Summary & Overview
CPT 78428: Left-to-Right Cardiac Shunt Detection
CPT code 78428 identifies a diagnostic procedure performed to detect a left-to-right shunt in the heart—an abnormal passage of blood from the left to the right cardiac chambers. This code matters nationally because detection of intracardiac shunts informs clinical management for congenital and acquired heart defects and can affect hospital and imaging resource utilization. Payers commonly involved in coverage and claims for this type of cardiac diagnostic service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise explanation of the clinical purpose of CPT code 78428, how it is used in practice, and the typical sites where the service is delivered. The publication provides benchmarks and comparative policy summaries for major national payers, outlines clinical context for interpretation of results, and highlights common billing considerations. Data gaps from the input are noted where specific taxonomies, ICD-10 pairings, or related codes are not provided. The piece is intended for a national audience of clinicians, coding professionals, and payers seeking clarity on the code’s clinical intent, expected care setting, and payer coverage landscape.
Billing Code Overview
CPT code 78428 describes a diagnostic procedure to identify a left-to-right cardiac shunt, where blood flows abnormally from the left to the right side of the heart. The primary goal of the procedure is to detect abnormalities or defects in intracardiac blood flow that may indicate congenital or acquired shunting.
Service type: Diagnostic cardiac imaging/shunt detection
Typical site of service: Hospital inpatient or outpatient cardiovascular imaging/blood-flow assessment suite, including cardiac catheterization or advanced imaging facilities when needed.
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Clinical & Coding Specifications
Clinical Context
A typical patient is a pediatric or adult outpatient referred to a cardiac imaging lab for evaluation of a suspected intracardiac shunt after abnormal murmur detection, unexplained right-sided volume overload on echocardiography, or hypoxemia. The patient arrives for a nuclear medicine shunt study performed by a cardiology or nuclear medicine team to quantify a left-to-right shunt and localize abnormal intracardiac or extracardiac flow. Pre-procedure workflow includes verification of indications, review of prior echocardiogram or catheterization reports, informed consent, and IV access placement. A radiopharmaceutical is administered intravenously and dynamic and gated imaging is acquired to assess transit of tracer between left and right circulations. A cardiologist or nuclear medicine physician interprets images, documents shunt fraction (if measured), and issues a report with recommendations for correlation with echocardiography or cardiac catheterization if clinically indicated. Typical site of service is an outpatient imaging center, hospital nuclear medicine department, or ambulatory surgery center for patients who require sedation or monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
26 | Professional component | Use when billing only the interpreting physician/service portion of the procedure. |