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Clinical Guidelines UPDATED 03.01.2019 CLINICAL GUIDELINES Cardiology Services Overview Statement The purpose of these clinical guidelines is to assist healthcare professionals in selecting the medical service that may be appropriate and supported by evidence to improve patient outcomes. These clinical guidelines neither preempt the clinical judgment of trained professionals nor advise anyone on how to practice medicine. The healthcare professionals are responsible for all clinical decisions based on their assessment. These clinical guidelines do not provide authorization, certification, explanation of benefits, or guarantee of payment, nor do they substitute for, or constitute, medical advice. Federal and State law, as well as member benefit contract language, including definitions and specific contract provisions/exclusions, take precedence over clinical guidelines and must be considered first when determining eligibility for coverage. All final determinations on coverage and payment are the responsibility of the health plan. Nothing contained within this document can be interpreted to mean otherwise. Medical information is constantly evolving, and HealthHelp reserves the right to review and update these clinical guidelines periodically. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, electronic, mechanical, photocopying, or otherwise, without permission from HealthHelp. All trademarks, product names, logos, and brand names are the property of their respective owners and are used for purposes of information/illustration only. Clinical Guidelines for Medical Necessity Review of Cardiology Services http://www.healthhelp.com | © 2019HealthHelp. All rights reserved. 16945 Northchase Dr #1300, Houston, TX 77060 (281) 447-7000 Page 2 of 151 Table of Contents 1 Overview Statement 2 Table of Contents 3 Cardiac Ablation 5 Cardiac Catheterization 8 Left Heart Catheterization 8 Left and Right Heart Catheterization 15 Right Heart Catheterization 17 Cardiac Defibrillation Device 21 Sub-Cutaneous Implantable Cardiac Defibrillator (SICD) 21 Automatic Implantable Cardiac Defibrillator – Insertion (ICD) 23 Automatic Implantable Cardiac Defibrillator – Removal or Replacement (ICD) 29 Cardiac Electrophysiology Studies 34 Cardiac Pacemaker Device 41 Cardiac Positron Emission Test 48 Cardiac Resynchronization Therapy 55 Cardiac Resynchronization Therapy: Defibrillator (CRT-D) 55 Cardiac Resynchronization Therapy: Pacemaker (CRT-P) 57 Cardiac Single Photon Emission Computerized Tomography 60 Coronary Computed Tomography Angiography 70 Clinical Guidelines for Medical Necessity Review of Cardiology Services http://www.healthhelp.com | © 2019HealthHelp. All rights reserved. 16945 Northchase Dr #1300, Houston, TX 77060 (281) 447-7000 Page 3 of 151 Echocardiogram 73 Transthoracic Echocardiogram (TTE) 73 Tranesophageal Echocardiogram (TEE) 92 Implantable Loop Recorder 101 Leadless Intracardiac Pacemaker 113 Left Atrial Appendage Closure 115 MRA Heart 117 MRI Heart 119 Percutaneous Coronary Interventions 121 Percutaneous Ventricular Assistive Device 128 Trans catheter Aortic Valve Replacement 131 Trans catheter Mitral Valve Replacement 136 Wearable Cardiac Defibrillator 139 Clinical Guidelines for Medical Necessity Review of Cardiology Services http://www.healthhelp.com | © 2019HealthHelp. All rights reserved. 16945 Northchase Dr #1300, Houston, TX 77060 (281) 447-7000 Page 4 of 151 Cardiac Ablation Utilization of a cardiac ablation may be medically appropriate and supported by evidence to improve patient outcomes for the following indications. − Ablation for atrial fibrillation (a-fib) may be reasonable and appropriate when the patient’s medical record demonstrates EITHER of the following: (2, 6) o Patient has atrial fibrillation that terminates spontaneously within seven (7) days of onset or within 48 hours or less with electrical or pharmacological cardioversion; (2,6) o Patient has continuous atrial fibrillation that is sustained for greater than seven (7) days or does not convert after greater than 48 hours following electrical or pharmacological cardioversion; and EITHER of the following; (1,8) . Patient had poor response or was intolerant of at least one antiarrhythmic medication; (2,7) . Patient’s lifestyle would be severely limited by atrial fibrillation or the patient does not prefer long-term therapy. (1,6-7) − Ablation for supraventricular tachycardia (SVT) may be reasonable and appropriate when the patient’s medical record demonstrates EITHER of the following: o Patient is diagnosed with atrioventricular nodal reentrant tachycardia (AVNRT); and ANY of the following: . Patient had poor response or was intolerant of at least one antiarrhythmic medication; (2) . Patient’s lifestyle would be severely limited by atrial fibrillation or the patient does not prefer long-term therapy; (7) . Prior EPS illustrated rapid ventricular rate of concomitant arrhythmia; . Patient is intolerant of drug therapy with recurrent break-through episodes that are life altering. (2) o Patient is diagnosed with Wolf-Parkinson-White (WPW) with tachycardia or other atrioventricular reentrant tachycardia, there is rapid ventricular response via accessory pathway noted; and EITHER of the following: (3) Clinical Guidelines for Medical Necessity Review of Cardiology Services http://www.healthhelp.com | © 2019HealthHelp. All rights reserved. 16945 Northchase Dr #1300, Houston, TX 77060 (281) 447-7000 Page 5 of 151 . Patient had poor response or was intolerant of at least one antiarrhythmic medication; (3,4) . Patient is intolerant of drug therapy with recurrent break-through episodes that are life altering. − Ablation for ventricular tachycardia (VT) may be reasonable and appropriate when the patient’s medical record demonstrates ANY of the following: o Patient has a history of sustained monomorphic VT; and ANY of the following: . Patient is symptomatic with drug-resistant tachycardia; (5) . Patient is symptomatic and intolerant of drug therapy; (9) . Patient is symptomatic and does not desire long-term drug therapy; . Patient has an implantable cardioverter defibrillator (ICD) and is receiving multiple defibrillations not manageable by reprogramming the device or additive drug therapy. o Patient has bundle branch reentrant tachycardia; (5) o Patient has non-sustained monomorphic VT, which is resistant to drug therapy. o Patient is drug intolerant. (5) o Patient does not desire long-term drug therapy. Clinical Guidelines for Medical Necessity Review of Cardiology Services http://www.healthhelp.com | © 2019HealthHelp. All rights reserved. 16945 Northchase Dr #1300, Houston, TX 77060 (281) 447-7000 Page 6 of 151 REFERENCES: 1. Song, M., Maeda, T., Toyoda, Y., & Ishiyama, M. (2011). Midterm Results of Surgical Box Line Ablation for Atrial Fibrillation by Bipolar Radiofrequency. Journal of Cardiac Surgery,26(6), 669-672. doi:10.1111/j.1540- 8191.2011.01328.x 2. Narayan, S., Krummen, D., Shivkumar, K., Clopton, P., Rappel, W., & Miller, J. (2012). Treatment of Atrial Fibrillation by the Ablation of Localized Sources. Journal of American College of Cardiology,60(7), 628-636. Retrieved February 13, 2019, from http://www.onlinejacc.org/content/accj/60/7/628.full.pdf 3. Ceresnak, S. R., Dubin, A. M., Kim, J. J., Valdes, S. O., Fishberger, S. B., Shetty, I., . Pass, R. H. (2015). Success Rates in Pediatric WPW Ablation Are Improved with 3-Dimensional Mapping Systems Compared with Fluoroscopy Alone: A Multicenter Study. Journal of Cardiovascular Electrophysiology,26(4), 412-416. doi:10.1111/jce.12623 4. Wolpert, C., Pitschner, H., & Borggrefe, M. (2007). Evolution of ablation techniques: From WPW to complex arrhythmias. European Heart Journal Supplements,9(Suppl_I). doi:10.1093/eurheartj/sum073 5. Ouyang, F., Fotuhi, P., & Ho, S. (2002). Repetitive monomorphic ventricular tachycardia originating from the aortic sinus cusp. Electrocardiographic characterization for guiding catheter ablation. ACC Current Journal Review,11(4), 86-87. doi:10.1016/s1062-1458(02)00748-1 6. Henz, B. D., Nascimento, T. A., Dietrich, C. D., Dalegrave, C., Hernandes, V., Mesas, C. E., . Paola, A. A. (2009). Simultaneous epicardial and endocardial substrate mapping and radiofrequency catheter ablation as first-line treatment for ventricular tachycardia and frequent ICD shocks in chronic chagasic cardiomyopathy. Journal of Interventional Cardiac Electrophysiology,26(3), 195-205. doi:10.1007/s10840-009-9433-4 7. Mallidi, J., Nadkarni, G. N., Berger, R. D., Calkins, H., & Nazarian, S. (2011). Meta-analysis of catheter ablation as an adjunct to medical therapy for treatment of ventricular tachycardia in patients with structural heart disease. Heart Rhythm,8(4), 503-510. doi:10.1016/j.hrthm.2010.12.015 8. Tung, R., Vaseghi, M., Frankel, D. S., Vergara, P., Biase, L. D., Nagashima, K., . Shivkumar, K. (2015). Freedom from recurrent ventricular tachycardia after catheter ablation is associated with improved survival in patients with structural heart disease: An International VT Ablation Center Collaborative Group study. Heart Rhythm,12(9), 1997- 2007. doi:10.1016/j.hrthm.2015.05.036 9. Mathuria, N., Tung, R., & Shivkumar, K. (2012). Advances in Ablation of Ventricular Tachycardia in Nonischemic Cardiomyopathy. Current Cardiology Reports,14(5), 577-583. doi:10.1007/s11886-012-0302-xb Clinical Guidelines for Medical Necessity Review of Cardiology Services http://www.healthhelp.com | © 2019HealthHelp. All rights reserved. 16945 Northchase Dr #1300, Houston, TX 77060
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