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The CPT® Code 0504T refers to a noninvasive procedure that estimates the coronary fractional flow reserve (FFR) derived from data obtained through coronary computed tomography angiography (CCTA). This procedure utilizes advanced computational fluid dynamics physiologic simulation software to analyze functional data, which is essential for assessing the severity of coronary artery disease (CAD). The primary purpose of this procedure is to evaluate the degree of ischemia caused by coronary stenosis, which is a narrowing of the coronary arteries that can lead to reduced blood flow to the heart muscle. By determining the severity of ischemia, healthcare providers can make informed decisions regarding the potential benefits of surgical revascularization compared to medical management options. During the procedure, images from the CCTA are used to create a digital model of the coronary arteries. This model incorporates patient-specific physiological conditions, particularly during peak hyperemia, which is a state of increased blood flow. The FFR is calculated across the entire coronary vascular tree, allowing for a comprehensive assessment of blood flow and pressure under maximum hyperemic conditions. The integration of anatomical data, physiological parameters, and computational fluid dynamics is crucial for accurately calculating coronary artery blood flow and pressure. CPT® Code 0504T specifically reports the review of anatomical data in conjunction with the estimated FFR model to address any discrepancies in the data. This includes the interpretation of the findings and the generation of a report that summarizes the results. It is important to note that this code is part of a series of codes that collectively describe the various components involved in the assessment of coronary artery disease using CCTA and computational fluid dynamics, ensuring a thorough evaluation of the patient's condition.
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The noninvasive estimated coronary fractional flow reserve (FFR) procedure is indicated for patients who exhibit symptoms or conditions related to coronary artery disease (CAD). The following are specific indications for performing this procedure:
The procedure for estimating coronary fractional flow reserve (FFR) using CPT® Code 0504T involves several critical steps, each contributing to the overall assessment of coronary artery disease. The following outlines the procedural steps:
Post-procedure care following the noninvasive estimated coronary fractional flow reserve assessment typically involves monitoring the patient for any immediate reactions to the procedure. Since this is a noninvasive test, there are generally no significant recovery concerns. However, healthcare providers may review the findings with the patient and discuss the implications for treatment options, including potential surgical revascularization or continued medical management. Follow-up appointments may be scheduled to further evaluate the patient's condition and response to any initiated treatment plans based on the results of the FFR assessment.
| Short Descr | COR FFR DATA REVIEW I&R | Medium Descr | COR FFR CTA DATA REVIEW W/INTERPJ & FINAL REPORT | Long Descr | Noninvasive estimated coronary fractional flow reserve (FFR) derived from coronary computed tomography angiography data using computation fluid dynamics physiologic simulation software analysis of functional data to assess the severity of coronary artery disease; anatomical data review in comparison with estimated FFR model to reconcile discordant data, interpretation and report | Status Code | Carriers Price the Code | Global Days | XXX - Global Concept Does Not Apply | PC/TC Indicator (26, TC) | 2 - Professional Component Only Code | Multiple Procedures (51) | 9 - Concept does not apply. | Bilateral Surgery (50) | 9 - Concept does not apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 9 - Concept does not apply. | Co-Surgeons (62) | 9 - Concept does not apply. | Team Surgery (66) | 9 - Concept does not apply. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Items and Services Not Billable to the MAC | Berenson-Eggers TOS (BETOS) | none | MUE | Not applicable/unspecified. |
| X5 | Diagnostic services requested by another clinician: for reporting services by a clinician who furnishes care to the patient only as requested by another clinician or subsequent and related services requested by another clinician; this modifier is reported for patient relationships that may not be adequately captured by the above alternative categories; reporting clinician service examples include but are not limited to, the radiologist's interpretation of an imaging study requested by another clinician | GZ | Item or service expected to be denied as not reasonable and necessary | GC | This service has been performed in part by a resident under the direction of a teaching physician | MH | Unknown if ordering professional consulted a clinical decision support mechanism for this service, related information was not provided to the furnishing professional or provider | ME | The order for this service adheres to appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | GY | Item or service statutorily excluded, does not meet the definition of any medicare benefit or, for non-medicare insurers, is not a contract benefit | MF | The order for this service does not adhere to the appropriate use criteria in the clinical decision support mechanism consulted by the ordering professional | GA | Waiver of liability statement issued as required by payer policy, individual case | 52 | Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 76 | Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | 77 | Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service. | CC | Procedure code change (use 'cc' when the procedure code submitted was changed either for administrative reasons or because an incorrect code was filed) | FS | Split (or shared) evaluation and management visit | GV | Attending physician not employed or paid under arrangement by the patient's hospice provider | MA | Ordering professional is not required to consult a clinical decision support mechanism due to service being rendered to a patient with a suspected or confirmed emergency medical condition | MB | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of insufficient internet access | MC | Ordering professional is not required to consult a clinical decision support mechanism due to the significant hardship exception of electronic health record or clinical decision support mechanism vendor issues | MG | The order for this service does not have applicable appropriate use criteria in the qualified clinical decision support mechanism consulted by the ordering professional | PD | Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days | Q0 | Investigational clinical service provided in a clinical research study that is in an approved clinical research study | Q1 | Routine clinical service provided in a clinical research study that is in an approved clinical research study | X4 | Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period |
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| 2023-12-31 | Deleted | Code Deleted. See 75580. |
| 2021-01-01 | Note | Guidelines changed. |
| 2018-01-01 | Added | Code Added. |
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