Download CT Coronary Angiography (CCTA) CPT Codes: 75574 Current

CROSSWALK OF NIA CCTA GUIDELINE CHANGES
CT Coronary Angiography (CCTA) Current Indications
CPT Codes: 75574
New Indications
Cardiac evaluation for patient with Evaluate patient with suspected coronary artery
suspected coronary artery disease: disease, who is in the low or intermediate risk
category for coronary artery disease when stress
echocardiography and/or ETT (exercise treadmill
testing) is equivocal.
Nonacute symptoms possibly representing an ischemic
equivalent: Low pretest probability of CAD; ECG
interpretable and able to exercise
Nonacute symptoms possibly representing an ischemic
equivalent: Intermediate pretest probability of CAD;
ECG interpretable AND able to exercise
Nonacute symptoms possibly representing an ischemic
equivalent: Low pretest probability of CAD; ECG
interpretable or unable to exercise
Nonacute symptoms possibly representing an ischemic
equivalent: Intermediate pretest probability of CAD;
ECG interpretable or unable to exercise
Nonacute symptoms possibly representing an ischemic
equivalent: High pretest probability of CAD; ECG
uninterpretable or unable to exercise
Acute symptoms with suspicion of ACS: Persistent
ECG ST-segment elevation following exclusion of MI
Acute symptoms with suspicion of ACS: • Acute chest
pain of uncertain cause (differential diagnosis includes
pulmonary embolism, aortic dissection, and ACS ["triple
rule out"])
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CROSSWALK OF NIA CCTA GUIDELINE CHANGES
Pretest Probability of CAD: Non-acute symptoms
possibly representing an ischemic equivalent; Normal
ECG and cardiac biomarkers (Troponin and CPK/CPKMB
Pretest Probability of CAD: Non-acute symptoms
possibly representing an ischemic equivalent; ECG
uninterpretable.
Pretest Probability of CAD: Non-acute symptoms
possibly representing an ischemic equivalent;
Nondiagnostic ECG or equivocal cardiac biomarkers.
Low global CHD risk estimate; Family history of
premature CHD
Detection of CAD/Risk Assessment
in asymptomatic individuals without
known CAD
Risk assessment in asymptomatic patients; no known
CAD
Coronary CTA, asymptomatic; no known CAD
Coronary CTA following heart transplantation; routine
evaluation of coronary arteries.
New onset or newly diagnosed clinical HF and no prior
CAD; reduced left ventricular ejection fraction (,40%
EF)
New onset or newly diagnosed clinical HF and no prior
CAD; normal left ventricular ejection fraction
Detection of CAD in Other Clinical
Scenarios
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CROSSWALK OF NIA CCTA GUIDELINE CHANGES
Other indications for CCTA:
Pre-operative evaluation prior to cardiac surgery
including; aortic or cardiac valve surgery, pacemaker
placement, pulmonary vein ablation for treatment of
atrial fibrillation or non-invasive coronary artery
mapping (including internal mammary artery) prior to
repeat cardiac surgical revascularization AND has not
had a Nuclear Cardiology study within the past six
months.
Preoperative coronary assessment prior to noncoronary
cardiac surgery: coronary evaluation before
noncoronary cardiac surgery
Nonsustained ventricular tachycardia
Arrhythmias - Etiology Unclear
after Initial Evaluation
Syncope: Low global CAD risk initial evaluation
includes echocardiogram; Intermediate and high global
CAD risk initial evaluation includes echocardiogram.
Elevated Troponin of Uncertain
Clinical Significance
Elevated Troponin without additional evidence of ACS
or symptoms suggestive of CAD
Use of CTA in the setting of prior
test results
Prior ECG exercise test; continued symptoms
Prior ECG exercise testing; intermediate risk Duke
Treadmill Score
Sequential testing after stress
imaging procedures
Discordant ECG exercise and imaging results. Prior test
imaging results
Prior CCS
Zero coronary calcium score >5 years ago
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CROSSWALK OF NIA CCTA GUIDELINE CHANGES
Diagnostic impact of coronary calcium on the decision
to perform contrast CTA in symptomatic patients;
Coronary calcium score 401 - > 1000
Diagnostic impact of coronary calcium on the decision
to perform contrast CTA in symptomatic patients;
Coronary calcium score <100 -400
Previous stress imaging study abnormal
Evaluation of new or worsening
symptoms in the setting of past
stress imaging study
Previous stress imaging study normal
Intermediate risk surgery; functional capacity <4 METS
with 1 or more clinical risk predictors
Preoperative Evaluation of
Noncardiac Surgery without Active
Cardiac Conditions
Vascular surgery: functional capacity <4 METS with 1
or more clinical risk predictors
Symptomatic (Ischemic equivalent) Evaluation of graft
patency after CABG; Prior coronary stent with stent
diameter ≥ 3mm
Risk Assessment Post
revascularization (PCI or CABG)
Asymptomatic - CABG: prior coronary bypass surgery
≥ 5 years ago
Asymptomatic - prior coronary stenting: Prior left main
coronary stent with stent diameter ≥ 3mm
Asymptomatic - prior coronary stenting: Stent diameter
≥ 3mm, greater than or equal to 2 years after PCI
Adult congenital heart disease: assessment of anomalies
of coronary arterial and other thoracic arteriovenous
vessels.
Evaluation of Cardiac Structure
and Function
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CROSSWALK OF NIA CCTA GUIDELINE CHANGES
Evaluation of intra and extracardiac structures:
localization of coronary bypass grafts and other
retrosternal anatomy; Prior to reoperative chest or
cardiac surgery
Framingham Risk Factors:
2011 National Imaging Associates
Patient is considered to be a high risk for CAD if they
have three (3) of the following risk factors; patient is
considered to be at intermediate risk for CAD if they
have two (2) of the following risk factors and low risk
for CAD if they have zero (0) to one (1) of the
following risk factors:
o Age 55 and/or older
o Diabetic
o Hypertension
o Active history of smoking
o History of LDL cholesterol > 130
o History of HDL cholesterol < 35
o Obesity with BMI > 30
o Family history of premature or early onset of CAD:
° Father below age 55
° Mother below age 65
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CROSSWALK OF NIA HEART CT OR HEART CT CONGENITAL GUIDELINE CHANGES
Heart CT CPT Codes
75573
75572,
Indications for Heart CT or Heart
CT Congenital
Current Indications
New Indications
For assessment of complex congenital heart disease
including great vessels, and cardiac chambers and
valves.
Assessment of anomalies of coronary arterial and other
thoracic arteriovenous vessels
Further assessment of complex adult congenital heart
disease after confirmation by echocardiogram
For evaluation of cardiac masses, e.g., myxoma,
suspected tumor or thrombus.
Evaluation of cardiac mass (suspected tumor or thrombus)
Inadequate images from other noninvasive methods
For evaluation of pericardial conditions, e.g.,
Evaluation of pericardial anatomy
pericardial mass, constrictive pericarditis or
complications of cardiac surgery.
For evaluation of pulmonary vein anatomy prior to
Evaluation of pulmonary vein anatomy; prior to
invasive radiofrequency ablation for atrial fibrillation. radiofrequency ablation for atrial fibrillation.
For non-invasive coronary vein mapping prior to
placement of biventricular pacemaker.
Noninvasive coronary vein mapping prior to placement of
biventricular pacemaker.
Evaluation of left ventricular function
Following acute MI or in HF patients
Inadequate images from other noninvasive methods
Quantitative evaluation of right ventricular function
Assessment of right ventricular morphology
Suspected arrhythmogenic right ventricular dysplasia
Assessment of myocardial viability
Prior to myocardial revascularization for ischemic left
ventricular systolic dysfunction
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CROSSWALK OF NIA HEART CT OR HEART CT CONGENITAL GUIDELINE CHANGES
Other imaging modalities are inadequate or
contraindicated
Characterization of native cardiac valves
Suspected clinically significant valvular dysfunction
Inadequate images from other noninvasive methods
Characterization of prosthetic cardiac valves
Suspected clinically significant valvular dysfunction
Inadequate images from other noninvasive methods
Localization of coronary bypass grafts and other
retrosternal anatomy
Prior to reoperative chest or cardiac surgery
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CROSSWALK OF NIA HEART MRI GUIDELINE CHANGES
HEART MRI
CPT Codes: 75557, 75559,
75561, 75563 +75565
Indications for Heart MRI:
Current Indications
New Indications
For evaluation of cardiac masses and thrombi.
Evaluation of cardiac mass (suspected tumor or thrombus).
Use of contrast for perfusion and enhancement
For evaluation of pericardial abnormalities in patients Evaluation of pericardial conditions (pericardial mass,
with clinical evidence of abnormal pleural or
constrictive pericarditis)
pericardial effusion.
For evaluation of known or suspected cardiomyopathy
for patients whose cardiac status deteriorated within
last two weeks.
For evaluation of great vessel disease for patients who
have not had a recent chest CT.
For evaluation of unusual arrhythmias when the results
of other conventional studies are inconclusive.
For pre-operative evaluation of congenital cardiac
defect, known valvular disease or for a great vessel
repair.
For progressive post-operative complications such as
bleeding, wound disruption or infection from
congenital cardiac defect repair or great vessel repair.
For post-operative evaluation for known valvular
disease due to clinical evidence of progressive postoperative complications such as bleeding, wound
disruption or infection.
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CROSSWALK OF NIA HEART MRI GUIDELINE CHANGES
For the evaluation of a pediatric patient under the care
of a pediatric cardiologist.
For evaluation of known or suspected congenital
cardiac disease in patients who are 18 years old or
younger.
For failure of previous cardiac exam, e.g., nuclear
cardiac study, coronary CTA, echocardiogram, to
determine a clear diagnosis
Intermediate pre-test probability of CAD; ECG interpretable
AND able to exercise.
Evaluation of Chest Pain
Syndrome
Intermediate pre-test probability of CAD; ECG
uninterpretable OR unable to exercise.
High pre-test probability of CAD
Evaluation of suspected coronary anomalies
Evaluation of Intra-Cardiac
Structures
Intermediate pre-test probability of CAD; No ECG changes
and serial cardiac enzymes negative.
Intermediate CHD risk (Framingham); Equivocal stress test
(exercise, stress SPECT, or stress echo)
Coronary angiography (catheterization or CT); stenosis of
unclear significance
Intermediate perioperative risk predictor
Risk Assessment with Prior
Test Results
Preoperative Evaluation for
Non-Cardiac Surgery
Assessment of complex congenital heart disease including
anomalies of coronary circulation, great vessels, and cardiac
chambers and valves
Evaluation of Ventricular and
Valvular Function
Procedures may include LV/RV mass and volumes, MR
angiography, quantification of valvular disease, and contrast
enhancement
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CROSSWALK OF NIA HEART MRI GUIDELINE CHANGES
Evaluation of LV function following myocardial infarction
OR in heart failure patients
Evaluation of LV function following myocardial infarction
OR in heart failure patients
Patients with technically limited images from echocardiogram
Quantification of LV function
Discordant information that is clinically significant from prior
tests
Evaluation of specific cardiomyopathies (infiltrative
[amyloid, sarcoid], HCM, or due to cardiotoxic therapies)
Use of delayed enhancement
Characterization of native and prosthetic cardiac
valves—including planimetry of stenotic disease and
quantification of regurgitant disease
Patients with technically limited images from echocardiogram
or TEE
Evaluation for arrythmogenic right ventricular
cardiomyopathy (ARVC)
Patients presenting with syncope or ventricular arrhythmia
Evaluation of myocarditis or myocardial infarction with
normal coronary arteries
Positive cardiac enzymes without obstructive atherosclerosis
on angiography
Evaluation for aortic dissection
To determine the location, and extent of myocardial necrosis
including ‘no reflow’ regions
Post acute myocardial infarction
To detect post PCI myocardial necrosis
To determine viability prior to revascularization
Evaluation of Myocardial Scar
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CROSSWALK OF NIA HEART MRI GUIDELINE CHANGES
Establish likelihood of recovery of function with
revascularization (PCI or CABG) or medical therapy
To determine viability prior to revascularization
Viability assessment by SPECT or dobutamine echo has
provided "equivocal or indeterminate" results
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CROSSWALK OF NIA HEART (CARDIAC) PET SCAN GUIDELINE CHANGES
HEART (Cardiac) PET Scan
CPT Codes: 78459, 78491, 78492
Current Indications
New Indications
Refer to Nuclear Cardiac Imaging/Myocardial
Perfusion Study Guideline
Indications for Cardiac PET Scan with
Approved FDA Radioisotopes:
Evaluation in patient with suspected or
known coronary artery disease
To qualify for PET perfusion scan done either at rest
or with pharmacologic stress, the patient must meet
National Imaging Associates criteria for indicated
nuclear cardiac imaging/myocardial perfusion study
and also:
To qualify for PET perfusion scan done either at rest
or with pharmacologic stress, the patient must meet
criteria◊ for indicated nuclear cardiac
imaging/myocardial perfusion study AND
Patient had a previous inadequate SPECT/MPI
imaging due to inadequate findings, technical
difficulties with interpretation, or discordant results
with previous clinical data.
Be likely to experience attenuation artifact with
SPECT imaging due to factors such as morbid
obesity, large breasts, breast implants, previous
mastectomy, chest wall deformity, pleural pericardial
effusion: OR
Have had a previous inadequate SPECT scan due to
inadequate findings, technical difficulties with
interpretation, or discordant results with previous
clinical data
Evaluation of myocardial viability prior to Previous SPECT test for viability is inadequate; AND Previous SPECT/MPI imaging for viability is
possible percutaneous or surgical
inadequate; AND
revascularization if:
Patient has severe left ventricular dysfunction (LVEF Patient has severe left ventricular dysfunction (LVEF
≤ 35%)
≤ 35%)
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FREQUENTLY USED CARDIAC ABBREVIATIONS
ACS
APC
CABG
CAD
CMR
CRT
CT
ECG
HF
ICD
LBBB
LV
MET
acute coronary syndrome
atrial premature contraction
coronary artery bypass grafting surgery
coronary artery disease
cardiovascular magnetic resonance
MI
cardiac resynchronization therapy
computed tomography
electrocardiogram
heart failure
implantable cardioverter-defibrillator
left bundle-branch block
left ventricular
estimated metabolic equivalents of exercise
myocardial infarction
RNI
SPECT MPI
radionuclide imaging
single-photon emission computed tomography myocardial perfusion imaging
STEMI
ST-segment elevation myocardial infarction
SVT
supraventricular tachycardia
TEE
transesophageal echocardiogram
TIA
transient ischemic attack
PCI
percutaneous coronary intervention
TIMI
thrombolysis in myocardial infarction
TTE
transthoracic echocardiogram
UA/NSTEMI
unstable angina/non–ST-segment elevation myocardial infarction
VPC
ventricular premature contraction
VT
ventricular tachycardia
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