3D and list mode). Then re-bin the data to allow AQMBF and export the data set to a dedicated computer with software program for AQMBF. Transfer the processed data set and quality control information to the interpreting physician. Then review the quality control for AQMBF (e.g., the bolus duration, peak, and plateau waveforms) and, if quality is acceptable, review the numeric output for AQMBF in ml/g/min for rest, stress, and indexed/reserve flow for each coronary bed and for the global left ventricular. Also review the interactive polar map display. Integrate the AQMBF data with the static perfusion image data, attenuation maps, clinical data, and generate an overall report.