High-Speed CT for Heart Disease - AAPC

MEDICAL POLICY

Policy #: 355

Original policy date: 6/1996 Revised date: 4/11/2014

Page: 1 of 12

Title High-speed CT for Heart Disease Contrast-Enhanced Computed Tomographic Angiography (CTA) for Coronary Artery Evaluation Computed Tomography to Detect Coronary Artery Calcification Electron Beam CT Scan (Ultrafast CT or Cine CT)

When services are covered for commercial products (excluding Medicare HMO Blue, and Medicare PPO Blue) We cover contrast-enhanced computed tomographic angiography for evaluation of anomalous (native) coronary arteries in symptomatic patients when conventional angiography is unsuccessful or equivocal and when the results will impact treatment (ICD-9-CM diagnosis 746.85).6

We cover contrast-enhanced computed tomographic angiography for the evaluation of patients without known coronary artery disease and acute chest pain in the emergency room/emergency department setting.6

When services are not covered for commercial products (excluding Medicare HMO Blue, and Medicare

PPO Blue)

We do not cover contrast-enhanced computed tomographic angiography for coronary artery evaluation for

all other indications since it is considered investigational and does not meet the BCBSMA medical Technology Assessment Guidelines, #350.6

We do not cover High Speed CT Technology, which may be referenced as the following, for other than the indications stated above:

Multislice or Multidetector contrast enhanced computed tomographic angiography (MDCT) Angiography (CTA) for Coronary Artery Evaluation Electron Beam (EBCT): ultrafast CT or Cine CT

We do not cover computed tomography to detect coronary artery calcification since it is considered investigational and does not meet the BCBSMA Medical Technology Assessment Guidelines, #350. 9

Note: The high-speed technology used in this exam is either the Electron beam (EBCT)/Ultra fast CT or Multidetector Computed Tomographic Angiography (MDCT).

When services are covered for Medicare HMO Blue and Medicare PPO Blue7 We cover multislice or multidetector contrast-enhanced computed tomographic angiography (CCTA) for the following indications in accordance with Medicare Local Coverage Determination (LCD.)7

Facilitation of the diagnostic cardiac evaluation of a patient with chest pain syndrome (e.g. chest pains, anginal equivalent, angina). Note: Depending on the clinical presentation, the MDCT for coronary artery evaluation may precede a perfusion stress test, or it may be used to clarify a perfusion stress test that is non-diagnostic, equivocal, or is inadequate in explaining the patient's symptoms.

 For facilitation of the management decision of a symptomatic patient with known coronary artery disease. (eg., post-stent, post CABG) when the results of the MDCT may guide the decision for repeat invasive intervention.

For assessment of suspected congenital anomalies of coronary circulation or great vessels. For assessment of the symptomatic patient when presentation is suspicious of aortic dissection. For assessment of coronary artery anatomy prior to non-coronary cardiac surgery (e.g. valve repair or

replacement, ascending aortic aneurysm or dissection repair). For facilitation of diagnostic evaluation and management of patients with or without implantable

cardiac devices (pacemakers, ICDs) who are about to undergo, or have undergone therapeutic electrophysiological procedures, in which detailed anatomical knowledge of the atria, pulmonary veins, and cardiac veins is required. Patients with indications for revascularization with significant coronary lesions found on MDCT may still require diagnostic coronary angiography to direct final decisions regarding revascularization and performance of PTCA. Such diagnostic angiography must be performed in a setting capable of therapeutic angiography.

Note: For diagnoses that are considered medically necessary for Medicare HMO Blue, and Medicare PPO Blue members, see footnote 7.

When services are not covered for Medicare HMO Blue and Medicare PPO Blue7 We do not cover multislice or multidetector contrast-enhanced computed tomographic angiography (CCTA) of the heart and great vessels for the following in accordance with Medicare Local Coverage Determination.7

Screening, i.e., in the absence of signs, symptoms or disease. This modality for coronary artery assessment when devices used are other than those that process thin,

high resolution slices (1 mm or less). The multidetector scanner must have at least 16 slices per second capability. The administration of beta blockers and the monitoring of the patient by a cardiologist during the MDCT are not separately payable services. When the study is prescribed by other than a physician or a qualified non-physician practitioner. When a physician or qualified non-physician provider are not present during testing. The electron beam tomography (EBT) technology Coronary artery evaluation of a patient where there is pre-test knowledge of extensive coronary calcification that would diminish the interpretive value Coronary artery evaluation of a patient presenting with an acute myocardial infarction or an acute coronary syndrome. If performed prior to percutaneous revascularization in a patient who has already undergone diagnostic cardiac catheterization.

Individual consideration (Clinical Exceptions) All our medical policies are written for the majority of people with a given condition. Each policy is based on medical science. For many of our medical policies, each individual's unique clinical circumstances may be considered in light of current scientific literature. For consideration of an individual patient, physicians may send relevant clinical information to:

Policy #355: High-speed CT for Heart Disease -2-

For services already billed Blue Cross Blue Shield of Massachusetts Provider Appeals PO Box 986065 Boston, MA 02298

Prior to performance of service Blue Cross Blue Shield of Massachusetts Case Creation/Medical Policy One Enterprise Drive Quincy, MA 02171 Tel: 1-800-327-6716 Fax: 1-888-282-0780

Managed care guidelines Any specialist visit requires a referral for Medicare HMO Blue. For all other Managed Care plans, any specialist visit requires a referral, except for visits performed by

OB/GYN specialists. Authorizations are not required.

Indemnity and PPO guidelines All authorization requirements are determined by the individual's subscriber certificate, however: Authorizations are required for all inpatient services Authorizations are not required for most outpatient services as determined by the individual's subscriber

certificate Referrals to a specialist are not required.

Coding information Procedure codes are from current CPT, HCPCS Level II, Revenue Code, and/or ICD-9-CM manuals, as recommended by the American Medical Association, Centers for Medicare and Medicaid Services and American Hospital Associations. Blue Cross Blue Shield Association

The following codes are included below for informational purposes. Inclusion or exclusion of a code does not constitute or imply member coverage or provider reimbursement. Please refer to the member's contract benefits in effect at the time of service to determine coverage or non-coverage as it applies to an individual member.

CPT codes CPT codes: 75571 75572

75573

75574

Code Description Computed tomography of the heart, without contrast material, with quantitative evaluation of coronary calcium Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed) Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease (including 3D image postprocessing, assessment of LV cardiac function, RV structure and function and evaluation of venous structures, if performed) Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed)

HCPCS Codes

HCPCS codes: S8092

Code Description Electron beam computed tomography (also known as ultra fast CT and cine CT)

Policy #355: High-speed CT for Heart Disease -3-

ICD-9 Diagnosis Codes

ICD-9-CM diagnosis codes: 746.85

Code Description Congenital coronary artery anomaly

Note: For additional diagnoses that are considered medically necessary for Medicare HMO Blue, and Medicare PPO Blue, see footnote 7.

Other information For Medical Technology Assessment Guidelines see document #350.

Policy update history Issued 6/96. Reviewed 7/97; no changes in coverage were made. Reviewed 4/98; patient information added. No changes in coverage were made. Reviewed 4/99, no changes in coverage were made. Updated 4/00 to include individual consideration guidelines for patients with significant risk factors for CAD who have equivocal stress test results. Reviewed 4/01, no changes in coverage were made. Reviewed 4/02 MPG Cardiology, no changes in coverage were made. Reviewed 4/03 MPG Cardiology, no changes in coverage were made. Updated 4/04 MPG cardiology, no changes in coverage were made. 1/05 updated to include BCBSA new national policy summary information and associated references for computed tomographic angiography (CTA) for coronary artery evaluation, no changes in coverage were made (see footnote #6). Reviewed 4/06 MPG- cardiology, no changes in coverage were made. Updated 7/06 billing information and footnote 6 rationale and references based on BCBSA national policy for CTA for coronary artery evaluation. 9/06 updated to include covered indications for Multislice or multidetector computed tomography angiography for Medicare HMOB and Medicare PPO Blue (only), effective 9/23/06, in accordance w/ Local Medicare's LCD; footnote #7 lists ICD-9-CM diagnoses which support the coverage indications defined in the Local Medicare LCD. 11/06 clarified non-covered language under "when services are not covered"- first paragraph; and the Individual Consideration (IC) language; removal of the reference to "patients with significant risk factors for coronary artery disease" supports IC for clinical indications as determined by a participating physician provider. 1/07 BCBSA National Policy reviewed 6.01.43 Contrast-enhanced Computed Tomography Angiography (CTA) for Coronary Artery Evaluation; BCBSMA to cover CTA for the clinical indication of anomalous (native) coronary artery(ies) (ICD-9-CM diagnosis 746.85) in symptomatic patients, effective March 2007. 4/07 BCBSA National Policy reviewed-6.01.43 Contrast-enhanced Computed Tomography Angiography (CTA) for Coronary Artery Evaluation; no policy statement changes; references added to footnote 6. Reviewed 4/07 MPG Cardiology, no changes is coverage were made. 6/07 Comparison review of BCBSA National Policy, Computed Tomography to Detect Coronary Artery Calcification, completed. BCBSMA policy continues to benchmark BCBSA National policy statement which is unchanged- investigational; footnote #9 added to provide BCBSA policy rationale, recent update, and pertinent references. 4/08 Comparison review of the BCBSA National medical policy Contrast Enhanced-CTA for Coronary Artery Evaluation completed; coverage language unchanged. BCBSMA's coverage language benchmarks this national policy for all Plans excluding Medicare HMOB, Medicare PPO Blue and Blue Medicare PFFS Plus Rx; footnote #6 edited to include additional BCBSA policy rationale and references. Reviewed 4/08 MPGCardiology, no changes in coverage were made. 5/08 Comparison review of BCBSA National medical policy Screening for Lung Cancer Using CT Scanning or Chest Radiographs, completed; investigational coverage status unchanged which BCBSMA benchmarks; this document language edited by adding specific non-covered language for clarity When services are not covered; related footnote edited adding references. 9/08 Comparison review of BCBSA National medical policy Computed Tomography to Detect Coronary Artery Calcification; investigational coverage status unchanged which BCBSMA benchmarks; related footnote edited adding references. 4/09 Comparison of BCBSA National medical policy Contrast Enhanced-CTA for Coronary Artery Evaluation completed; coverage language unchanged. BCBSMA's benchmarks this national policy for all Plans; footnote #6 edited to include additional BCBSA policy rationale and references 2, and 17-26. Reviewed 4/09 MPG ? Cardiology, no changes in coverage were made. 5/09 Clarified the coverage statements

Policy #355: High-speed CT for Heart Disease -4-

for commercial and Medicare Advantage products for contrast enhanced computed tomographic angiography (CCTA); coverage language for these products re-ordered. Updated 9/09 based on the BCBSA non-coverage national policy, Computed Tomography to Detect Coronary Artery Calcification, that is unchanged, which BCBSMA benchmarks. References 7, 12, and 13 added. Updated 12/09 to add new 2010 CPT codes that are effective 1/1/10, and removed deleted CPT codes 0144T, 0145T, 0146T, 0147T, 0148T, 0149T, 0150T and 0151T, effective 1/1/2010. Updated 1/10 based on a comparison review of the BCBSA national policy, Screening for Lung Cancer Using CT Scanning or Chest Radiographs. BCBSA investigational non-covered language, which BCBSMA benchmarks, is unchanged. Footnote 5 edited to add the recent rationale, references re-ordered with the addition of new references 2, 8, 10 and 11. Reviewed 4/2010 MPG-Cardiology, no changes in coverage were made. Updated 1/2011 with additional references for CT scanning and chest rays for screening for lung cancer. Reviewed 4/2011 MPG ? Cardiology and Pulmonology, no changes in coverage were made. Updated 3/2012 with additional references based on BCBSA national policy, reviewed 7/ 2011. Updated 3/2012 to add procedure code 87.41. Reviewed 4/2012 MPG-Cardiology and Pulmonology, no changes in coverage were made. Updated 11/1/2012 Contrast-Enhanced Computed Tomographic Angiography (CTA) for Coronary Artery Evaluation - Medically necessary indication added for acute chest pain in the emergency setting. Effective November 1, 2012. Updated 11/1/2012 Screening for Lung Cancer Using CT Scanning - Low-dose CT scans for lung cancer screening changed to medically necessary annually for 3 consecutive years for selected individuals and investigational in all other situations. Effective November 1, 2012. Updated 11/1/2012 - Sscreening for Lung Cancer Using CT Scanning - Policy statement on chest radiographs removed and title changed accordingly. Updated 1/8/2014 - Language on Screening for Lung Cancer Using CT was transferred to MP: #619, Screening for Lung Cancer Using CT. 2/2014 New references added from BCBSA National medical policy. 4/2014 Clarified coding information

Scientific background, Rationale and References 1 Based upon a 8/94 TEC (Technology Evaluation Center) assessment of medical literature from 1990-7/94 on EBCT to detect coronary artery calcification as a screen for CAD, to evaluate bypass graft patency, and to evaluate myocardial perfusion.

Screening: of asymptomatic individuals by detecting coronary calcification. Most studies combined results of symptomatic and asymptomatic individuals. Only one reported prevalence and extent for coronary artery calcium in asymptomatic men and women: Janowitz (1993 n=1396). Calcium was detected in 11% of men under age 29, 21% of men 30-39, 44% of men 40-49, 72% of those 50-59, 85% of those 60-69, 94% of those 70-79, and in 100% of those over age 80. In women, the prevalence was about half that reported for men, until age 60, when the difference diminished.

Does the detection of calcium change management? Numerous studies have tried to correlate the degree of calcification with the presence of CAD (Agatston 1992, Janowitz 1991, and others) using history, angiography, autopsy, and other measures. Unfortunately, none of these studies examines exclusively asymptomatic individuals. Of those with asymptomatic subgroups, the studies suffer from flawed analysis, pooling results of symptomatic and asymptomatic individuals.

Agatston (1990) studied subjects with (n=109) and without (n=475) known CAD (Hx MI or >50% narrowing on angio). There were significant differences in mean total calcium scores for those with and without CAD, grouped by decade of life. (Ex: for patients aged 40-49, mean calcium scores were 27+/-9 in those without clinical CAD vs 291+/-93 in those with CAD). however, the PPV were low, ranging from 24% with a calcium score of 25, up to 60% in those with calcium scores of 300 for the 40-49 age group. These results reflect data from both symptomatic and asymptomatic patients. Breen (1992) noted that in "younger" patients, EBCT was sensitive (94%) and moderately specific (72%), for angiographically detectable disease. However, all his patients were ones referred for cath, hence unlikely to be asymptomatic. Janowitz (1993) (n=1396) reported data with large standard deviations from the mean in each age group. Whether this quality of results permits risk stratification is unclear.

Policy #355: High-speed CT for Heart Disease -5-

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download