ASNC Model Coverage Policy: Cardiac positron emission tomographic imaging

摘要

This document is intended as a model coverage policy for cardiac positron emission tomography (PET) imaging studies and delineates under which clinical situations such a study is indicated. This document examines a variety of patient clinical indications and symptoms which support the use of cardiac PET by cross-referencing the indication with the appropriate use criteria (AUC) for radionuclide studies developed by the American College of Cardiology (ACC)/American Society of Nuclear Cardiology (ASNC) in 2005 and subsequently revised in 2009. In addition, the use of cardiac PET in patients with the indications delineated in the policy is supported by references to an abundance of the literature in the provided scenarios. Finally, we have provided the International Classification of Diseases (ICD)-9 codes which correlate to each of the indications to demonstrate which codes, or ranges of codes, are appropriate for each clinical indication.