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Download CT Coronary Angiography (CCTA) CPT Codes: 75574 Current
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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"]) 2011 National Imaging Associates Confidential Proprietary 1 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 2011 National Imaging Associates Confidential Proprietary 2 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 2011 National Imaging Associates Confidential Proprietary 3 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 2011 National Imaging Associates Confidential Proprietary 4 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 Confidential Proprietary 5 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 2011 National Imaging Associates Confidential Proprietary 1 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 2011 National Imaging Associates Confidential Proprietary 2 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. 2011 National Imaging Associates Confidential Proprietary 1 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 2011 National Imaging Associates Confidential Proprietary 2 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 2011 National Imaging Associates Confidential Proprietary 3 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 2011 National Imaging Associates Confidential Proprietary 4 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%) 2011 National Imaging Associates Confidential Proprietary 1 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 2011 National Imaging Associates Confidential Proprietary 1