Mechanical In-Exsufflator (Cough Machine)
DESCRIPTION
The mechanical in-exsufflator, or cough machine, is a portable machine intended to stimulate a cough for individuals unable to cough or clear secretions effectively. It works by gradually applying a positive pressure to the airway, then rapidly shifting to a negative pressure. The rapid shift in pressure, via facemask or mouthpiece, produces a high expiratory flow rate from the lungs. A cough is stimulated, which assists in clearing broncho-pulmonary secretions.
POLICY
The mechanical in-exsufflator, when used as an alternative to tracheostomy or other invasive procedures, is considered medically necessary if the medical appropriateness criteria are met. (See Medical Appropriateness below.)
Any device utilized for this procedure must have FDA approval specific to the indication, otherwise it will be considered investigational.
MEDICAL APPROPRIATENESS
The mechanical in-exsufflator, when used as an alternative to tracheostomy or other invasive procedures, is considered medically appropriate with ALL the following:
Inability to cough or clear secretions effectively due to reduced peak cough expiratory flow (less than two to three liters per second)
Inability to successfully and adequately mobilize retained secretions with standard treatments such as chest percussion and postural drainage
The individual has a high spinal cord injury, or a neuro-muscular deficit, or severe fatigue associated with intrinsic lung disease
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
Careful consideration should be given before the mechanical in-exsufflator is used for individuals with any of the following conditions: history of bullous emphysema, known susceptibility to pneumothorax or pneumo-mediastinum, or known to have had a recent barotrauma.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (4:2004). Mechanical insufflation-exsufflation as a expiratory muscle aid (1.01.21). Retrieved July 7, 2009 from BlueWeb. (12 articles and/or guidelines reviewed)
Health Technology Assessment Information Service. Target database. (2003, March). Mechanical insufflation-exsufflation for respiratory insufficiency. Retrieved July 28, 2006 from ECRI HTAIS. (20 articles and/or guidelines reviewed)
Miske, L. J., Hickey, E. M., Kolb, S. M., Weiner, D. J., & Panitch, H. B. (2004). Use of the mechanical in-exsufflator in pediatric patients with neuromuscular disease and impaired cough. Chest, 125 (4), 1406-1412.
National Guideline Clearinghouse. (2005). Respiratory management following a spinal cord injury: A clinical practice guideline for health-care professionals. Retrieved July 28, 2006 from National Guideline Clearinghouse database.
U. S. Food and Drug Administration (1992, November). Center for Devices and Radiological Health. 510(K) Pre-market Notification. Retrieved September 17, 2003 from http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfPMN/pmn.cfm?ID=73280.
ORIGINAL EFFECTIVE DATE: 1/8/1998
MOST RECENT REVIEW DATE: 9/10/2009
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.