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<strong>KCE</strong> Reports 82 Multislice CT in Coronary Heart Disease 53<br />
For <strong>the</strong> Wisconsin Physician Service Insurance Corporation (WPS) active in Wisconsin,<br />
Illinois, Michigan and Minnesota, MSCT coronary angiography may be used (1) as an<br />
alternative to invasive angiography, following an equivocal stress test, (2) to assess<br />
patients suspected of having congenital coronary anomaly for surgery, (3).to assess<br />
acute chest pain in <strong>the</strong> emergency department, <strong>the</strong> examination being preferably<br />
ordered by a cardiologist, (4) to assess coronary or pulmonary venous anatomy (e.g.<br />
before <strong>the</strong> placement of a pacemaker). Devices have to possess at least 64 slices (1 mm<br />
resolution max.). Coverage of <strong>the</strong> test may be denied on post-pay review when <strong>the</strong>re<br />
was a pre-test knowledge of calcification diminishing <strong>the</strong> value of <strong>the</strong> test. WPS requires<br />
that beta-blockers are injected by an experienced physician and that <strong>the</strong> study is<br />
ordered by a physician or practitioner similar to stress myocardial perfusion imaging or<br />
ultrasound evaluation. Finally, a physician must supervise <strong>the</strong> contrast enhanced study.<br />
As seen on Table 12, MSCT coronary angiography codes are classified in Category III of<br />
<strong>the</strong> Current Procedure Terminology (CPT) coding system of <strong>the</strong> American Medical<br />
Association (AMA), used for Medicare billing purposes. This category groups temporary<br />
codes for emerging technology, services or procedures. The long descriptors of <strong>the</strong><br />
cardiac CT codes can be found in appendix (Table 26). In <strong>the</strong> last example, WPS covers<br />
codes between 0145T and 0149T but codes 0144T, 0150T and 0151T are considered<br />
experimental and investigational and are <strong>the</strong>refore not covered.<br />
To give a rough idea of <strong>the</strong> amounts on a comparative scale, <strong>the</strong> last example of CIGNA<br />
was chosen that covers currently (conditionally) all codes from 0144T through 0151T.<br />
CIGNA covers <strong>the</strong> MSCT use as an adjunct to o<strong>the</strong>r testing in a specific cardiac<br />
population subset with intermediate pre-test probability of CAD. It cannot be used as a<br />
screening tool as it still involves significant radiation exposure and potential for<br />
iodinated contrast related reactions. For some indications, <strong>the</strong> examination is covered<br />
only if performed on a 64-SCT scanner (intermediate coronary syndrome, angina<br />
pectoris, heart failure, coronary a<strong>the</strong>rosclerosis of native coronary artery, unspecified<br />
chronic ischemic heart disease and unspecified chest pain). The fees reimbursed in Idaho<br />
are given in Table 12.<br />
Table 12 : US Idaho Medicare Physician Fee Schedule for cardiac CT<br />
examinations (2008)<br />
CPT Short descriptor Technical Professional Total Fee (€)<br />
Code<br />
component(€) component(€)<br />
0144T Calcium scoring 163 37 200<br />
0145T Cardiac morphology only 380 71 451<br />
0146T Coronaries only 447 76 523<br />
0147T Coronaries and calcium scoring 451 80 531<br />
0148T Coronaries and cardiac<br />
morphology 455 83 538<br />
0149T Coronaries, calcium scoring and<br />
cardiac morphology 460 82 542<br />
0150T congenital studies, non-coronary 458 86 544<br />
+0151T RVEF/LVEF and wall motion (add<br />
on code) +152 +70 222<br />
The professional part of <strong>the</strong> fee is <strong>the</strong> amount paid to <strong>the</strong> physician while <strong>the</strong> technical<br />
component is supposed to cover <strong>the</strong> hospital costs<br />
Recently, <strong>the</strong> Centers for Medicare and Medicaid Services (CMS) conducted a coverage<br />
analysis including a systematic review of <strong>the</strong> recently published evidence and a public<br />
consultation. As a result, in December 2007, CMS issued a proposition of coverage for<br />
MSCT coronary angiography for <strong>the</strong> diagnosis of CAD for two indications: (1)<br />
symptomatic patients with chronic stable angina at intermediate risk of CAD (sic)<br />
(Framingham risk score between 10% and 20%), (2) symptomatic patients with unstable<br />
angina at a low-risk of short-term death and intermediate risk of CAD. The coverage<br />
was planned ‘with evidence development’, indicating that imaging should be delivered in