Medical Policy Updates

Table Of Contents

Blue Cross and Blue Shield of North Carolina Medical Policy Update for January 29, 2013

Medical Guidelines Reason for Update
Anesthesia Services Specialty Matched Consultant Advisory Panel review 1/16/2013. Under the When Covered section, moved spinal anesthesia under regional anesthesia and added epidural to bulleted list. No change to policy intent.
Bone Morphogenetic Protein References updated. No changes to Policy Statements.
Breast Surgeries References updated. No changes to Policy Statements.
Capsaicin (Qutenza®) Specialty Matched Consultant Advisory Panel review 1/16/2013. No change to policy.
Cardiac (Heart) Transplantation References updated. Description section updated. No changes to Policy Statements.
Cardiovascular Disease Risk Tests Policy Statement revised from "Measurement of cardiovascular risk factors for assessment of cardiovascular risk is considered investigational." to "Measurement of cardiovascular risk factors (i.e., apolipoprotein B, apolipoprotein A-I, apolipoprotein E, LDL subclass, HDL subclass, lipoprotein[a], long chain fatty acids, fibrinogen, cystatin C) is considered investigational as an adjunct to LDL cholesterol in the risk assessment and management of cardiovascular disease. BCBSNC does not provide coverage for investigational services or procedures." Added the following codes to the Billing/Coding section: 278.01, 278.02, 278.03, V12.50, V12.51, V12.52, V12.53, V12.54, V12.55, V12.59.
Code Bundling Rules Not Addressed in ClaimCheck® or Correct Coding Initiative New codes added for 2013. Complex chronic care coordination services (99487-99489), continuous intraoperative neurophysiology monitoring (95940, 95941), interfacility transport care (99485, 99486), interactive complexity (90785), pharmacologic management (90863), transitional care management services (99495, 99496) are considered incidental and are not eligible for separate reimbursement.
Cryosurgical Ablation of Primary or Metastatic Liver Tumors Related policies added. Reference added. No change to policy statement.
Fetal Surgery for Malformations Reference added. No change to policy statement.
Genetic Testing for Long QT Syndrome Added the following statement to the Policy Statement section: "Determining the pretest probability of LQTS is not standardized. An example of a patient with a moderate-to-high pretest probability of LQTS is a patient with a Schwartz score of 2-3." Replaced the word "intermediate" with "moderate" in the Description section for consistency. Medical Director review 1/2013.
Genetic Testing for Predisposition to Inherited Hypertrophic Cardiomyopathy References updated. Description section updated. No changes to Policy Statements.
H-Wave Electrical Stimulation Archive policy. Medical Director review 1/8/2013.
Heart-Lung Transplantation References updated. Description section updated. No changes to Policy Statements.
Hyperbaric Oxygen Pressurization Description section revised. The following statement was added to the Policy section: "Topical Hyperbaric Oxygen Therapy is considered investigational. BCBSNC does not cover investigational services." Acute osteomyelitis, acute surgical and traumatic wounds, idiopathic femoral neck necrosis, chronic wounds, other than those in patients with diabetes who meet the criteria specified in the medically necessary statement, acute ischemic stroke, Bell's palsy, and chronic arm lymphedema following radiotherapy for cancer added to the list of non-covered indications in the When HBO is Not Covered section. Utilization of hyperbaric oxygen information added to Policy Guidelines Section. Summary statements for Hyperbaric Oxygen Therapy and Topical Hyperbaric Oxygen Therapy added to Policy Guidelines Section. Added HCPCS code A4575 and E0446 to Billing/Coding section. Senior Medical Director review 10/14/2012. Notification given 10/30/2012 for effective date of 1/29/2013. Specialty Matched Consultant Advisory Panel. No change to policy.
Immune Cell Function Assay Description section revised. Policy Guidelines updated. Reference added.
Intravenous Anesthetics for the Treatment of Chronic Pain Specialty Matched Consultant Advisory Panel 1/16/2013. No change to policy. Reference added.
Magnetic Resonance Spectroscopy Reference added. No change to policy statement.
Neural Therapy Specialty Matched Consultant Advisory Panel review 1/16/2013. No change to policy intent. Reference added.
Nonpayment for Serious Adverse Events Updated list of hospital acquired conditions and codes per CMS IPPS Fiscal Year 2013 Final Rule. New categories added: surgical site infection following cardiac implantable electronic device and iatrogenic pneumothorax with venous catheterization. Pertinent ICD-9 codes were revised in the following categories: blood incompatibility and vascular catheter-associated infection.
Orthotics Policy returned to active status and will undergo scheduled review. References updated. No changes to Policy Statements.
Pharmacogenetic Testing for Warfarin Dose Description section updated. Policy Guidelines updated. References updated. No changes to Policy Statement.
Rapid Opioid Detoxification Reference added. No change to Policy statement.
Sexual Dysfunction Treatment, Male Medical Director review. Please refer to the Member's Benefit Booklet for availability of benefits for these services. Policy archived.
Signal-Averaged ECG References updated. No changes to Policy Statement.
Spinal Manipulation under Anesthesia Specialty Matched Consultant Advisory Panel review 1/16/2013. No changes to policy. References added.
Topical Hyperbaric Oxygen Therapy Policy archived and combined into policy entitled; Hyperbaric Oxygen Pressurization. Medical Director review 10/14/12.
Transcatheter Heart Valve Implantation Description section updated. "When Covered" section revised to include coverage for transapical surgical approach. Added "Left Ventricular Ejection Fraction >20%" as a criterion for coverage in the "When Covered" section. "When not Covered" section revised to state: "Transcatheter pulmonary valve implantation is considered investigational for all other indications. Transcatheter aortic valve replacement is considered investigational for all other indications, including but not limited to: patients with a degenerated bio-prosthetic valve ("Valve-in-Valve" implantation); procedures performed via the transaxillary, transiliac, transaortic, or other approaches." Policy Guidelines updated. References updated. Medical Director review 1/2013.
Evidence Based Guidelines
Ambulatory Blood Pressure Monitoring Specialty Matched Consultant Advisory Panel review 10/2012. References updated. Medical Director review 1/2013.
Human Papillomavirus (HPV) Vaccine Medical Director review 1/15/13. Archive policy.
Monitored Anesthesia Care (MAC) Description section revised. No change to guideline intent. Reference added. Specialty Matched Consultant Advisory Panel review 1/16/2013.