External Counterpulsation Therapy (ECP & EECP) Reimbursement Protocol.
In the U.S, ECP is reimbursed by Medicare and most private insurance companies. The reimbursement process is quite simple but it must be followed precisely. This article is designed to show the important documents that should be included in each patient chart to insure smooth reimbursement.
1. Documented Coronary Artery Disease
Patients with documented Coronary Artery Disease (CAD) or ischemia. Documentation must meet ‘Objective Assessment “B” (evidence of Cardiovascular Disease) by way of a positive Cardiac Catheterization, Nuclear (SPECT) Study, Stress test, Holter Monitor study or resting EKG.
2. Symptoms Upon Physical Exertion
Any patient who were to walk 1 – 2 blocks or up 1 flight of stairs and complains of anginal chest pain, shortness of breath, fatigue or palpitations. Any of these symptoms on physical exertion would meet the symptoms requirement.
Important Note: There are patients that may not complain of discomfort because they have already adjusted their lifestyle to match their disease and are ideal candidates for ECP.
3. Not Adequate Relief from Medical Management / Medications
In most cases, patients are already on medical management such as beta blockers, Ca antagonists and long acting nitrates. These medications in large part are pallative (providing temporary relief). ECP treats the disease by improving endothelial function, collateralization and LV function (both systolic and diastolic).
4. Not Amenable to Surgical Intervention
• Co-morbid conditions that create excessive risk
• High risk of operative complications
• High risk of post operative failure (patients with prior failed revascularization)
• Unsuitable anatomy (location of lesion, diffuse or distal disease, small vessel disease)
Keep in mind, ECP & EECP Therapy is a rehabilitation process much like an exercise program. The ideal candidates for this treatment are those with a stable condition that strive a more active and quality lifestyle. The Benefits of External Counterpulsation Therapy is an ideal tool to restore cardiac & vascular wellness.
