Bullet Points on NCD 20

Bullet Points on NCD 20.4 – ICD’s

There is a Major Focus on indications for implantation.

READ AND UNDERSTAND NCD 20.4 regarding the specifics of what patients are appropriate for ICD placement and document the specifics on the procedure note.

Briefly:

1. Documented VF not due to transient or reversible cause.

2. VT (spontaneous or induced at EPS) not associated with acute MI or transient or reversible cause.

3. Familial or inherited conditions at high risk of life threatening arrhythmias.

4. CAD, prior MI, EF < 35%, VT or VF at EPS and IF a. MI more than 40 days prior to implant AND b. EPS performed more than 4 weeks after MI.

5. Prior MI, EF < 30%, as long as patient is NOT a. NYHC Class IV b. In cardiogenic shock or having symptomatic hypotension in a stable rhythm. c. Post CABG or Coronary Intervention in past 3 months. d. Post enzyme positive MI in past 40 days. e. In need of and a candidate for coronary revascularization. f. Otherwise expected to survive for less than 1 year

6. Prior MI, Ischemic DCM, EF < 35%, and FC II or III CHF.

7. Non-Ischemic DCM, EF < 35%, > 3 months duration, and FC II or III CHF.

8. Candidates for CRT, FC IV CHF, and do not have irreversible brain damage. 9. In general, exclusions are: a. Irreversible brain damage. b. Not otherwise expected to survive for more than 1 year. c. Inability to give informed consent.

Other notable points are:

1. EF can be documented by cath, nuclear, or echo.

2. For Primary Prevention indications, center must participate in a CMS approved registry or clinical trial.

3. For Primary Prevention indications, must justify the use of a device other than a single lead device. See NCD 20.8 – Pacemakers for further information regarding this.

"Please be sure to define admissions as OUTPATIENT as opposed to INPATIENT unless criteria for the latter are clearly met. See the discussion on this subject that is listed separately in this information as well."