Oct-Nov 00 Part A Bulletin - Medicare

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LOCAL AND FOCUSED MEDICAL REVIEW POLICIES 84484: Troponin (continued) Journal of the American College of Cardiology, 29 (1), 43-48. Mair, J. (1997). Cardiac troponin I and troponin T: Are enzymes still relevant as cardiac markers? Clinica Chimica Acta, 99-115. Martins, J., Li, D., Baskin, L., Jialal, I., & Kepper, J. (1996). Comparison of Cardiac Troponin I and Lactate Dehydrogenase Isoenzymes for the late diagnosis of myocardial injury. Clinical Chemistry, 106 (6), 705-708. Ohman, E., Armstrong, P., Christenson, R., et al. (1996). Cardiac Troponin T levels for risk stratification in acute myocardial ischemia. The New England Journal of Medicine, 335 (18), 1333-1341. Polanczyk, C. A., Kuntz, K. M., Sacks, D. B., Johnson, P. A., & Lee, T. H. (1999). Emergency department triage strategies for acute chest pain using creatine kinase-MB and troponin I assays: A cost-effectiveness analysis. Annals of Internal Medicine, 131 (12), 909-918. Rice, M. S., & MacDonald, D. C. (1999). Appropriate roles of cardiac troponins in evaluating patients with chest pain. The Journal of the American Board of Family Practice, 12 (3), 214-218. Willerson, J. T. (1995). Cardiovascular Medicine. New York: Churchill Livingstone. Advisory Committee Notes This policy does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the contractor, this policy was developed in cooperation with the contractor’s Advisory Committee, which includes representatives from the Florida Cardiology and Florida Emergency Medicine Societies. Start Date of Comment Period N/A Start Date of Notice Period 10/01/2000 Revision History Revision Number: 3 Start Date of Comment Period: N/A Start Date of Notice Period: 10/01/2000 Oct/Nov 2000 Bulletin Revised Effective Date: 08/10/2000 Explanation of Revision: An evaluation in the use of both Troponin and CK-MB in the evaluation of patients warranted a revision to the indications section to better clarify the indications of coverage. Start Date of Comment Period: N/A Start Date of Notice Period: 12/07/98 Original Effective Date: 11/02/98 Revision Date/Number: 11/02/98 2 Start Date of Comment Period: Start Date of Notice Period: N/A Original Effective Date: 11/02/98 Revision Date/Number: 1999 ICD-9-CM update 10/01/98 1 Start Date of Comment Period: 10/31/97 Start Date of Notice Period: 09/18/98 Original Effective Date: 11/02/98 � 32 The Florida Medicare A Bulletin October/November 2000
LOCAL AND FOCUSED MEDICAL REVIEW POLICIES 93875: Noninvasive Extracranial Arterial Studies Revision Overview—ICD-9-CM diagnosis codes 433.30 and 433.31 have been added to the “ICD-9-CM Codes that Support Medical Necessity” section of the policy for procedure codes 93875, 93880 and 93882 effective August 2, 2000. The same section of the policy has been revised to include changes and additions affected by the implementation of the 2001 ICD-9- CM update. The “Revenue Code” section of the policy has been revised to include additional revenue codes based on the outpatient prospective payment system (OPPS) initiative effective August 1, 2000. Policy Number 93875 Contractor Name First Coast Service Options, Inc. Contractor Number 090 Contractor Type Intermediary LMRP Title Noninvasive Extracranial Arterial Studies AMA CPT Copyright Statement CPT codes, descriptions, and other data only are copyright 1998 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Apply. HCFA National Coverage Policy Coverage Issues Manual, Section 50-6 Coverage Issues Manual, Section 50-7 Coverage Issues Manual, Section 50-37 Hospital Manual, Section 443 Intermediary Manual 3, Section 3631 Primary Geographic Jurisdiction Florida Secondary Geographic Jurisdiction N/A HCFA Region Region IV HCFA Consortium Southern Policy Effective Date 11/15/1999 Revision Effective Date 10/01/2000 Revision Ending Effective Date 09/30/2000 Policy Ending Date N/A LMRP Description Non-invasive extracranial arterial studies involve the use of direct and occasionally indirect methods of ultrasound to evaluate and monitor the blood vessels that supply the brain. The direct methods of assessment are Doppler and duplex ultrasound, whereas the indirect methods include techniques such as oculoplethysmography. Doppler ultrasonography is used to evaluate hemodynamic parameters, specifically the velocity of blood October/November 2000 The Florida Medicare A Bulletin flow and the pattern or characteristics of flow. The Doppler ultrasound involves the evaluation of the supraorbital, common carotid, external carotid, internal carotid, and the vertebral arteries in the extracranial cerebrovascular assessment. The second key component of vascular diagnostic ultrasound is the B-mode, or brightness-mode image. This real time imaging technique provides a two-dimensional gray-scale image of the soft tissues and vessels based on the acoustic properties of the tissues. Duplex ultrasonography combines the direct visualization capabilities of B-mode ultrasonography and the blood-flow velocity measurements of Doppler ultrasonography. In addition to the direct methods of Doppler and duplex ultrasonography to evaluate the cerebrovascular arterial system, indirect methods such as supraorbital Doppler ultrasonography and oculoplethysmography are used as an adjunct to assess the carotid artery. Supraorbital Doppler ultrasonography indirectly assesses blood flow from collateral branches of the internal carotid artery through the supraorbital vessels. This test is done by placing a directional Doppler probe over a supraorbital artery and observing the flow with and without compression of neighboring arteries. Oculoplethysmography indirectly measures blood flow in the ophthalmic artery by graphically recording ocular pulses obtained from corneal cups held in place by mild suction. Because the ophthalmic artery is the first major branch of the internal carotid artery, its blood flow accurately reflects carotid blood flow and ultimately that of cerebral circulation. Indications and Limitations of Coverage and/or Medical Necessity Florida Medicare will consider non-invasive extracranial arterial studies medically reasonable and necessary under the following circumstances: • To evaluate a patient with suspected occlusive cerebrovascular disease as demonstrated by the presence of transient ischemic attacks (TIA’s), possible carotid bruit(s), diminished or absent pulses in the neck or arms, and/or a blood pressure difference in 2 arms of greater than 10mmHg. • To evaluate a patient with signs/symptoms of subclavian steal syndrome. The symptoms usually associated with subclavian steal syndrome are a bruit in the supraclavicular fossa, unequal radial pulses, arm claudication following minimal exercise, and a difference of 20mmHg or more between the systolic blood pressures in the arms. • To monitor a patient with known carotid stenosis. Patients demonstrating a diameter reduction of 30-50% are normally followed on an annual basis, whereas 33
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Oct-Nov 00 Part A Bulletin - Medicare

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