Cpt 78452 effective date
Cardiac Indications: Aetna considers SPECT medically necessary for the diagnosis of coronary artery disease and for the assessment of prognosis in persons with coronary artery disease except as outlined in "exclusion criteria" below.". Diagnosing and assessing hemangiomas of the liver; or. A history of physical impairments that would preclude physically performing the exercise portion of a stress test; or. Single photon emission computed tomography has a far greater sensitivity for detecting silent ischemia than stress ECG. Pooled data of exercise SPECT studies in over 1,000 patients revealed a 90 % overall sensitivity for detecting CAD. In assessing myocardial viability, studies indicate that, even in patients with severe irreversible thallium defects on standard exercise-redistribution imaging, thallium re-injection provides information regarding myocardial viability that is comparable to that provided by positron emission tomography (PET). As a routine screening evaluation after a percutaneous transluminal coronary angioplasty (PTCA) with or without stenting or coronary artery bypass surgery (CABG) prior to discharge from the acute care setting; or. Diagnosis or assessment of members with personality disorders (e.g., aggressive and violent behaviors, anti-social personality disorder including psychopathy, schizotypal personality disorder, as well as borderline personality disorder); or. Footnotes ** According to ACC guidelines, the following are impediments or contraindications to non-nuclear stress testing:. In AD, SPECT shows decreased perfusion in the association cortex of the parietal lobe and the posterior temporal regions. Frontal association cortex is predominantly affected in some cases, but usually is not involved until late in the course of the disease. The occipital lobes are less involved and the paracentral cortex is spared. Although SPECT studies have been reported in over 500 patients with AD, in most cases the diagnosis was made clinically and only in 53 patients it was confirmed by autopsy. Controlled studies of SPECT in AD have shown a sensitivity of this procedure to vary from 50 % to 95 %. The best results have been reported in the more recent studies, using higher resolution equipment. In the 2001 practice parameter on the diagnosis of dementia, the American Academy of Neurology does not recommend SPECT for routine use in either initial or differential diagnosis of dementia (Knopman et al, 2001). Proven CAD by past SPECT or coronary catheterization; or. Aetna considers SPECT-CT fusion medically necessary for parathyroid imaging in persons with an enlarged parathyroid gland, parathyroid hyperplasia or suspected parathyroid adenoma or carcinoma, and laboratory evidence of hyperparathyroidism (parathyroid hormone greater than 55 pg/ml and serum calcium greater than 10.2 mg/dL). Neuroimaging markers are increasingly important in the early diagnosis of the dementias, not only to detect the rare tumor, but also to differentiate the various types of neurodegenerative dementias. The potential of MRI and PET as surrogates for disease progression for therapeutic trials is being examined in a large multi-center trial. However, SPECT has been reported to show specific findings in both fronto-temporal dementia (FTD) and AD and is much more available and less expensive than PET. McNeil et al (2007) evaluated the diagnostic accuracy of technetium-99–labeled hexamethyl propylene amine oxime SPECT images obtained at initial evaluation in 25 pathologically confirmed ca Exclusion criteria: Aetna considers SPECT myocardial perfusion imaging experimental and investigational for the following indications for which the study is considered "inappropriate" according to appropriateness criteria from the American College of Cardiology (ACC):. Aetna considers freehand SPECT/ultrasonography (US) fusion imaging in persons with thyroid disease experimental and investigational because of insufficient evidence of its effectiveness. Diagnosis or assessment of members with attention deficit/hyperactivity disorder ( CPB 0426 - Attention Deficit/Hyperactivity Disorder ); or. As an imaging marker of pre-diagnostic Parkinson's disease; or. Intermediate-risk surgery (risk of cardiac death or MI 1 % to 5 %): carotid endarterectomy, head and neck surgery, surgery of the chest or abdomen, orthopedic surgery, prostate surgery. The member's ECG would prevent interpretation of a standard stress testing by being "uninterpretable" during the test, i.e., left bundle branch block (LBBB), paced rhythm, Wolf Parkinson White syndrome, left ventricular hypertrophy (LVH) with ST segment depression, or digoxin use. Pre-surgical evaluation of members undergoing lung volume reduction surgery; or. Aetna considers SPECT experimental and investigational for all other cardiac indications because its effectiveness for indications other than the ones listed above has not been established. Low-risk surgery (cardiac death or MI less than 1 %): endoscopic procedures, superficial procedures, cataract surgery, breast surgery. High-risk surgery (risk of cardiac death or myocardial infarction (MI) greater than 5 %): emergent major operations (particularly in the elderly), aortic and peripheral vascular surgery, prolonged surgical procedures associated with large fluid shifts and/or blood loss. [ASKDEEIPSNPPET-21-23] >/MediaBox[ 0 0 792 612] /Contents 4 0 R/Group /Tabs/S/StructParents 0>> endobj 4 0 obj. >/MediaBox[ 0 0 612 792] /Contents 4 0 R/Group /Tabs/S/StructParents 0>> endobj 4 0 obj.