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Response to Comments: Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography


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Response to Comments: Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography
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Response to Comments
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Noridian's Response to Provider Recommendations for Cardiovascular Stress Testing, Including Exercise and/or Pharmacological Stress and Stress Echocardiography. (for comment period ending 12/15/2016).

Response To Comments

1Two comments indicated it would be helpful to state more clearly those aspects of the LCD that relate to coverage of nuclear imaging and its interpretation and reporting.We agree and this has been expanded in the policy. In addition, the ACCF/ASNC/ACR/AHA/ASE/SCCT/SCMR/SNM 2009 Appropriate Use Criteria for Cardiac Radionuclide Imaging has been added as a reference.
2One comment indicated a need to clarify if the policy applies to the radiology component of any stress images, whether echocardiographic or nuclear.We agree; it does, and this has been clarified.
3Comments recommended the addition of the following diagnosis codes. No literature was submitted.We Agree, the following have been added: E78.00: Pure hypercholesterolemia, unspecified E78.2: Mixed hyperlipidemia I25.119: Atherosclerotic heart disease of native coronary artery with unspecified angina pectoris I42.9: Cardiomyopathy, unspecified I44.7: Left bundle-branch block, unspecified I47.1: Supraventricular tachycardia I48.91: Atrial fibrillation unspecified I48.92: Unspecified atrial flutter I49.3: Ventricular premature depolarization (Already included in LCD) R00.0: Tachycardia, unspecified R00.1: Bradycardia, unspecified R00.2: Palpitations R06.00: Dyspnea R07.9: Chest pain, unspecified E10-13.9: Diabetes M79.602: Pain in left arm M79.601: Pain in right arm R68.84: Jaw Pain
4Comments recommended the addition of the following diagnosis codes. No literature was submitted.We do not agree. In each case the diagnosis is too non-specific and there are more appropriate choices for nearly all likely clinical circumstances. These have not been added: E78.5: Hyperlipidemia, unspecified I27.2: Unspecified atrial flutter (Note: Unspecified atrial flutter added with corrected code) R06.9: Unspecified abnormalities of breathing Z01.818: Encounter for other pre-procedural exam R73.09: Elevated Blood Sugar I10: Essential (primary) hypertension
5One comment indicated “we hope there is a recognition that signs and symptoms consistent with CAD gives recognition to the myriad of atypical presentations of ‘angina equivalents’ especially in the elderly, women, and even in the younger patient, to include forms of back pain, diaphoresis, weakness, and other unusual symptoms.We agree. The LCD specifically states: “Angina pectoris or angina equivalent symptoms.” The medical record must clarify the signs and symptoms that are being considered “angina equivalent”.
6A comment was received that a positive coronary calcium score should be specifically included, “as a far more specific indication of CAD than abnormalities on the ECG”. No literature or specific coding recommendation was provided.We are adding R93.1 Abnormal findings on diagnostic imaging of heart and coronary circulation.

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  • Cardiovascular
  • Stress
  • Testing
  • Exercise
  • Pharmacological
  • Echocardiography