Medicare Guidelines for Non-Cancer

HEART DISEASE

  1. Patient is already optimally treated w/ diuretics and

      vasodilators (ACE Inhibitors) or Nitrates plus Hydralazine

  2. Patient has significant symptoms of recurrent CHF at

      rest, and is classified as a NYHA Class IV

 

Supportive Documentation

1. O2 Sat. < 88%

2. Ejection Fraction of 20% or less

3. SV or Ventricular Arrythmias

4. Hx. Of Cardiac Arrest

5. Hx. Of Syncope, unexplained

6. Brain embolism

 

*If patient can’t tolerate ACE Inhibitors, MD must

document why

 

ICD-9 Codes that support medical necessity:

 414.8 Chronic Ischemic Heart Disease

 424.0-428.9 Congestive Heart Failure