Download cardiology procedures - Medical Benefits Administration

SIERRA NEVADA MEDICAL ASSOCIATES, INC. (IPA)
UTILIZATION GUIDELINES
DIAGNOSTIC EXAMS
CARDIAC STRESS TESTING
Exercise Electrocardiography
1. Classic angina pectoris.
2. Atypical angina pectoris or atypical chest pain.
3. Post MI.
4. Valvular heart disease to assess exercise tolerance.
5. Every one to two years in patients with known CAD and stable or no symptoms,
especially if with LV dysfunction or with prior silent myocardial infarction.
6. Shortly after coronary revascularization procedures and approximately 3-6
months after an interventional cardiology procedure.
7. Asymptomatic male over 45 years old or female over 50 years old with two CAD
risk factors or abnormal resting EKG (may not be a covered benefit).
8. Evaluation of ventricular tachycardia.
NOTE:
 Non-cardiac chest pain, e.g., musculoskeletal chest pain, is NOT an
indication.
 Initiation of an exercise program is NOT an indication unless a criterion above
is met.
Exercise Electrocardiography with Echocardiogram or Radionucleide
Scintigraphy
1. Without prior exercise EKG or cardiac cath:
a) Uninterpretable exercise EKG.
 Drug induced or other baseline ST abnormalities
 LBBB or left ventricular hypertrophy with ST abnormalities
 Wolff-Parkinson-White syndrome
b) Post MI to determine extent and reversibility of CAD.
c) If routine stress testing provides equivocal information about severity of
CAD and coronary angiography is not desired as the next step.
d) In females.
DE - CARDIAC STRESS
Page1 of 2
2. With prior catherization:
a) To confirm or identify ischemia in lesions of less than 70% magnitude or if
angina is present and more than one vessel is diseased.
b) To localize areas of reversible ischemia prior to PTCA or CABG.
3. With prior exercise EKG:
a) Positive exercise EKG without classic or strongly positive symptoms.
b) Negative exercise EKG with classic or strongly positive symptoms.
Echocardiography or radionucleide scintigraphy with pharmacologic stimulus:
1. For patients with indications as outlined above for stress testing who cannot
exercise well or have been found to have not reached an adequate workload or
heart rate during exercise to tests for ischemia.
Exercise EKG with Gated Blood Pool Scan
1. Evaluation of generalized or regional ventricular wall motion in a patient who will
not undergo contrast ventriculography if this and other noninvasive studies are
negative.
2. Stress echocardiography is more cost-effective.
DE - CARDIAC STRESS
Page2 of 2