Cardiology Coding Alert

Question: Does Medicare cover the Heartsbreath test for heart transplant patients?
Maryland SubscriberAnswer: CMS currently doesn't consider the test reasonable and necessary based on the available evidence, but it is soliciting public comment before posting its final decision memo (www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?from2=viewdraftdecisionmemo.asp&id=217&).Other payers vary. For example, Blue Cross Blue Shield policy finds the test investigational and won't cover it (www.bcbsnc.com/services/medical-policy/pdf/breath_testing_for_heart_transplant_rejection_detection.pdf).Aetna, on the other hand, "considers the Heartsbreath Test (Menssana Research, Inc., Fort Lee, NJ) medically necessary for use as an aid to diagnose grade 3 heart transplant rejection in persons who have received heart transplants within the preceding year" (www.aetna.com/cpb/medical/data/500_599/0586.html).The test: The Heartsbreath test is noninvasive and helps "in the diagnosis of grade 3-heart transplant rejection in first year heart transplant recipients," according to AMA's CPT Assistant (May 2005). The patient breathes into a collection apparatus for two minutes, and a lab compares volatile organic compounds (VOCs) in the patient sample to an air sample taken from the room. The lab then generates a report on likelihood of rejection. Code 0085T (Breath test for heart transplant rejection) describes the test.-- You Be the Coder and Reader Questions prepared with the assistance of Jim Collins, CPC-CARDIO, ACS-CA, CHCC, president of CardiologyCoder.Com Inc. and compliance manager for several cardiology groups around the country.