Cardiac PET Testing103a70a28a1956d20396-44fa3cb5073b9b8b82c169d0de54e506.r66.cf5… · WHY PET...
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United Health – PET is the preferred modality OR for prior equivocal study Medicaid – PET is NOT covered Last updated 2-13-2012 BMI>35 BMI>40 "obesity, large or pendulous breasts " Breast Implants Known or suspected CAD Equivocal Stress test Unable to exercise LBBB or uninterpretable resting ECG Conditions associated with high risk for morbidity (contrast allergy, nephropathy, thrombocytopenia) Medicare X X Peoples Health Choice 65 X X Humana X X X X BCBS X X X X Cigna X X X X X X Aetna X X X X Coventry X X X X PET CRITERIA FOR INSURANCE PROVIDER (X= provider will cover without peer to peer) John Ochsner Heart and Vascular Institute TM © 2012 Ochsner Health System (ochsner.org) is a non-profit, academic, multi-specialty, healthcare delivery system dedicated to patient care, research and education. “Appropriate Use Criteria for Nuclear Stress Testing” – http://content.onlinejacc.org/cgi/content/full/53/23/2201 STRESS TESTING ALGORITHM Is stress testing with imaging indicated? NO Exercise Treadmill YES Does the patient have known CAD or CAD equivalent AND traditional Medicare? Is the patient’s BMI≥40 for all insurers OR≥35 for Humana OR BCBS or Cigna? Has the patient had an equivocal or false positive Stress Echo or SPECT? Does the patient have a LBBB **? Either Stress Echo or SPECT NO NO NO NO YES YES YES YES PET PET PET SPECT § United Health Care allows for PET to be utilized as the first line imaging modality ** Cigna prefers PET with underlying LBBB, paced rhythm or inability to exercise ***If the patient has BCBS and has known contrast allergy or renal dysfunction for which angiography increases the likelihood of renal failure, PET is the preferred stress modality. Cardiac PET Testing OHS_2946_BD_PET Stress Test Bi-Fold BRO_10x8.5.indd 1 3/2/12 12:47 PM
Transcript of Cardiac PET Testing103a70a28a1956d20396-44fa3cb5073b9b8b82c169d0de54e506.r66.cf5… · WHY PET...
United H
ealth – PET is the preferred modality O
R for prior equivocal study M
edicaid – PET is NO
T covered Last updated 2-13-2012
BM
I>35 BM
I>40 "obesity, large or pendulous
breasts "
Breast Im
plants Know
n or
suspected C
AD
Equivocal
Stress test
Unable to
exercise LBBB or uninterpretable resting EC
G
Conditions associated w
ith
high risk for morbidity
(contrast allergy,
nephropathy,
thrombocytopenia)
Medicare
X X
Peoples H
ealth C
hoice 65
X X
Hum
ana X
X
X
X
BCBS
X
X
X
X
Cigna
X
X X
X
X X
Aetna
X X
X
X
Coventry
X
X X
X
PET CRITERIA FO
R INSU
RANC
E PROVID
ER
(X= provider will cover w
ithout peer to peer)
John Ochsner Heart and Vascular Institute
TM
© 2012 Ochsner Health System (ochsner.org) is a non-profit, academic, multi-specialty, healthcare delivery system dedicated to patient care, research and education.
“Appropriate Use Criteria for Nuclear Stress Testing” – http://content.onlinejacc.org/cgi/content/full/53/23/2201
STRESS TESTING ALGORITHMIs stress testing with imaging indicated?
NO
Exercise Treadmill
YES
Does the patient have known CAD or CAD equivalent AND traditional Medicare?
Is the patient’s BMI≥40 for all insurers OR≥35 for Humana OR BCBS or Cigna?
Has the patient had an equivocal or false positive Stress Echo or SPECT?
Does the patient have a LBBB **?
Either Stress Echo or SPECT
NO
NO
NO
NO
YES
YES
YES
YES
PET
PET
PET
SPECT
§ United Health Care allows for PET to be utilized as the first line imaging modality
** Cigna prefers PET with underlying LBBB, paced rhythm or inability to exercise
***If the patient has BCBS and has known contrast allergy or renal dysfunction for which angiography increases the likelihood of renal failure, PET is the preferred stress modality.
Cardiac PET Testing
OHS_2946_BD_PET Stress Test Bi-Fold BRO_10x8.5.indd 1 3/2/12 12:47 PM
WHY PET STRESS TESTING? 1) Diagnostic accuracy is better than treadmill, SPECT and Stress ECHO.2) Soft tissue attenuation correction allows for excellent quality (especially in obese patients) when compared to other medications.3) Ability to detect pre-clinical disease. PET1-4 Stress ECHO5 SPECT6 Exercise treadmill7
Sensitivity .90-.93 (.91) .71-.97 (.85) .87 .50-.72 (.68)Specificity .89-.92 (.91) .41-.91 (.77) .73 .69-.90 (.73)
1. Gould KL, J Am Coll Cardiol. 1986;7:775–789.2. Machac J. Semin Nucl Med 2005;35:17-36.3. Di Carli MF, Hachamovitch R. Circulation 2007;115:1464-1480.4. Demer LL, Gould KL, Goldstein RA Circulation 1989;79:825-8355. Armstrong WF J Am Coll Cardiol 2005;45:1739–476. Marcassa Eur. Heart J., February 2, 2008; 29(4): 557 - 563.7. Gibbons, R., Balady, G.; Timothybricker, J., Chaitman, B., Fletcher, G., Froelicher, V., Mark, D., McCallister, B. Task Force on Practice Guidelines, Journal of the American College of Cardiology
Ochsner Heart and Vascular Institute – Metairie Services2005 Veterans BlvdMetairie, Louisiana 70003
To Order SPECT, call 504-842-4168
Ochsner Heart and Vascular Institute – Main Campus Services1516 Jefferson HwyNew Orleans, Louisiana 70121
To Order PET, call 504-842-4010
Awards & Accolades: • One of America’s Best Hospitals, citing top 25 ranking for exceptional care in Heart & Heart Surgery, U.S. News and World Report, 2011-2012.
• A Top 15 Major Teaching Hospitals by Thomson Reuters National Benchmark Study. • HealthGrades® Five-Stars for Coronary Interventional Procedures, Treatment of Heart Attack, and Heart Failure while in the hospital.
OHS_2946_BD_PET Stress Test Bi-Fold BRO_10x8.5.indd 2 3/2/12 12:47 PM
