Coding for two different types of myocardial perfusion PET/CT studies

Q.

Can you explain the difference between CPT^® codes 78431 and 78433?

A.

78431 is a myocardial perfusion PET/CT with multiple studies (rest and stress). It’s essentially the same as the older code 78492 with the addition of a non-diagnostic CT for attenuation correction and anatomic localization when both are performed on the same machine. In addition, this year, CPT specifically included wall motion and ejection fraction in the codes when performed.

CPT code 78433 defines a myocardial perfusion PET/CT plus a metabolic (myocardial viability) PET/CT-2 PET studies are done in the same session, using 2 different radiopharmaceuticals, usually for cardiac sarcoidosis.

The codes and full descriptions are as follows:

78431   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), with concurrently  acquired computed tomography transmission scan

78433   Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (e.g., myocardial viability); with concurrently acquired computed tomography transmission scan