Cardiovascular and Peripheral Vascular Surgery/ Vascular Lab Services

Published by: Apollo Managed Care Consultants

Published: Apr. 15, 2009 - 131 Pages

Table of Contents

Introduction

Cardiology - Guidelines (refer to Cardiothoracic Surgery & Vascular Laboratory sections)

Acoustic Heart Scans/Recordings (New 8-04, 6-07)

Ambulatory blood pressure monitoring (Added 1-01, updated 04-04, 4-05, 11-05, 6-06, 4-07)

Ambulatory electrocardiography (Holter)/Cardiac Event Monitors - Also refer to the following EKC section

Medicare coverage framework (update 8-04)

Cardiac Event Monitors/Real Time Cardiac Surveillance System - Loop Recorders (updated 12-01, 8-04, 10-05, 7-07, 12-08)

Holter Monitors/Dynamic Electrocardiograms (New 3-06, 12-06, 4-07)

Implanted Loop Recorders (Added 09-02, update 8-04, 6-07)

Mobile Cardiac Outpatient Telemetry (MCOT) (New 3-06)

Angioplasty - refer to PTCA in this chapter and Angioplasty in the Cardiovascular Surgery chapter

Brachytherapy, Coronary - refer to Radiation Therapy chapter

Cardiology Consultation or Referral for Care (added 04-03, update 6-05, 3-06)

Chest pain - acute myocardial ischemia/infarct (AMI), admission criteria, evaluation & management guideline resources (updated 10-01, 3-05, 5-05, 8-05, 8-06)

Cardiac catheterization

Cardiac catheterization, right; Central venous access & pressure monitoring (updated 10-01, 11-04, 5-06, 9-07)

Cardiac Catheterization, left; Coronary arteriography; Angiography and Ventriculography (rev 12-00, update 8-04, 1-06, 5-06, 12-06, 7-07)

Cardiac catheter or operative ablation of arrythmogenic foci (New 12-04, update 3-05, 5-05)

Cardiac output and related hemodynamic measurements

Cardiac output Doppler monitoring (New 5-07)

Electrical Bioimpedance, Thoracic - Cardiac output and related hemodynamic measurements (updated 08-03, 12-04, 3-05, 4-07)

Inert gas re-breathing techniques to measure cardiac output (New 10-05, update 7-07)

Cardiovascular Nuclear Medicine Studies - refer to Nuclear Medicine chapter

Central venous catheter placement (New 1-09)

CHF/Heart Failure - admission, discharge criteria (updated 9-04, 12-04, 5-05, 8-05, 11-05, 2-06, 7-07)

CT, Cardiac

CT screens for coronary artery calcifications (update 4-04, 10-05, 7-06, 1-07, 7-07, 5-08)

Cardiac Computed Tomography, Computed Tomography Coronary Angiography (New 7-06, updated 1-07, 4-07, 3-08, 7-08, 11-08, 3-09)

Coronary artery revascularization procedures (New 1-09)

Refer to the PTCA and CABG guidelines in this chapter and the Cardio-thoracic Surgical chapter respectively

Defibrillator devices, external/wearable and automatic implantable cardioverter (ICDs, AICDs) (updated 09-04, 12-04, 3-05, 5-05, 11-05, 1-06, 8-06, 10-07, 2-09)

Defibrillators for home use (New 10-05, 7-07)

Direct current cardioversion (Update 4-05, 7-07) also refer to Atrial fibrillation ablative procedures in the CV Surgery chapter that follows.

Directional coronary atherectomy (DCA)/Percutaneous transluminal rotational atherectomy (update 4-05, 7-07)

Displacement cardiography/cardiokymography and photokymography (New 5-07)

Echocardiograms

Adult and pediatric, transthoracic, transesophageal (updated 6-04, 7-05, 10-06, 7-07, 2-09)

Doppler Echocardiography (updated 01-03, 3-05, 2-07)

Stress Echocardiography (New 10-06)

Electrocardiograms - refer to the preceding Ambulatory Electrocardiography section

EKG criteria (update 7-04, 12-04, 3-05, 5-07, 7-07)

Cardiointegram (CIG) (New 4-05, update 4-07)

Body Surface Potential Mapping (New 7-05)

Electrophysiology testing (ET)/Electrophysiologic Studies (EPS) (update 5-05, 1-07, 5-07)

His bundle studies (New 5-07)

T-Wave Alternans (TWA) testing (added 10-01, updates 9-04, 12-04, 3-05, 10-05, 3-06, 5-07, 5-08)

External Counterpulsation, Enhanced (EECP) Therapy (update 1-04, 12-04, 3-05, 10-05, 3-06, 7-07)

Exercise Treadmill Test (ETT)/ ‘stress test’, (update 4-04, 3-05, 5-05, 3-06, 3-09)

Exercise Treadmill Test with Thallium imaging/Stress Test (update 06-01, 11-04, 6-07)

BNP and NT-proBNP TES Testing with Stress Exercise Tests (New 3-09)

Pediatric stress testing guideline link (New 4-06)

Holter Monitor - refer to ambulatory electrocardiography/event monitors sections

Left Ventricular End Diastolic Pressure (LVEDP) Measurement in the Outpatient Setting (New 10-05)

MRI/MRA (MR Angiography) - Cardiovascular studies - refer to Radiology chapter

Pacemakers

Permanent cardiac pacemakers/Resynchronization therapy (update 07-04, update 3-05, 10-05, 7-06, 5-07)

Pacemaker monitors; Monitoring frequency (update 4-07)

Pacemakers/External manually activated devices to terminate tachyarrhythmias (update 5-04)

Pacemaker reference list (update 5-04, 3-05, 5-05, 7-05, 7-07)

Percutaneous Transluminal Coronary Angioplasty (PTCA) (update 6-03, 5-05, 11-05, 5-06, 10-06, 7-07, 11-07, 1-09)

Vascular cryoplasty (New 5-08)

Pulmonary artery catheters - refer to the preceding cardiac catheterization section & the Central venous catheter placement guideline

Pulmonary Artery Hypertension - Iloprost therapy (New 3-07)

Prostacyclin infusion therapy for pulmonary hypertension - refer to the Pharmacy chapter

Pulmonary vein stenosis, infants (New 1-09)

Radiofrequency Catheter Ablation Procedures - Cardiac (update 5-01, 8-04, 12-04, 5-05, 4-06, 4-07)

Resynchronization therapy - refer to the preceding ‘Permanent cardiac pacemakers’ guideline

Revascularization procedures - refer to coronary artery revascularization procedures as well as the individual procedures listed in this and the following chapter

Stents, coronary (update 10-03, 5-05, 10-05)

Stress tests - refer to the preceding Exercise Treadmill Test sections

Syncope, evaluation of - guideline link (New 8-06)

Thoracic electrical bioimpedance (TEB) - refer to the preceding guideline: ‘Electrical bioimpedence, thoracic’

Tilt table testing (Updated 10-01, 12-04, 10-05, 7-07)

Thrombolysis for acute myocardial infarction (update 05-02, 5-05)

Cardiac Rehabilitation

Cardiac Rehabilitation Program Guidelines (update 5-01, 8-04, 3-05, revision 3-06, update 3-07, 5-08)

Cardiac Rehabilitation Services - CMS policy (added 11-00, updated 5-05, 3-06, 5-06, 10-06, 2-08)

Phonocardiography and Vectorcardiography (added 8-04)

Screening for ischemic cardiac disease (new 4-04)

Length of stay benchmarks/targets for cardiology diagnoses (update 6-05, 2-08)

Acute Myocardial Infarction LOS - reference list

Pulmonary embolus (New 11-08)

Cardiology Guideline Resources - web links (New 8-04, update 8-06, 7-08)

NY Heart Association Classification (New 2-07)

Ultrafiltration therapy for heart failure - refer to the Nephrology chapter for guideline

Cardiology Notes (update 12-06, 5-07, 11-08)

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Cardiovascular/Thoracic & Peripheral Vascular Surgery and/or Interventional Vascular Radiology -Guidelines (also refer to Cardiology, Radiology and Vascular Laboratory sections)

Alcohol-induced septal ablation for hypertrophic obstructive cardiomyopathy/Non-surgical ablation (new 2-04, update 2-05, 5-06, 7-07)

Angioplasty, Percutaneous Transluminal (PTA) and/or Atherectomy; peripheral, renal, dialysis fistulae -[refer to guidelines for coronary arteries (PTCA) in the Cardiology chapter; while aortic, carotid, renal, intracranial and vertebral arteries follow in this chapter] (update 5-05, 2-06, 2-07, 7-07, 2-09)

Cryoplasty, peripheral arterial (New 5-08)

Angioplasty Aorta (for aortic stenosis) (New 7-07)

Angioplasty, coronary - refer to the Percutaneous Coronary Angioplasty (PTCA) guideline

Aortic Aneurysm Repair - indications, options (open, endovascular stent-grafts); (New 06-02, update 10-04, 10-05, 3-06, 4-07, 4-08, 12-08, 2-09) Refer to AAA ultrasound screening coverage in the Radiology chapter

Abdominal aorta aneurysms

Thoracic aorta aneurysms (update 3-08, 12-08)

Aneurysm reference/resource list (update 7-07)

Aortic valve replacement/repair - refer to the following Valve replacement and/or repair guideline

Arterial elasticity as a screening tool for CV disease (New 3-07)

Artificial hearts and related devices (New 4-07, update 7-07, 5-08) - also refer to the ‘Heart Transplant’ and Ventricular Assist Devices guidelines in this chapter.

Continued on the following page ⇒⇒⇒

Cardiovascular and Peripheral Vascular Surgery/Vascular/Lab Services

Atrial fibrillation - ablative procedures (New 5-05, update 7-06, 11-08, 1-09)

Maze Procedure for atrial fibrillation/flutter (new 3-02, update 4-05, 7-07)

Pulmonary vein isolation for atrial fibrillation (new 3-02, update 5-05, 7-07, 11-08)

Atrial Septal Defect, repair (update 3-05, 10-05, 1-07, 6-07) - Also refer to Ventricular Septal guidelines

Autologous cell transplant therapy for damaged myocardium (New 7-07, update 12-08)

Carotid body tumor resection (Glomectomy) (New 4-00, update 5-05, 4-07)

Carotid sinus nerve stimulation (New 4-07)

Carotid Endarterectomy (CEA) - Indications, LOS (update 9-04, 2-06, 9-06, 7-07)

Carotid and Vertebral Artery Percutaneous Transluminal Angioplasty (PTA) and Stenting Procedures (update 9-04, 3-05, 5-05, 11-05, 3-06, 1-07, 7-07, 4-08, 5-08, 4-09)

Carotid, noninvasive tests - refer to the vascular lab chapter in this manual

Coronary artery bypass graft(s) surgery (CABG)/Off-pump CAB; Indications, LOS (updates 10-04, 10-05, 10-06, 7-07, 1-09)

Dynamic Cardiomyoplasty (New 4-07)

Extracranial-Intracranial arterial bypass surgery (update 5-05, 11-05, 5-07) - refer to PTA stents in the preceding guideline

Heart/Cardiac and Heart-Lung Transplants (New 5-05, 8-05, 10-05, 2-07, 12-08)

Heartsbreath test for rejection (New 12-08, 2-09)

Impedance plethysmography - refer to Plethysmodgraphy guideline in the Vascular Laboratory chapter

Intraoperative Ventricular Mapping (new 4-00, update 5-05, 5-07)

Maze Procedure for atrial fibrillation/flutter (new 3-02, update 4-05, 7-07)

Microsurgical lymphaticovenous anastomosis operation for lymphedema (new 1-01, update 5-05, 4-07)

Microvascular arterial bypass surgery for impotence (New 5-05, update 10-05, 4-07)

Mitral valve replacement/repair - refer to the following Valve replacement and/or repair guideline

Pain - Post-thoracotomy or post-mastectomy - Intercostal nerve lesion excision (new 4-00, update 9-06, 7-07)

Patent ductus arteriosus closure (New 5-05, update 10-05, 7-07, 1-09)

Patent foramen ovale - closure indication (New 3-05, update 10-05, 7-07, 1-09)

Pectus excavatum and pectus carinatum - Surgical correction (updated 3-02, 5-05, 7-07)

Percutaneous Transluminal Coronary Angioplasty (PTCA) - refer to the cardiology chapter

Peripheral vascular disease

Cryoplasty (New 4-07)

Peripheral vascular percutaneous interventional procedures (PTA, other) (New 3-07, update 9-07)

Peripheral vascular rehabilitation programs (New 12-04, update 6-06, 1-07, 7-07)

Photopheresis, extracorporeal - Therapy for heart transplant rejection (New 4-00, update 5-05, revised 3-07)

Pulmonary embolectomy, transvenous (New 5-07)

Pulmonary valve replacement/repair - refer to the following ‘Valve replacement and/or repair’

Pulmonary vein isolation for atrial fibrillation (added 3-02, update 5-05, 7-07, 11-08)

Renal Artery Stenosis - Angioplasty, Stent placement (New 11-04, 7-07, 11-07)

Robotically-assisted cardiac surgery (New 4-05, 7-07)

Thoracoscopy (New 7-08)

Thoracoscopic aortopexy for tracheomalacia (New 11-08)

Thoracoscopic epicardial radiofrequency ablation for atrial fibrillation - refer to atrial fibrillation, ablative procedures

Thrombectomy, arterial or venous (New 7-07)

Total Artificial Heart Replacement - refer to the preceding ‘Artificial heart’ guideline

Tracheo-bronchial stents - refer to the Pulmonary chapter

Transjugular Intrahepatic Portosystemic Shunt (TIPS) (New 11-04, update 5-05, 7-07)

Transmyocardial laser revascularization (update 1-04, 5-05, 10-05, 5-07)

Transplantation - refer to the preceding Heart/Cardiac and Heart-Lung Transplants in this chapter

Tricuspid valve replacement/repair - refer to the following ‘Valve replacement and/or repair’ guideline

Valve Replacement and/or Repair: Aortic/Mitral/Tricuspid/Pulmonary (update 5-05, 8-06, 2-07, 7-07, 12-07, 6-08)

Varicose Vein/Perforator Vein Therapies - including sclerotherapy, endovenous radiofrequency or laser ablation (refer to the Vascular Lab chapter for related guidelines) (update 5-04, 4-05, 10-05, 8-06, 5-07, 5-08)

∞ Venous stents (New 1-07)

Ventricular Assist Devices (New 10-03, rev 4-07, update 12-08) - also refer to Artificial Heart, Heart transplant guidelines

Ventricular Reduction/Remodeling or Partial Left Ventriculectomy (PLV) (New 12-00, update 4-05, 3-06, 10-06)

Ventricular Septal Region Procedures

Ventricular Septal Defect (VSD) - closure (New 10-05, update 5-06, 1-09)

Transcoronary ablation of septal hypertrophy (TASH) (Added 3-02, update 3-05)

Cardiovascular/Peripheral Vascular Surgery - additional resources, risk calculator

Cardiovascular surgery notes/links: General resource; Bloodless surgery - links (update 12-06, 7-07)

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Vascular Laboratory - Clinical Review Guidelines; refer to the ‘Cardiovascular/Thoracic/Peripheral Vascular Surgery’, Urology and ‘Radiology’ chapters for related criteria

Noninvasive cerebrovascular studies of extracranial arteries/Carotid function (new 12-01, update 10-03, 11-04, 2-05, 5-06, 5-07)

Ocular Plethysmography (OPG) and Ophthalmodynamometry

Ultrasonographic measurement of carotid intimal-medial thickness as an assessment of subclinical atherosclerosis (New 4-06)

Penile doppler and corpora cavernosonography studies for impotence (update 3-06)

Peripheral arterial non-invasive studies (section updates 11-04, 6-05, 3-06)

Segmental Doppler Pressures and Pulse Volume Recording

Ankle/Brachial Index (ABI) (New 7-06)

Exercise (Stress) Doppler Test

Digital Arterial Evaluation

Hemorheograph (New 5-04, update 5-07)

Visceral arterial duplex imaging

Plethysmography (update 12-04, 6-05)

Peripheral venous non-invasive studies/ultrasonography

(update 06-02, 11-04, 2-05, 4-05, 5-06)

Scintigraphic Imaging for Detection/Localization of Lower Limb Deep Vein Thrombosis (DVT) (added 2-01, update 4-07)

Thermography and Temperature Gradient Studies - refer to Radiology chapter

Hemodialysis Access Shunts - refer to Nephrology chapter

Vascular Laboratory Notes

Web Sites for Cardiology and Cardiovascular Surgery

‘Famous Last Words’

Apollo’s publication list

Abstract

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