May/June 2005 - Center Care Health Benefits Programs

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Policy & Practice Updates Payment Policy for Doppler Color Flow Velocity Mapping CPT 93325 Doppler echocardiography color flow velocity mapping (CPT 93325) displays the instantaneous velocity and direction of blood flow, allowing for detailed physiological and functional information to be obtained non-invasively. Although the technical capacity to perform this study may be readily available, it may not be useful in many clinical circumstances. Effective September 1, 2005, Aetna will limit coverage for doppler echocardiography color flow velocity mapping in adults to those indications for which this diagnostic study is considered useful. The ACC/AHA/ASE 2003 Guideline Update for the Clinical Application of Echocardiography 1 is intended to assist physicians in clinical decision making by describing a range of generally acceptable approaches for the diagnosis, management, or prevention of specific diseases or conditions. Clinical Situations for Color Doppler Color Doppler is noted to be useful only in the following clinical situations: ■ ■ ■ ■ ■ Evaluation of septal defects Evaluation of the severity of valve stenosis or regurgitation Evaluation of site of left-to-right or right-to-left shunts Assessment of diseases of the aorta Evaluation of prosthetic valves Please note that Aetna will not change coverage policies for M mode, 2D and Spectral Doppler studies or for transesophageal echocardiography. 1 American College of Cardiology/ American Heart Association/American Society of Echocardiography. 2003 Guideline: Clinical Application of Echocardiogram (Cheitlin, et al. 2003). Policy Update for Physicians Fulfilling Military Service To support our physicians engaged in military service, we allow participating physicians and other health care professionals to remain in the Aetna network while they are fulfilling their military obligations. Recredentialing is suspended for providers on military leave, and their information is temporarily suppressed so they won’t appear in DocFind ® , our online referral directory, or in printed directories. We thank our participating physicians for their military service and wish them a safe return. Military Service — Simply Inform Us When You Leave and Return Notify Aetna of your military obligation using: Aetna Credentialing Customer Service 1-800-353-1232 8 Aetna OfficeLink Updates
Clinical, Payment and Coding Policy Changes As part of Aetna’s ongoing policy review process, we regularly adjust our clinical, payment and coding policy positions and urge physicians to consult our website on a regular basis. We are firmly committed to establishing and maintaining clinical policies that are based on solid, peer-reviewed studies, scientific data and best-practice guidelines within the medical community. In developing our payment and coding policies, we also collaborate with external professional organizations, medical societies and associations. We also receive feedback from individual practicing physicians, such as those on the independent Physician Advisory Board, which provides advice to us on issues of importance to physicians. Recently, we made several positive coding and policy changes that we want to share with you. The chart below outlines the changes. Find all Clinical, Payment and Coding Policy Changes on the Website Clinical policy changes are documented in Clinical Policy Bulletins (CPBs). To access CPBs, go to “Clinical Resources” on the secure website and select “Clinical Policy Bulletins.” To access payment and coding changes on the secure website, go to “Claims,” and then select “Policy Information” and choose “Payment and Coding Policies.” CODE(S) IMPACTED 76082, 76083 POLICY Digital Mammography REASON FOR CHANGE We consider computer-aided detection (CAD) a medically necessary adjunct to mammography. Digital mammography is an acceptable alternative to screen film mammography. Policy changes regarding mammography and CAD can be found in Clinical Policy Bulletin #584. Based upon additional information provided by the American Urological Association and discussions with the Physician Advisory Board, we will allow separate reimbursement of codes. Input from the American College of Radiology and the American Society for Therapeutic Radiology and Oncology, as well as discussions with the Physician Advisory Board, created a change to allow reimbursement of code 77336. Based on additional information from the American College of Cardiology and the American Society of Nuclear Cardiology, as well as discussions with the Physician Advisory Board, we will allow separate reimbursement of codes. We worked with the American Society of Retina Specialists to make these changes based on new information. Changes are found in Clinical Policy Bulletin #344. SUMMARY Allow payment of code DATE OF CHANGE 04/01/2005 76872 / 76942 Rectal Ultrasound & Biopsy Allow separate payment of codes 06/15/2005 77336 Radiation Physics Consult Allow payment of code 04/01/2005 78478 / 78480 Ejection Fraction (add-ons) Allow separate payment of codes 06/15/2005 92135 Ophthalmic Imaging Retinal Allow payment of code for glaucoma, retinal diseases and optic nerve disorders but not routine screening of the general population 04/01/2005 Aetna OfficeLink Updates 9
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May/June 2005 - Center Care Health Benefits Programs

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