Cardiac rehabilitation is the process by which people with cardiovascular disease are restored to their optimal functional status, including their physiological, psychological, social, vocational, and emotional status. Cardiac rehabilitation services include formal exercise sessions, risk factor education, and behavior modification counseling. Phase II cardiac rehabilitation is immediate outpatient therapy during the convalescent period following hospital discharge. Individualization of the program is achieved through a case management perspective with attention to patient and family needs.
NOTE: This policy applies only to those contracts which specifically include cardiac rehabilitation as a benefit. This policy does not apply if cardiac rehabilitation is specifically excluded by the individual contract. Also, most contracts limit cardiac rehabilitation to a maximum of 36 visits per calender year regardless of the number of qualifying episodes per calender year.
Case Management approval is required for underwritten and most self-funded groups.
Phase II Cardiac Rehabilitation
Phase II cardiac rehabilitation (immediate outpatient therapy during the convalescent period following hospital discharge) may be offered to patients with the following cardiovascular disease diagnoses (qualifying episodes) including:
Severe coronary artery disease and marked exercise-induced myocardial ischemia (>2mm ST-segment depression)
Phase II cardiac rehabilitation may include continuous or intermittent ECG monitoring based on the patient’s risk level. The type and frequency of ECG monitoring should be determined on a patient-by-patient basis. Minimum guidelines to follow are:
Use-intensive monitoring (e.g., continuous or more frequent intermittent ECG monitoring). A staff decision to use intermittent monitoring may be acceptable if the patient is clinically stable and exercise prescription is appropriately conservative.
When clinically appropriate (i.e., no abnormal response to exercise or adverse signs or symptoms) progress to less intensive monitoring.
Teach self-monitoring as a primary method of ensuring safety. Encourage frequent self-monitoring with appropriate checks by staff during the first 2 to 4 weeks.
Use more intensive ECG monitoring when clinically warranted (i.e., abnormal response to exercise or adverse signs or symptoms).
Evaluate patient’s exercise response and monitoring needs routinely, although not necessarily with a graded exercise test.
Initiation of Service
Formal cardiac rehabilitation service should be initiated within 3 months after discharge from the hospital.
Frequency and Duration of Service
Patient education and risk factor modification are considered part of the formal cardiac rehabilitation service.
Patients who are determined appropriate for cardiac rehabilitation based on recommendation by the referring physician and on patient selection criteria as outlined above are eligible for formal cardiac rehabilitation services.
The number of visits covered is based on patient severity as follows:
Three factors determine the appropriateness of discontinuing the cardiac rehabilitation program. These include:
Evidence that the patient is clinically stable
Achievement of the goals set at program entry
Determination that the patient has received optimal or near-optimal benefits
The final decision as to risk determination shall be the joint responsibility of the referring physician and the director of the cardiac rehabilitation program (added 7-9-2001).
Place of Service
Formal cardiac rehabilitation services must be conducted at a facility meeting the following criteria:
The cardiac rehabilitation program holds a current certification from the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR). The program does not have to be in the State of Mississippi, as long as it is certified by the AACVPR (added 7-9-2001).
The following programs are certified by AACVPR in Mississippi for Cardiac Rehabilitation (added 9-19-2000):
GilmoreMemorialHospital Cardiac Rehabilitation Program
A search of the literature was completed through the MEDLINE database for the period of January 1990 through October 1996. The search strategy focused on references containing the following Medical Subject Heading: Cardiac Rehabilitation.
Cardiac Rehabilitation, Clinical Practice Guideline, Number 17, U.S. Department of Health & Human Services, October 1995.
American Association of Cardiovascular and Pulmonary Rehabilitation
Hayes Medical Technology Directory
Blue Cross Blue Shield Association policy # 8.03.08 (added 7-16-2001)