L29412 CARDIOVASCULAR STRESS TESTING

 

 

01/01/2013

 

Indications and Limitations of Coverage and/or Medical Necessity

 

• A cardiovascular stress test will be considered medically reasonable and necessary for the following conditions:

o To evaluate the prognosis and functional capacity of patients with Coronary Artery Disease (CAD) soon after a myocardial infarction (before discharge or early after discharge and again 6-8 weeks after uncomplicated MI).

o To assess for the presence or absence of coronary disease, appropriate heart rate and/or blood pressure response for cardiac transplant patients.

 For optimal management of these patients, annual testing is recommended.

o Evaluation of patients before and after coronary artery revascularization by the following methods:

 Coronary Artery Bypass Grafting (CABGs).

• Testing is recommended in patients with suspected incomplete revascularization, technical difficulties during or after the operation, initial difficulties in being disconnected from the extra corporeal support system, enzymatic or electrocardiographic evidence of intraoperative MI, or other evidence of perioperative complications.

 Percutaneous Coronary Intervention (PCI)).

• Testing is performed prior to discharge (1-3 days after procedure) and again at 3 to 6 months (helps identify the 20-30% of patients who restenose in the first 6 months after the procedure).

o To evaluate functional capacity serially in the course of an exercise cardiac rehabilitation program (prior to starting rehab and at 12 weeks).

 

• Initial evaluation of patients with symptoms consistent with recurrent, exercise-induced cardiac arrthymias (e.g., shortness of breath (SOB) on exertion, syncope, palpitations, etc.).

o Initial evaluation of exercise capacity of selected patients with valvular heart disease with related symptomatology.

o Initial diagnostic workup for a patient that presents with abnormal signs and symptoms such as chest pain, palpitations, dyspnea, etc., which may suggest a cardiac origin. (Including those with RBBB or less than 1 mm ST depression, with an intermediate pre-test probability of CAD).

o Initial evaluation of patients with new onset of arrhythmias.

o Initial evaluation of a patient with an old Myocardial Infarction in which a workup has not been previously performed.

o Evaluation of a patient presenting with recent changes in an ECG.

o Evaluation of a patient with known CAD that presents with new symptoms such as increasing SOB, palpitations, change in EKG, etc.

o Evaluate patient’s response to a newly established therapy for angina, palpitations, arrhythmias, SOB or any other cardiopulmonary disease process.

o Evaluation of other symptomatology which may indicate a cardiac origin especially in those patients who have a history of a MI, CABG surgery or PCI or patients who are being treated medically after a positive stress test or cardiac catheterization.

• General contraindications to exercise testing include:

o Very recent acute myocardial infarction (generally within 2 days)

o High risk, unstable angina

o Uncontrolled asymptomatic heart failure

o Untreated cardiac arrhythmia causing symptoms or hemodynamic compromise

o Acute pericarditis, myocarditis or endocarditis

o Symptomatic severe aortic stenosis (calculated effective orifice less than .75 cm2 /m2 BSA or a peak systolic pressure gradient exceeding 50 mg Hg in presence of normal cardiac output)

o Severe arterial hypertension (generally > 200 mmHg systolic or 110 mmHg diastolic)

o Acute pulmonary embolus or pulmonary infarction

o Acute aortic dissection

o Acute or serious noncardiac disorder

• Patients with an abnormal resting ECG because of left bundle branch block, pre-excitation syndrome, left ventricular hypertrophy (LVH) or digoxin therapy, an exercise or pharmacological imaging study should be considered, because the accuracy of the exercise ECG in detecting provokeable ischemia is reduced.

• Cardiovascular stress testing may be performed in conjunction with additional cardiac diagnostic tests including echocardiography and nuclear cardiac imaging.

o It is expected that only the most appropriate test(s) necessary will be performed and billed to Medicare.

o The routine and repetitive monitoring of such patients beyond the first cardiac stress test, in the absence of a documented change in condition (i.e. new symptoms or progression of existing symptoms) is not considered medically necessary.

• Specific coverage of additional cardiac diagnostic tests e.g., (nuclear cardiac imaging studies) is outside the scope of the LCD.

o Please refer to LCDs related to those procedures for details of their coverage.

Exercise testing should be supervised by an appropriately trained physician.

o Exercise testing in selected patients can be performed safely by properly trained nurses, exercise physiologists, physician assistants, physical therapists, or medical technicians working directly under the supervision of a physician, who should be in the immediate vicinity and available for emergencies.

 

 

CPT/HCPCS Codes

 

93015 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; WITH SUPERVISION, INTERPRETATION AND REPORT

 

93016 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; SUPERVISION ONLY, WITHOUT INTERPRETATION AND REPORT

 

93017 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT

 

93018 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; INTERPRETATION AND REPORT ONLY

 

 

ICD-9 Codes that Support Medical Necessity

 

391.0 ACUTE RHEUMATIC PERICARDITIS

391.1 ACUTE RHEUMATIC ENDOCARDITIS

391.2 ACUTE RHEUMATIC MYOCARDITIS

391.8 OTHER ACUTE RHEUMATIC HEART DISEASE

391.9 ACUTE RHEUMATIC HEART DISEASE UNSPECIFIED

392.0 RHEUMATIC CHOREA WITH HEART INVOLVEMENT

394.0 MITRAL STENOSIS

394.1 RHEUMATIC MITRAL INSUFFICIENCY

394.2 MITRAL STENOSIS WITH INSUFFICIENCY

394.9 OTHER AND UNSPECIFIED MITRAL VALVE DISEASES

395.0 RHEUMATIC AORTIC STENOSIS

395.1 RHEUMATIC AORTIC INSUFFICIENCY

395.2 RHEUMATIC AORTIC STENOSIS WITH INSUFFICIENCY

395.9 OTHER AND UNSPECIFIED RHEUMATIC AORTIC DISEASES

396.0 MITRAL VALVE STENOSIS AND AORTIC VALVE STENOSIS

396.1 MITRAL VALVE STENOSIS AND AORTIC VALVE INSUFFICIENCY

396.2 MITRAL VALVE INSUFFICIENCY AND AORTIC VALVE STENOSIS

396.3 MITRAL VALVE INSUFFICIENCY AND AORTIC VALVE INSUFFICIENCY

396.8 MULTIPLE INVOLVEMENT OF MITRAL AND AORTIC VALVES

396.9 MITRAL AND AORTIC VALVE DISEASES UNSPECIFIED

398.0 RHEUMATIC MYOCARDITIS

398.90 RHEUMATIC HEART DISEASE UNSPECIFIED

398.91 RHEUMATIC HEART FAILURE (CONGESTIVE)

398.99 OTHER RHEUMATIC HEART DISEASES

402.00 MALIGNANT HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE

402.01 MALIGNANT HYPERTENSIVE HEART DISEASE WITH HEART FAILURE

402.10 BENIGN HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE

402.11 BENIGN HYPERTENSIVE HEART DISEASE WITH HEART FAILURE

402.90 UNSPECIFIED HYPERTENSIVE HEART DISEASE WITHOUT HEART FAILURE

402.91 UNSPECIFIED HYPERTENSIVE HEART DISEASE WITH HEART FAILURE

404.00 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED

404.01 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED

404.02 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE

404.03 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, MALIGNANT, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE

404.10 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED

404.11 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED

404.12 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE

404.13 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, BENIGN, WITH HEART FAILURE AND CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE

404.90 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED

404.91 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITH HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE I THROUGH STAGE IV, OR UNSPECIFIED

404.92 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITHOUT HEART FAILURE AND WITH CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE

404.93 HYPERTENSIVE HEART AND CHRONIC KIDNEY DISEASE, UNSPECIFIED, WITH HEART FAILURE AND CHRONIC KIDNEY DISEASE STAGE V OR END STAGE RENAL DISEASE

410.00 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL EPISODE OF CARE UNSPECIFIED

410.01 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL INITIAL EPISODE OF CARE

410.02 ACUTE MYOCARDIAL INFARCTION OF ANTEROLATERAL WALL SUBSEQUENT EPISODE OF CARE

410.10 ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL EPISODE OF CARE UNSPECIFIED

410.11 ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL INITIAL EPISODE OF CARE

410.12 ACUTE MYOCARDIAL INFARCTION OF OTHER ANTERIOR WALL SUBSEQUENT EPISODE OF CARE

410.20 ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL EPISODE OF CARE UNSPECIFIED

410.21 ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL INITIAL EPISODE OF CARE

410.22 ACUTE MYOCARDIAL INFARCTION OF INFEROLATERAL WALL SUBSEQUENT EPISODE OF CARE

410.30 ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL EPISODE OF CARE UNSPECIFIED

410.31 ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL INITIAL EPISODE OF CARE

410.32 ACUTE MYOCARDIAL INFARCTION OF INFEROPOSTERIOR WALL SUBSEQUENT EPISODE OF CARE

410.40 ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL EPISODE OF CARE UNSPECIFIED

410.41 ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL INITIAL EPISODE OF CARE

410.42 ACUTE MYOCARDIAL INFARCTION OF OTHER INFERIOR WALL SUBSEQUENT EPISODE OF CARE

410.50 ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL EPISODE OF CARE UNSPECIFIED

410.51 ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL INITIAL EPISODE OF CARE

410.52 ACUTE MYOCARDIAL INFARCTION OF OTHER LATERAL WALL SUBSEQUENT EPISODE OF CARE

410.60 TRUE POSTERIOR WALL INFARCTION EPISODE OF CARE UNSPECIFIED

410.61 TRUE POSTERIOR WALL INFARCTION INITIAL EPISODE OF CARE

410.62 TRUE POSTERIOR WALL INFARCTION SUBSEQUENT EPISODE OF CARE

410.70 SUBENDOCARDIAL INFARCTION EPISODE OF CARE UNSPECIFIED

410.71 SUBENDOCARDIAL INFARCTION INITIAL EPISODE OF CARE

410.72 SUBENDOCARDIAL INFARCTION SUBSEQUENT EPISODE OF CARE

410.80 ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES EPISODE OF CARE UNSPECIFIED

410.81 ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES INITIAL EPISODE OF CARE

410.82 ACUTE MYOCARDIAL INFARCTION OF OTHER SPECIFIED SITES SUBSEQUENT EPISODE OF CARE

410.90 ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE EPISODE OF CARE UNSPECIFIED

410.91 ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE INITIAL EPISODE OF CARE

410.92 ACUTE MYOCARDIAL INFARCTION OF UNSPECIFIED SITE SUBSEQUENT EPISODE OF CARE

411.0 POSTMYOCARDIAL INFARCTION SYNDROME

411.1 INTERMEDIATE CORONARY SYNDROME

411.81 ACUTE CORONARY OCCLUSION WITHOUT MYOCARDIAL INFARCTION

411.89 OTHER ACUTE AND SUBACUTE FORMS OF ISCHEMIC HEART DISEASE OTHER

412 OLD MYOCARDIAL INFARCTION

413.0 ANGINA DECUBITUS

413.1 PRINZMETAL ANGINA

413.9 OTHER AND UNSPECIFIED ANGINA PECTORIS

414.00 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT

414.01 CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY

414.02 CORONARY ATHEROSCLEROSIS OF AUTOLOGOUS VEIN BYPASS GRAFT

414.03 CORONARY ATHEROSCLEROSIS OF NONAUTOLOGOUS BIOLOGICAL BYPASS GRAFT

414.04 CORONARY ATHEROSCLEROSIS OF ARTERY BYPASS GRAFT

414.05 CORONARY ATHEROSCLEROSIS OF UNSPECIFIED BYPASS GRAFT

414.06 CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY OF TRANSPLANTED HEART

414.07 CORONARY ATHEROSCLEROSIS OF BYPASS GRAFT (ARTERY) (VEIN) OF TRANSPLANTED HEART

414.10 ANEURYSM OF HEART (WALL)

414.11 ANEURYSM OF CORONARY VESSELS

414.12 DISSECTION OF CORONARY ARTERY

414.19 OTHER ANEURYSM OF HEART

414.2 CHRONIC TOTAL OCCLUSION OF CORONARY ARTERY

414.3 CORONARY ATHEROSCLEROSIS DUE TO LIPID RICH PLAQUE

414.4 CORONARY ATHEROSCLEROSIS DUE TO CALCIFIED CORONARY LESION

414.8 OTHER SPECIFIED FORMS OF CHRONIC ISCHEMIC HEART DISEASE

414.9 CHRONIC ISCHEMIC HEART DISEASE UNSPECIFIED

415.0 ACUTE COR PULMONALE

415.11 IATROGENIC PULMONARY EMBOLISM AND INFARCTION

415.12 SEPTIC PULMONARY EMBOLISM

415.13 SADDLE EMBOLUS OF PULMONARY ARTERY

415.19 OTHER PULMONARY EMBOLISM AND INFARCTION

416.0 PRIMARY PULMONARY HYPERTENSION

416.1 KYPHOSCOLIOTIC HEART DISEASE

416.2 CHRONIC PULMONARY EMBOLISM

416.8 OTHER CHRONIC PULMONARY HEART DISEASES

416.9 CHRONIC PULMONARY HEART DISEASE UNSPECIFIED

424.0 MITRAL VALVE DISORDERS

424.1 AORTIC VALVE DISORDERS

426.0 ATRIOVENTRICULAR BLOCK COMPLETE

426.10 ATRIOVENTRICULAR BLOCK UNSPECIFIED

426.11 FIRST DEGREE ATRIOVENTRICULAR BLOCK

426.12 MOBITZ (TYPE) II ATRIOVENTRICULAR BLOCK

426.13 OTHER SECOND DEGREE ATRIOVENTRICULAR BLOCK

426.2 LEFT BUNDLE BRANCH HEMIBLOCK

426.3 OTHER LEFT BUNDLE BRANCH BLOCK

426.4 RIGHT BUNDLE BRANCH BLOCK

426.50 BUNDLE BRANCH BLOCK UNSPECIFIED

426.51 RIGHT BUNDLE BRANCH BLOCK AND LEFT POSTERIOR FASCICULAR BLOCK

426.52 RIGHT BUNDLE BRANCH BLOCK AND LEFT ANTERIOR FASCICULAR BLOCK

426.53 OTHER BILATERAL BUNDLE BRANCH BLOCK

426.54 TRIFASCICULAR BLOCK

426.6 OTHER HEART BLOCK

426.7 ANOMALOUS ATRIOVENTRICULAR EXCITATION

426.81 LOWN-GANONG-LEVINE SYNDROME

426.82 LONG QT SYNDROME

426.89 OTHER SPECIFIED CONDUCTION DISORDERS

426.9 CONDUCTION DISORDER UNSPECIFIED

427.0 PAROXYSMAL SUPRAVENTRICULAR TACHYCARDIA

427.1 PAROXYSMAL VENTRICULAR TACHYCARDIA

427.2 PAROXYSMAL TACHYCARDIA UNSPECIFIED

427.31 ATRIAL FIBRILLATION

427.32 ATRIAL FLUTTER

427.41 VENTRICULAR FIBRILLATION

427.42 VENTRICULAR FLUTTER

427.5 CARDIAC ARREST

427.60 PREMATURE BEATS UNSPECIFIED

427.61 SUPRAVENTRICULAR PREMATURE BEATS

427.69 OTHER PREMATURE BEATS

427.81 SINOATRIAL NODE DYSFUNCTION

427.89 OTHER SPECIFIED CARDIAC DYSRHYTHMIAS

427.9 CARDIAC DYSRHYTHMIA UNSPECIFIED

428.0 CONGESTIVE HEART FAILURE UNSPECIFIED

428.1 LEFT HEART FAILURE

428.20 UNSPECIFIED SYSTOLIC HEART FAILURE

428.21 ACUTE SYSTOLIC HEART FAILURE

428.22 CHRONIC SYSTOLIC HEART FAILURE

428.23 ACUTE ON CHRONIC SYSTOLIC HEART FAILURE

428.30 UNSPECIFIED DIASTOLIC HEART FAILURE

428.31 ACUTE DIASTOLIC HEART FAILURE

428.32 CHRONIC DIASTOLIC HEART FAILURE

428.33 ACUTE ON CHRONIC DIASTOLIC HEART FAILURE

428.40 UNSPECIFIED COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE

428.41 ACUTE COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE

428.42 CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE

428.43 ACUTE ON CHRONIC COMBINED SYSTOLIC AND DIASTOLIC HEART FAILURE

428.9 HEART FAILURE UNSPECIFIED

780.2 SYNCOPE AND COLLAPSE

780.4 DIZZINESS AND GIDDINESS

785.0 TACHYCARDIA UNSPECIFIED

785.1 PALPITATIONS

785.2 UNDIAGNOSED CARDIAC MURMURS

785.3 OTHER ABNORMAL HEART SOUNDS

786.00 RESPIRATORY ABNORMALITY UNSPECIFIED

786.01 HYPERVENTILATION

786.02 ORTHOPNEA

786.03 APNEA

786.04 CHEYNE-STOKES RESPIRATION

786.05 SHORTNESS OF BREATH

786.06 TACHYPNEA

786.07 WHEEZING

786.09 RESPIRATORY ABNORMALITY OTHER

786.50 UNSPECIFIED CHEST PAIN

786.51 PRECORDIAL PAIN

786.52 PAINFUL RESPIRATION

786.59 OTHER CHEST PAIN

794.31 NONSPECIFIC ABNORMAL ELECTROCARDIOGRAM (ECG) (EKG)

V42.1* HEART REPLACED BY TRANSPLANT

V45.01* CARDIAC PACEMAKER IN SITU

V45.81* POSTSURGICAL AORTOCORONARY BYPASS STATUS

V45.82* PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY STATUS

V67.00 FOLLOW-UP EXAMINATION FOLLOWING UNSPECIFIED SURGERY

V67.09 FOLLOW-UP EXAMINATION FOLLOWING OTHER SURGERY

V67.59 OTHER FOLLOW-UP EXAMINATION

* According to the ICD-9-CM book, Diagnosis codes V42.1, V45.01, V45.81, and V45.82 are secondary diagnosis codes and should not be billed as the primary diagnosis.

 

 

Documentation Requirements

 

• Medical record documentation maintained by the ordering/referring physician must indicate the medical necessity for performing the test, including:

o history and physical

o office/progress note,

And

o test results

• If the provider of the service is other than the ordering/referring physician, the provider of the service must maintain hard copy documentation of test results and interpretation, along with copies of the ordering/referring physician’s order for the studies.

o The physician must state the clinical indication/medical necessity for the study in his order for the test.

 

Utilization Guidelines

 

• It is expected that these services would be performed as indicated by current medical literature and/or standards of practice.

o When services are performed in excess of established parameters they may be subject to review for medical necessity.

• Reimbursement of cardiovascular stress testing (93015-93018) which exceeds the frequency or duration indicated by the accepted standards of medical practice are not covered unless there are special circumstances which justify additional cardiovascular stress testing.

o The routine and repetitive monitoring of such patients beyond the first cardiac stress test, in the absence of a documented change in condition (i.e. new symptoms or progression of existing symptoms) is not considered medically necessary.

Treatment Logic

• Cardiovascular Stress Testing or Exercise Stress Test (EST) consists of the continuous monitoring of an electrocardiogram (generally a 12-lead system) with frequent 3-lead or 12-lead recordings taken according to clinical circumstances, frequent blood pressure determinations and continuous patient observation before, during and after exercise of progressively increasing intensity (usually with a treadmill or cycle ergometer) to any of a number of test end points.

• Usually, the heart rate, blood pressure, and EKG are recorded at the end of each stage of exercise, immediately before and immediately after stopping exercise, and for each minute for at least 5-10 minutes in the recovery stage.

• A minimum of three leads should be displayed continuously on the cathode ray screen during the test.

• Arm exercise is occasionally used in selected patients, although it is seldom as satisfactory.

• Exercise Stress Testing is valuable for diagnosing ischemic heart disease and in investigating physiologic mechanisms underlying cardiac symptoms, such as angina, dysrhythmias, inordinate rises in blood pressure, and functional valve incompetence.

• EST also measures functional capacity for work, sport, or participation in a rehabilitation program and estimates response to medical or surgical treatment.

• Additionally, the function of physiologic responsive pacemakers (testing for upper rate limits) can be evaluated.

• Normally, the systolic blood pressure increases with exercise and the diastolic remains essentially unchanged.

• An exercise test is considered negative when the patient does not exhibit significant symptoms, arrhythmias, or other ECG abnormalities at 85% of maximum heart rate predicted for age and sex.

• In many instances, exercise testing may be combined with other procedures, such as myocardial perfusion imaging, radionuclide ventriculography, echocardiography or other imaging procedures.

 

 

Sources of Information and Basis for Decision

 

American College of Cardiology (ACC) /American Heart Association (AHA) (2002). Guideline update for exercises testing. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Committee on Exercise Testing.

 

Braunwald, E., (2007). Heart Disease: A Textbook of Cardiovascular Medicine (8th ed.). Philadelphia: W.B. Saunders Company.

 

Rodgers, et.al, (2000). Clinical Competence Statement on Stress Testing. College of Cardiology/American Heart Association Clinical Competence Statement on Stress Testing. Journal of American College Cardiology. (36) 1441-53.

 

01/01/2013

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

 

AMA CPT / ADA CDT Copyright Statement

 

CPT codes, descriptions and other data only are copyright 2011 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

Local Coverage Determination (LCD) - Cardiovascular Stress Testing (L29412)