Medical Policy Updates

Table Of Contents

Blue Cross and Blue Shield of North Carolina Medical Policy Update for April 27, 2010

Medical Guidelines Reason for Update
Ambulatory Blood Pressure Monitoring Description section revised. Specialty Matched Consultant Advisory Panel review 3/24/2010. Removed Medical Policy number. No change in policy statement.
Ambulatory Event Monitors Specialty Matched Consultant Advisory Panel review 3/24/2010. Removed Medical Policy number. No changes to policy
Enhanced External Counterpulsation (EECP) Specialty Matched Consultant Advisory Panel review 3/24/2010. Medical Policy number removed. No changes to policy.
Insulin Therapy, Chronic Intermittent Intravenous (CIIIT) Policy status changed from "Active Policy, no longer scheduled for routine literature review" to "Active". Removed the Policy Number. Added the following statement to the "Description" section indicating; "*The infusion pump used is specially designed for the purposes of CIIIT. The pump received U.S. Food and Drug Administration (FDA) marketing clearance through a 510(k) process." New HCPCS code G9147 added to the "Coding/Billing" section. References added.
Intravascular Ultrasound Imaging (IVUS) Specialty Matched Consultant Advisory Panel Review 3/24/2101. Added CPT code 75945 and 75946 to Billing/Coding section. Removed Medical Policy number.
Removal of Impacted Cerumen Implementation of new policy. BCBCNC will provide coverage for the removal of impacted cerumen when the medical criteria and guidelines outlined in this policy have been met. Policy effective 07/01/2010.
Evidence Based Guidelines
Apolipoprotein B in Cardiac Disease Risk Assessment Specialty Matched Consultant Advisory Panel Review 3/24/2010. Removed Policy Guideline number. No changes to policy.
Apolipoprotein E Genotype or Phenotype in Cardiac Disease Risk Assessment Specialty Matched Consultant Advisory Panel review 3/24/2010. Removed Policy Guideline number. No changes to policy.
Endoscopic Radiofrequency Ablation for Barretts Esophagus Policy name changed to include Cryoablation. "Guideline Number" removed. Updated "Description" section. Added "Radiofrequency ablation may be appropriate for treatment of Barrett's esophagus with high-grade dysplasia. Radiofrequency ablation for Barrett's esophagus with high-grade dysplasia may be used in combination with endoscopic mucosal resection of nodular/visible lesions. The diagnosis of high-grade dysplasia should be confirmed by two pathologists prior to radiofrequency ablation. Radiofrequency ablation of high-grade dysplasia in Barrett's esophagus has been shown to be at least as effective in eradicating high-grade dysplasia as other ablative techniques with a lower progression rate to cancer, and may be considered as an alternative to esophagectomy." "Radiofrequency ablation is not recommended for treatment of Barrett's esophagus with low-grade dysplasia or Barrett's esophagus in the absence of dysplasia. More data are required concerning the use of RFA for the eradication of low-grade dysplasia and nondysplastic Barrett's esophagus. Longer follow-up is needed to show that eradication will persist, and that the benefits will outweigh potential complications in these patients who show a lower rate of progression to adenocarcinoma than those with high-grade dysplasia. Cryoablation is not recommended for Barrett's esophagus, with or without dysplasia. Data for the efficacy of cryoablation of Barrett's esophagus with or without dysplasia are limited. The studies consist of small numbers of patients with short-term follow-up, and therefore this approach is considered investigational." Added to the "When not recommended" section. Reviewed with the Senior Medical Director 3/28/2010. References added.
High Density Lipoprotein Subclass Testing in Cardiac Disease Risk Assessment Specialty Matched Consultant Advisory Panel review 3/24/10. Removed Policy Guideline number. No change to policy.
High Sensitivity C Reactive Protein in Cardiac Disease Risk Assessment Specialty Matched Consultant Advisory Panel review 3/24/10. Removed Policy Guideline number. No changes to policy.
Homocysteine Testing in Cardiac Disease Risk Assessment Specialty Matched Consultant Advisory Panel review 3/24/2010. Removed Policy Guideline number. No change to policy.
Lipoprotein (a) Enzyme Immunoassay in Cardiac Disease Risk Assessment Specialty Matched Consultant Advisory Panel review 3/24/2010. Removed Policy Guideline number. No change to policy.
Partial Left Ventriculectomy Removed Policy Guideline number. Deleted CPT code 33548. New policy titled "Surgical Ventricular Restoration" initiated that is inclusive of CPT code 33548.