Wednesday, August 29, 2007

Blue Cross Illinois to Permit Reimbursement for CTA

Effective 1 September 2007, Blue Cross/Blue Shield of Illinois will permit reimbursement for CT Angiography for the following conditions:
Computed Tomography (CT) Angiography (CTA), with or without contrast enhancement or media, utilizing 64-slice or greater multi-detector row CT (MDCT) scanner, as an adjunct to other testing may be considered medically necessary for any of the following indications:

A. Detection of coronary artery disease (CAD) in:

Symptomatic individuals (such as, chest pain syndrome as described by the American College of Cardiology [ACC]) who:
Have intermediate pre-test probability of CAD (as identified by the ACC guidelines); AND
Had a non-diagnostic stress electrocardiograph (ECG or EKG) (as defined by the ACC guidelines); AND
Have a contraindication to an exercise stress test or for whom the results are equivocal or suspected to be inaccurate, OR
Symptomatic individuals with unexplained chest pain or anginal equivalent symptoms (as described by the ACC) who:
Have intermediate pre-test probability of CAD (as identified by the ACC guidelines); AND
Had no ECG changes suggestive of ischemia or infarction; AND
Had negative cardiac enzymes and cardiac marker results; AND
Have a contraindication to an exercise stress test or for whom the results are equivocal or suspected to be inaccurate.

B. Evaluation of cardiac structure and function:

To assess complex congenital heart disease, including anomalies of coronary circulation, great vessels, and cardiac chambers and valves; OR
To assess coronary arteries in individuals with new onset heart failure when ischemia is the suspected etiology and cardiac catheterization and nuclear stress test are not planned; OR
To assess a cardiac mass (suspected tumor or thrombus) in individuals with technically limited images from echocardiography, magnetic resonance imaging (MRI), or transesophageal echocardiography (TEE); OR
To assess a pericardial condition (such as, pericardial mass, constrictive pericarditis, or complications of cardiac surgery in patients) with technically limited images from echocardiography, MRI, or TEE; OR
For non-invasive coronary vein mapping prior to placement of a biventricular pacemaker; OR
For non-invasive coronary arterial mapping, including internal mammary artery prior to repeat cardiac surgical revascularization; OR
For evaluation of pulmonary vein anatomy prior to invasive radiofrequency ablation for atrial fibrillation; OR
To assess coronary arteries in asymptomatic patients scheduled for open heart surgery for valvular heart disease in lieu of invasive coronary arteriography.
Note: Refer to the Rationale in this medical policy for guidelines issued by the ACC.

MDCT with less than 64-slice scanner is considered experimental, investigational and unproven.

CTA, using MDCT, to screen asymptomatic individuals for CAD or to evaluate individuals with cardiac risk factors in lieu of cardiac evaluation and standard non-invasive cardiac testing is considered experimental, investigational and unproven.

CTA, using MDCT, for any other indication not listed above is considered experimental, investigational and unproven.

Note: For any other Electron Beam Computed Tomography (EBCT) Technology applications, such as Whole Body Scanning or Imaging for screening, see policy RAD604.006; for CT for Calcium Scoring, see policy RAD604.009.
It's a whole new world...

-Wes

Reference: Blue Cross/Blue Shield Illinois' website.

1 comment:

Rob said...

That's not why I get a CTA on a patient. I get coronary calcium scores on asymptomatic people who are at intermediate risk to assess how aggressive to be with their lipid lowering therapy. To me that is the main use of the modality. I do understand the desire to have more than one angiographic modality (especially with renal artery), but the volume of patients who meet my criteria is very high and it really does help with decision making.

I had a friend who is an academic blast me for doing testing on asymptomatic people, but I would far more want to diagnose coronary disease before it is symptomatic rather than after.