Board index ‹ EECP ‹ Reimbursement

[eecpforum]

CMS (Centers for Medicare and Medicaid Services) reimbursement coverage is provided for the use of ECP for patients who have been diagnosed with disabling angina (Class III or Class IV, Canadian Cardiovascular Society Classification or equivalent classification) who, in the opinion of a cardiologist or cardiothoracic surgeon, are not readily amenable to surgical intervention, such as PTCA or cardiac bypass because:
1. their condition is inoperable, or at high risk of operative complications or post-operative failure,
2. their coronary anatomy is not readily amenable to such procedures; or
3. they have co-morbid states which create excessive risk.

[josepht]

I would imagine to get reimbursement for syndrome x you would need a patient with a positive stress test but negative cardiac catheterization i.e. -angina not ameniable to revascularization proceedures and medical therapy?

[skiersid2]

Cardiac Syndrome X (CSX) patients typically present with mainly effort induced angina and have normal coronary arteries per angiogram as well as lack of evidence or coronary artery spasm.

The main documentation to support evidence of myocardial ischemia for reimbursement in CSX patients will come from:
1. ST segment depression on 12-lead ECG during anginal episodes.
2. ST segment depression during exercise or pharmacological induced stress testing.
3. Transient myocardial perfusion abnormailities during radionuclide studies.

Some research has demonstrated metabolic evidence of stress induced myocardial ischemia in CSX patients by measuring transmyocardial lactate production, coronary oxygen saturation and pH reductions, and stress induced changes of high energy phosphate depletion during nuclear imaging.

Research has also demonstrated that endothelial dysfunction may play a role in CSX paients. Ultrasound testing of brachial artery dilitation to increased blood flow is thought to reflect a fair assessment of coronary endothelial function and abnormal flow-mediated dilitation in the brachial arteries has been associated with transient myocardial perfusion defects in patients with CSX.

C-reactive protein (CRP), an inflammatory marker, may also be elevated in CSX patients.

Hope this is helpful,
Cindy

Cindy Watts, RN, BSN, CET
Senior Clinical Application Specialist
Vasomedical, Inc.

[VascuFlo]

We receive reimbursement from all carriers in Western New York. If you want the secret to our success, send me an email ahirsch@vascuflo.com and I may share it with you. Don't forget to visit http://www.vascuflo.com and http://www.buffalohearthealth.com as the secret may be within those sites.

[VascuFlo]

Must read this letter written by doctor to an insurance carrier regarding external counterpulsation.

http://www.buffalohearthealth.com/?p=1673

[enriqueomega]

Could you inform me the CPT code for EECP treatments? Thank you. Dr Chial

[eecpforum]

Medicare and most private insurers recognize HCPCS code G0166 for use in billing. The other code used if G0166 is not recognized is CPT code 92971, external cardiac assist. Depending on the insurer, other codes might be added to this.

Tom Riedman, RN
Vasomedical, Inc.