On Demand - Coronary CTA - Clinical Evidence and Guidelines Meet the Real World-Additional Resources

Additional Resources

Pdf Summary

Coronary Computed Tomography Angiography (CCTA) is a non-invasive diagnostic test that uses x-rays to examine the arteries of the heart and detect any narrowing caused by plaque buildup. It is primarily used for the diagnosis, exclusion, or evaluation of obstructive coronary artery disease (CAD). CCTA is also preferred in patients with suspected anomalous coronary arteries. The test provides direct images of the coronary arteries, distinguishing it from other noninvasive approaches to evaluate CAD.<br /><br />In some cases, after a CCTA of uncertain significance indicating a stenosis of 49-90%, a HeartFlow Analysis (FFRCT) may be performed. This pathway enhances diagnostic accuracy and is considered the highest-performing non-invasive test available. Medical necessity requirements for CCTA vary among different payers, but indications for use generally help determine if the test meets the health plan's guidelines and is consistent with guideline-directed medical therapy.<br /><br />Medicare's indications for CCTA include evaluating acute chest pain, unexplained dyspnea, or symptoms suggestive of angina pectoris in patients with intermediate pre-test probability of CAD, no EKG changes indicating acute myocardial injury or ischemia, and normal initial cardiac markers. The test is also indicated for evaluating chest pain syndrome with intermediate pre-test probability of CAD and uninterpretable EKG or stress tests. Additionally, CCTA may be used in the management of established CAD, suspected anomalous coronary arteries, hypertrophic cardiomyopathy, and for excluding ischemic heart disease or anomalous coronary arteries in individuals who have recovered from unexplained sudden cardiac arrest.<br /><br />The documentation requirements for CCTA may vary depending on the health plan guidelines, but they generally involve evidence of nonobstructive CAD, prior heart catheterization, or CCTA results. There are different ICD-10 codes that pertain to CCTA and HeartFlow FFRCT Medicare coverage.<br /><br />It is important to consider that each payer may have different guidelines for CCTA, so it is advisable to refer to the specific health plan for accurate guidance.<br /><br />Carelon and eviCore are two sources that provide guidelines and indications for CCTA.

Keywords

Coronary Computed Tomography Angiography

CCTA

non-invasive diagnostic test

obstructive coronary artery disease

anomalous coronary arteries

HeartFlow Analysis

FFRCT

Medicare indications

chest pain syndrome

payer guidelines