Post Heart Transplant Endomyocardial Biopsy
DESCRIPTION
Endomyocardial biopsy involves using a flexible bioptome to obtain tissue samples from the right and occasionally the left ventricle of the heart. The heart is approached via a transarterial or transvenous heart catheterization. Multiple tissue samples (usually four or more) are required because pronounced topographic variations may be found within the myocardium.
POLICY
Post heart transplant endomyocardial biopsy to monitor cardiac allograft rejection is considered medically necessary.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Endomyocardial biopsy is not an office procedure; the procedure must be performed via right/left heart catheterization. The procedure is performed as an outpatient or inpatient service.
There is no standardization in the number of post heart transplantation biopsies to be performed each year. The frequency may vary considerably on a case-by-case basis.
SOURCES
Cooper, L. T., Baughman, K. L., Feldman, A. M., Frustaci, A., Jessup, M., Kuhl, U., et al. (2007). The role of endomyocardial biopsy in the management of cardiovascular disease: A scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation, 116 (19), 2216-2233.
Luk, A., Metawee, M., Ahn, E., Gustafsson, F., Ross, H., Butany, J. (2009). Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy. The Canadian Journal of Cardiology, 25 (2), e48-e54.
ORIGINAL EFFECTIVE DATE: 9/13/1999
MOST RECENT REVIEW DATE: 5/13/2010
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
This document has been classified as public information.