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Medical Policy: 02.02.07
Original Effective Date: September 2001
Reviewed: August 2011
Revised: February 2010
Benefit Application
Benefit determinations are based on the applicable contract language in effect at the time the
services were rendered. Exclusions, limitations or exceptions may apply. Benefits may vary
based on contract, and individual member benefits must be verified. Wellmark determines medical
necessity only if the benefit exists and no contract exclusions are applicable. This medical
policy may not apply to FEP. Benefits are determined by the Federal Employee Program.
This Medical Policy document describes the status of medical technology at the time the document
was developed. Since that time, new technology may have emerged or new medical literature may
have been published. This Medical Policy will be reviewed regularly and be updated as scientific
and medical literature becomes available.
Description:
Thoracic electrical bioimpedance is a cardiovascular testing technique developed as an adaptation of plethysmography which can noninvasively measure hemodynamic information similar to that obtained by right heart catheterization. It is most commonly used in the hospital setting. In the outpatient setting, thoracic bioimpedance has been investigated as a technique to optimize drug therapy in patients with congestive heart failure. Echocardiography, transesophageal echocardiography (TEE), and Doppler ultrasound are other noninvasive methods for monitoring cardiac output.
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Prior Approval:
Not applicable
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Policy:
Thoracic electrical bioimpedance is considered investigational for all indications.
The quality of evidence for thoracic electrical bioimpedance is limited. Randomized trials as well as studies that specifically compare this technique with current care are lacking.
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Procedure Codes and Billing Guidelines:
- To report provider services, use appropriate CPT* codes, Modifiers, Alpha Numeric (HCPCS level 2) codes, Revenue codes, and/or ICD-9 diagnostic codes.
- 93701 Bioimpedance, thoracic, electrical
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Selected References:
- Strobeck, J.E., Silver, M.A., Ventura, H.O. Editorial: Impedance Cardiography: Noninvasive Measurement of Cardiac Stroke Volume and Thoracic Fluid Content. CHF 2000 March/April:3-6.
- Siver, M.A., Ventura, H.O. Atrioventricular Interval Optimization Utilizing Thoracic Electrical Bioimpedance. CHF 1999; 5:235-237.
- Weiss, S. et. all. Comparison of cardiac output measurements by thermodilution and thoracic electrical bioimpedance in critically ill versus non-critically ill patients. American Journal of Emergency Medicine 1995; 13:626-631.
- Imhoff, M., Lehner, J.H., Lohlein, D. Noninvasive whole-body electrical bioimpedance cardiac output and invasive thermodilution cardiac output in high-risk surgical patients. Critical Care Medicine 2000;28. 8:2812-2818.
- Moshkovitz Y, Kaluski E, Milo, Vered Z, Cotter G. Recent developments in cardiac output determination by bioimpedance: comparison with invasive cardiac output and potential cardiovascular applications. Curr Opin Cardiol. 2004 May;19(3):229-37. Abstract viewed on Medline.
- Engoren M, Barbee D. Comparison of cardiac output determined by bioimpedance, thermodilution, and the Fick method Am J Crit Care. 2005 Jan;14(1):40-5. Abstract retrieved March 23, 2005 from PubMed database.
- Health Technology Assessment Information Service. HTAIS Custom Hotline response. (2005, May) Thoracic electrical bioimpedance for cardiac output measurement. Retrieved January 25, 2006 from ECRI HTAIS.
- Stout CL, Van de Water JM, yet al. Impedance cardiography: can it replace thermodilution and the pulmonary artery catheter? Am Surg. 2006 Aug;72(8):728-32; discussion 733-4.
- Smith RD, Levy P, et al. Value of noninvasive hemodynamics to achieve blood pressure control in hypertensive subjects. Hypertension. 2006 Apr;47(4):771-7. Epub 2006 Mar 6.
- Wang DJ, Gottlieb SS. Impedance cardiography: More questions than answers. Curr Cardiol Rep. 2006 May;8(3):180-6.
- Jessup M, Abraham WT, Casey DE, et al. 2009 Focused Update : ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults : A Report of the American College of Cardiology Foundation/American Heart Association task Force on Practice Guidelines : Developed in Collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009 ; 119 : 1977-2016.
- ECRI Institute. Impedance Cardiography for Cardiac Output Measurement. Plymouth Meeting (PA): ECRI Institute; 2009 March 12. 11 p. [ECRI hotline response]. Also available: http://www.ecri.org.
- Taylor K, La Rotta G, McCrindle BW et al. A Comparison of Cardiac Output by Thoracic Impedance and Direct Fick in Children with Congenital Heart Disease Undergoing Diagnostic Cardiac Catheterization. J Cardiothorac Vasc Anesth. 2011 Jun 17. Epub ahead of print
- Vorwerk C, Jeyanithi H, Coats TJ. Thoracic electrical bioimpedance: a tool to determine cardiac versus non-cardiac causes of acute dyspnoea in the emergency department. Emerg Med J. 2010 May;27(5):359-63.
- Gujjar AR, Muralidhar K, Bhandopadhyaya A et al. Transthoracic electrical bioimpedance cardiac output: comparison with multigated equilibrium radionuclide cardiography. J Clin Monit Comput. 2010 Apr;24(2):155-9. Epub 2010 Mar 13.
- Absi MA, Lutterman J, Wetzel GT. Noninvasive cardiac output monitoring in the pediatric cardiac intensive care unit. Curr Opin Cardiol. 2010 Mar;25(2):77-9.
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Policy History:
Date Reason Action
August 2011 Annual review Policy renewed
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Wellmark medical policies address the complex issue
of technology assessment of new and emerging treatments, devices,
drugs, etc. They are developed to
assist in administering plan benefits and constitute neither offers of
coverage nor medical advice. Wellmark medical policies contain only a
partial, general description of plan or program benefits and do not
constitute a contract. Wellmark does not provide health care services
and, therefore, cannot guarantee any results or outcomes.
Participating providers are independent contractors in private
practice and are neither employees nor agents of Wellmark or its
affiliates. Treating providers are solely responsible for medical
advice and treatment of members. Our medical policies may be updated
and therefore are subject to change without notice.
*Current Procedural Terminology © 2010 American Medical Association. All Rights Reserved.
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