75574

Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D rendering and interpretation (CCTA)

CPT 75574 describes a Computed Tomographic Angiography (CTA) of the heart, specifically focusing on the coronary arteries and, if present, coronary artery bypass grafts. This procedure, commonly referred to as Coronary CTA (CCTA), is a non-invasive diagnostic imaging tool used to visualize the coronary anatomy and identify the presence of atherosclerotic plaque and luminal narrowing. The procedure requires high-speed multi-detector row CT (MDCT) scanners, typically 64-slice or higher, to provide the spatial and temporal resolution necessary to image the rapidly moving heart. The examination involves the intravenous administration of iodinated contrast material to opacify the coronary lumen. To ensure high-quality diagnostic images, the patient's heart rate must often be pharmacologically controlled (usually via beta-blockers) to a target of 60 beats per minute or lower, and sublingual nitroglycerin is frequently administered to dilate the coronary arteries for better visualization. The acquisition is synchronized with the electrocardiogram (EKG gating) to minimize motion artifacts, using either prospective triggering (pulsed radiation during a specific phase of the cardiac cycle) or retrospective gating (continuous radiation with data selected post-acquisition). The technical component of 75574 includes the data acquisition, necessary post-processing, and 3D rendering (such as multiplanar reformations, maximum intensity projections, and volume-rendered images) required for a comprehensive evaluation. The professional component involves the expert interpretation of the coronary anatomy, assessment of stenosis severity, plaque characterization (calcified vs. non-calcified), and evaluation of cardiac chambers and bypass grafts if applicable.

Clinical Indications

  • Evaluation of symptomatic patients with low to intermediate risk for coronary artery disease (CAD).
  • Assessment of suspected coronary anomalies.
  • Evaluation of coronary artery bypass graft (CABG) patency.
  • Clarification of equivocal or inconclusive stress test results (exercise, nuclear, or stress echo).
  • Evaluation of new-onset heart failure or cardiomyopathy to rule out ischemic etiology.
  • Pre-operative assessment prior to non-coronary cardiac surgery (e.g., valve replacement) in patients at risk for CAD.
  • Mapping of pulmonary veins prior to ablation for atrial fibrillation.
  • Evaluation of acute chest pain in the emergency department for patients with low-to-intermediate probability of acute coronary syndrome.

Procedure Steps

  1. Patient preparation: Ensure patient is NPO for several hours; assess renal function (creatinine/GFR) and allergy history.
  2. Heart rate optimization: Administer oral or intravenous beta-blockers or calcium channel blockers if the resting heart rate is above the threshold for optimal imaging.
  3. Vasodilation: Administer sublingual nitroglycerin immediately before the scan to maximize coronary artery diameter.
  4. Patient positioning: Place the patient supine on the CT table and apply EKG leads for cardiac gating.
  5. Scout imaging: Perform initial low-dose CT scans to determine the scan range (from the tracheal bifurcation to the base of the heart).
  6. Bolus tracking: Perform a test bolus or automated bolus tracking to determine the optimal delay for contrast arrival in the ascending aorta.
  7. Contrast administration: Inject 60-100 mL of iodinated contrast via a high-pressure power injector into an antecubital vein.
  8. Data acquisition: Execute the high-resolution CT scan during a single breath-hold (typically 5-15 seconds) with EKG synchronization.
  9. Post-processing: Use dedicated workstations to perform 3D reconstructions, including curved planar reformations (CPR) and volume rendering.
  10. Interpretation: Analyze the images for coronary stenosis, plaque morphology, and bypass graft integrity.

Coding Guidelines

  • Code 75574 includes 3D rendering (76376 or 76377); do not report these codes separately.
  • Do not report 75574 in conjunction with heart structure CT codes 75572 or 75573, or calcium scoring code 75571.
  • The code includes the administration of contrast; do not report 71275 (CTA chest) separately for the same session.
  • If coronary calcium scoring is performed during the same session, it is considered inclusive of 75574.
  • For Fractional Flow Reserve derived from CT (FFR-CT), see Category III codes 0501T, 0502T, 0503T, and 0504T.
  • The professional component (modifier 26) and technical component (modifier TC) may be billed separately depending on the setting.

Associated ICD-10 Codes