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Medical & Coding Policies
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Printer Friendly Version Optical Coherence Tomography for Imaging of Coronary Arteries
DESCRIPTIONOptical coherence tomography (OCT) is an imaging technique that uses near-infrared light to image the coronary arteries. Potential applications in cardiology include evaluating the characteristics of coronary artery plaques for the purpose of risk stratification and following coronary stenting to determine the success of the procedure.Optical coherence tomography (OCT) has important similarities to intravascular ultrasound (IVUS), and also important differences. Ultrasound uses acoustic waves for imaging, while OCT uses near-infrared electromagnetic light waves. OCT generates cross-sectional images by using the time delay and intensity of light reflected from internal tissue structures. The main obstacle to OCT is the difficulty of imaging through blood, necessitating saline flushes or occlusion techniques to obtain images. Frequency-domain OCT is a newer generation device that partially alleviates this problem by allowing faster scanning and less need for blood clearing. Optical coherence tomography (OCT) has important similarities to intravascular ultrasound (IVUS), and also important differences. Ultrasound uses acoustic waves for imaging, while OCT uses near-infrared electromagnetic light waves. OCT generates cross-sectional images by using the time delay and intensity of light reflected from internal tissue structures. The main obstacle to OCT is the difficulty of imaging through blood, necessitating saline flushes or occlusion techniques to obtain images. Frequency-domain OCT is a newer generation device that partially alleviates this problem by allowing faster scanning and less need for blood clearing. There are several OCT systems that have been cleared for marketing through the U.S. Food and Drug Administration’s (FDA’s) 510(k) program. For example, Lightlab Imaging, Inc. received FDA marketing clearance in April 2010 for its C7 Xr® Imaging System and in August 2011 for its next generation frequency domain C7 Xr® Imaging System.
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POLICYOptical coherence tomography is considered investigational when used as an adjunct to percutaneous coronary interventions with stenting.Optical coherence tomography is considered investigational in all other situations, including but not limited to, risk stratification of intracoronary atherosclerotic plaques and follow-up evaluation of stenting.
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POLICY EXCEPTIONSFederal Employee Program (FEP) may dictate that all FDA-approved devices, drugs or biologics may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
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POLICY GUIDELINESInvestigative service is defined as the use of any treatment procedure, facility, equipment, drug, device, or supply not yet recognized by certifying boards and/or approving or licensing agencies or published peer review criteria as standard, effective medical practice for the treatment of the condition being treated and as such therefore is not considered medically necessary.The coverage guidelines outlined in the Medical Policy Manual should not be used in lieu of the Member's specific benefit plan language.
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POLICY HISTORY03/22/2012: Approved by Medical Policy Advisory Committee.04/17/2013: Policy reviewed; no changes.
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SOURCE(S)Blue Cross Blue Shield Association policy # 2.02.29
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CODE REFERENCENon-Covered CodesThis is not an all-inclusive list of non-covered procedure codes. All codes billed for this procedure are considered investigational and not eligible for coverage.
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