LCD : CARDIAC COMPUTED TOMOGRAPHY (L23480)

LCD for CARDIAC COMPUTED TOMOGRAPHY (L23480)

Contractor Information

Contractor Name

BlueCross BlueShield of Tennessee (Riverbend Government Benefits Administrator)

Contractor Number

00390

Contractor Type

LCD Information

LCD ID Number

L23480

LCD Title

CARDIAC COMPUTED TOMOGRAPHY

Contractor's Determination Number

23480

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2007 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

CMS National Coverage Policy

• Title XVIII of the Social Security Act, Section 1862 (a)(7)
This section excludes routine physical examinations.
• Title XVIII of the Social Security Act, Section 1862 (a)(1)(A)
This section allows coverage and payment for only those services
considered medically reasonable and necessary.
• Title XVIII of the Social Security Act, Section 1833 (e)
This section prohibits Medicare payment for any claim which lacks
the necessary information to process the claim.
• CMS Manual System, Pub 100-3, National Coverage Determination Manual,
section 220.1
This section deals with diagnostic examination by CT scan.
• CMS Manual System, Pub 100-4, Medicare Claims Processing Manual,
Chapter 13, Section 20
This section addresses payment conditions for radiology services.
• CMS Manual System, Pub 100-9, Contractor Beneficiary and Provider
Communication Manual, Chapter 5, Section 20).
This section addresses standards of medical/surgical practice and
the correct coding initiative (CCI).

Primary Geographic Jurisdiction

New Jersey
Tennessee

Secondary Geographic Jurisdiction

Alaska
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West Virginia
Wyoming

Oversight Region

Region IV

Original Determination Effective Date

For services performed on or after 09/30/2006

Original Determination Ending Date

Revision Effective Date

For services performed on or after 09/30/2006

Revision Ending Date

Indications and Limitations of Coverage and/or Medical Necessity

Multislice or Multidetector Computed Tomography (MDCT) angiography with its advanced spatial resolution has opened up new possibilities in the imaging of the heart and major vessels of the chest, including the coronary arteries.

The MDCT technology requires thin (up to 1 mm) slices, 0.5 to 0.75 mm reconstructions, multiple simultaneous images (eg 16, 32, 64 or more slices), and cardiac gating (often requiring beta blockers for ideal heart rate). There is significant post processing, depending on the number of slices per second for image generation. For coronary artery imaging, the resulting images show a high correlation with stenotic lesions noted on diagnostic cardiac catheterization but more importantly, with atheromas on intracoronary ultrasound.

Current available body of evidence demonstrate that coronary CTA (CCTA) can reliably rule out the presence of significant coronary artery disease (CAD) in patients with a low to intermediate probability of having CAD and can reliably achieve a high degree of diagnostic accuracy and technical performance necessary to replace conventional angiography.

In other circumstances, CCTA may be proposed instead of or in addition to other noninvasive cardiac tests. This is particularly useful in the commonly encountered clinical scenario of patients having and equivocal stress myocardial perfusion test. The information from CCTA may be used to guide further diagnostic evaluation and/or appropriate therapy (e.g., revascularization versus medical management) and this may over the long term influence morbidity of CAD (e.g., angina or subsequent MI rate), functional status, or mortality. The use of contrast-enhanced coronary CTA might have both short and long-term effects on health outcomes depending on the clinical context. In the short term, CCTA may avoid the morbidity of invasive coronary angiography when CCTA provides reliable information that obviates the need for invasive coronary angiography. However, CCTA may be proposed in circumstances where invasive coronary angiography may not be clinically indicated. When CCTA is used instead of an alternative noninvasive test then the effect on health outcomes would be influenced by the relative morbidity of the tests, the relative diagnostic performance characteristics, and the ability of the test to guide subsequent diagnostic and therapeutic decisions.

Indications
1. Patient presenting with chest pain syndrome.

Coronary CTA may be used in lieu of an imaging stress test. The clinician must have a high degree of suspicion that CAD is high on the differential diagnosis of the symptoms. The performance of both an imaging stress test and CCTA for the same episode of illness (typically within a 90 day period of time) will result in the denial of the CCTA as not medically necessary. Since the negative predictive value of CCTA is high, the performance of both a CCTA and a subsequent coronary angiography for the same episode of illness (typically within a 90 day period of time) will result in the denial of the CCTA if the CCTA is negative or unchanged from prior studies.

The MDCT angiography of the chest for non-cardiac assessment (71275) is indicated when non-cardiac indications are also being considered, as for the following signs or symptoms of disease (e.g. the "triple rule-out":

a. Assessment of a symptomatic patient when presentation is suspicious for pulmonary emboli;

b. Abnormalities of the thoracic vasculature such as aortic dissection, aortic aneurysm, pulmonary AVM and other abnormalities of the systemic circulation, excluding the heart;

c. Assessment of suspected congenital anomalies of the heart or great vessels; and

d. Assessment of cardiac, mediastinal or lung parenchymal lesions, the vascularity of which is unknown or ill defined, but is critical to the diagnosis.

2. When the recurrence of symptoms in patients with known coronary artery disease may be related to progression/exacerbation of underlying disease.

The use of coronary CTA in this setting would be to evaluate the extent of previously diagnosed coronary artery disease in lieu of traditional coronary angiography. Patients with known disease may have had remote invasive angiography and/or stress testing to evaluate prior events or symptoms. New or recurrent symptoms may relate to a change in the coronary anatomy that can be assessed with coronary CTA. Since the negative predictive value of CCTA is high, the performance of both a CCTA and a subsequent coronary angiography for the same episode of illness (typically within a 90 day period of time) will result in the denial of the CCTA if the CCTA is negative or unchanged from prior studies.

3. When patients with prior bypass surgery present with chest pain or dyspnea.

Coronary bypass grafts are relatively well seen with coronary CTA. The rationale for coronary CTA would be to determine the patency and severity of possible graft stenoses that may be the source of chest pain. Since the negative predictive value of CCTA is high, the performance of both a CCTA and a subsequent coronary angiography for the same episode of illness (typically within a 90 day period of time) will result in the denial of the CCTA if the CCTA is negative or unchanged from prior studies.

Patients with prior intracoronary stents often present with recurrent chest pain. The rationale for a coronary CTA as an alternative to invasive angiography is to rule out stent restenosis as the cause of symptoms. However, accurate assessment of stent restenosis may be limited by the artifact caused by the stent material itself and the quality of the scan and scanner. Since these are factors that are known in advance, CCTA will typically not be covered in addition to a subsequent coronary angiography.

4. Suspected congenital anomalies of the coronary circulation.

Coronary CTA is used to assess patients suspected of having a congenital coronary anomaly. The cross-sectional nature of this technique allows one to determine accurately both the presence and possible future harm that could result from the anomaly. It is often used after an anomaly has been identified following a different test such as prior invasive coronary angiogram. A coronary CTA may help, decide if surgery is indicated and for surgical planning, but is generally not considered sufficient by surgeons. The performance of both a CCTA and a coronary angiography for the same evaluation may be considered medically necessary as long as the medical record supports the fact that both were expected to provide additional essential information.

5. The patient undergoing non-coronary artery cardiac surgery.

Certain patients who have non-coronary artery cardiac surgery (valve or ascending aortic surgery) may need a pre-operative invasive coronary angiogram. The surgical planning may also depend upon the exact location of the coronary arteries. The rationale for the use of coronary CTA in these patient subsets is to avoid potentially unnecessary invasive testing and still provide appropriate pre-surgical information. However, a preponderance of surgeons do not consider CCTA to be sufficient at this time, and surgical preferencres should be considered during work-up. The performance of both a CCTA and coronary angiography for the same episode of illness (typically within a 90 day period of time) will result in the denial of the CCTA as not medically necessary when used for this indication.

Limitations
1. The test is never covered for screening, i.e., in the absence of signs, symptoms or disease.
2. The selection of the test should be made within the context of other testing modalities such as stress myocardial perfusion images or cardiac ultrasound, so that the resulting information facilitates the management decision, not merely adds a new layer of testing. CCTA is not considered medically necessary following coronary angiography for the same episode of illness except in the unusual situation of congenital anomaly evaluation or clearly documented technical limitations in the angiography that can reasonably be circumvented by CCTA.
3. The “function evaluation” service should be restricted to carefully selected situations where information on left ventricular and/or right ventricular function is needed for management decision. It must not be ordered routinely with all studies. It should not be necessary to use this feature when there is available pre-test information on ventricular function from other sources such as an echocardiogram, cardiac MR or LV gram on cardiac catheterization. Function evaluation will not be considered to be medically necessary unless the information is immediately needed to plan further intervention.
4. Patient safety and comfort must be paramount in the consideration of this modality. The test must not be used to delay a more invasive intervention, when the patient’s presentation clearly indicates early intervention.
5. The test may be denied as not medically necessary when used for cardiac evaluation of a patient where there is a pre-test knowledge of sufficiently extensive calcification of the coronary segment in question that would diminish the interpretive value, or when a stent can be reasonably expected to similarly degrade the image in a critical section.
6. Coverage of this modality for coronary artery assessment is limited to devices that process thin, high resolution slices (1 mm or less). The multidetector scanner must have at least 40 slices per rotation capability for most of the services.
7. All studies must be ordered by a physician or a qualified non-physician practitioner similar to any other medical testing such as the stress myocardial perfusion imaging or cardiac ultrasound evaluation.
8.This LCD does not pertain to the electron beam tomography (EBT) technology or Ultrafast CT for coronary artery examination. There is no extension of coverage of EBT based on this policy.
9.Quantitative calcium scoring is not medically necessary; it is considered a screening procedure. (When performed in association with CT angiography, the service is not separately payable.)
10.Acceptable Levels of Competence for Performance and Interpretation:
The service is only medically necessary when performed within acceptable levels of competence. The acceptable levels of competence, as defined by the American College of Cardiology (ACC)/American Heart Association (AHA) Clinical Competence Statement on Cardiac Imaging with Computed Tomography and Magnetic Resonance (2005) and the American College of Radiology (ACR) Clinical Statement on Noninvasive Cardiac Imaging (2005), are outlined as follows:

For the technical portion, a recommended level of competence is fulfilled when the image acquisition is obtained under all of the following conditions:

a. The service is performed by a radiologic technologist who is credentialed by a nationally recognized credentialing body (American Registry of Radiologic Technologists or equivalent) and meets state licensure requirements where applicable.
b. If intravenous beta blockers or nitrates are to be given prior to a CT
coronary angiogram or calcium score, the test must be under the direct supervision of a certified registered nurse and physician (familiar with the administration of cardiac medications) who are available to respond to medical emergencies and it is strongly recommended that the certified register nurse and physician be ACLS certified.
c. When contrast studies are performed, the physician must provide direct supervision and the radiologic technologist or registered nurse administering the contrast must have appropriate training on the use and administration of contrast media.

For the professional portion, a recommended level of competence is fulfilled when the interpretation is performed by a physician meeting the following requirements:

a. The physician has appropriate additional training in CT Coronary
Angiography and cardiac CT imaging equivalent to the guidelines set forth by the ACC or ACR (for example: the ACCF/AHA Clinical Competence Statement on Cardiac Imaging with Computed Tomography and Magnetic Resonance (2005) and the ACR Clinical Statement on Noninvasive Cardiac Imaging (2005)), or
b. The physician has appropriate medical staff privileges to interpret CT Coronary Angiograms at a hospital that participates in the Medicare program, and is actively training in cardiac CT (as in paragraph a). A grace period of 24 months will be allowed to acquire the necessary training.

Coverage Topic

Outpatient Hospital Services

Coding Information

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

13x	Hospital-outpatient (HHA-A also) (under OPPS 13X must be used for ASC claims submitted for OPPS payment -- eff. 7/00)
14x	Non-Patient Laboratory Specimens
21x	SNF-inpatient, Part A

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

0359	CT scan-other CT scans

CPT/HCPCS Codes

71275	COMPUTED TOMOGRAPHIC ANGIOGRAPHY, CHEST (NONCORONARY), WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING
0145T	COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, CARDIAC GATING AND 3D IMAGE POSTPROCESSING; CARDIAC STRUCTURE AND MORPHOLOGY
0146T	COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, CARDIAC GATING AND 3D IMAGE POSTPROCESSING; COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF CORONARY ARTERIES (INCLUDING NATIVE AND ANOMALOUS CORONARY ARTERIES, CORONARY BYPASS GRAFTS), WITHOUT QUANTITATIVE EVALUATION OF CORONARY CALCIUM
0147T	COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, CARDIAC GATING AND 3D IMAGE POSTPROCESSING; COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF CORONARY ARTERIES (INCLUDING NATIVE AND ANOMALOUS CORONARY ARTERIES, CORONARY BYPASS GRAFTS), WITH QUANTITATIVE EVALUATION OF CORONARY CALCIUM
0148T	COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, CARDIAC GATING AND 3D IMAGE POSTPROCESSING; CARDIAC STRUCTURE AND MORPHOLOGY AND COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF CORONARY ARTERIES (INCLUDING NATIVE AND ANOMALOUS CORONARY ARTERIES, CORONARY BYPASS GRAFTS), WITHOUT QUANTITATIVE EVALUATION OF CORONARY CALCIUM
0149T	COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, CARDIAC GATING AND 3D IMAGE POSTPROCESSING; CARDIAC STRUCTURE AND MORPHOLOGY AND COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF CORONARY ARTERIES (INCLUDING NATIVE AND ANOMALOUS CORONARY ARTERIES, CORONARY BYPASS GRAFTS), WITH QUANTITATIVE EVALUATION OF CORONARY CALCIUM
0150T	COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, CARDIAC GATING AND 3D IMAGE POSTPROCESSING; CARDIAC STRUCTURE AND MORPHOLOGY IN CONGENITAL HEART DISEASE
0151T	COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, CARDIAC GATING AND 3D IMAGE POSTPROCESSING, FUNCTION EVALUATION (LEFT AND RIGHT VENTRICULAR FUNCTION, EJECTION-FRACTION AND SEGMENTAL WALL MOTION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Non-covered Procedure.
0144T is considered to be a screening procedure and is non-covered. All covered indications are expected to either require contrast or meet the definition of other CPT codes.

0144T

COMPUTED TOMOGRAPHY, HEART, WITHOUT CONTRAST MATERIAL, INCLUDING IMAGE POSTPROCESSING AND QUANTITATIVE EVALUATION OF CORONARY CALCIUM

ICD-9 Codes that Support Medical Necessity

411.1	INTERMEDIATE CORONARY SYNDROME
412	OLD MYOCARDIAL INFARCTION
413.0	ANGINA DECUBITUS
413.1	PRINZMETAL ANGINA
413.9	OTHER AND UNSPECIFIED ANGINA PECTORIS
414.00	CORONARY ATHEROSCLEROSIS OF UNSPECIFIED TYPE OF VESSEL NATIVE OR GRAFT
414.01	CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY
414.02	CORONARY ATHEROSCLEROSIS OF AUTOLOGOUS VEIN BYPASS GRAFT
414.03	CORONARY ATHEROSCLEROSIS OF NONAUTOLOGOUS BIOLOGICAL BYPASS GRAFT
414.04	CORONARY ATHEROSCLEROSIS OF ARTERY BYPASS GRAFT
414.05	CORONARY ATHEROSCLEROSIS OF UNSPECIFIED BYPASS GRAFT
414.06	CORONARY ATHEROSCLEROSIS OF NATIVE CORONARY ARTERY OF TRANSPLANTED HEART
414.07	CORONARY ATHEROSCLEROSIS OF BYPASS GRAFT (ARTERY) (VEIN) OF TRANSPLANTED HEART
414.10	ANEURYSM OF HEART (WALL)
414.11	ANEURYSM OF CORONARY VESSELS
414.12	DISSECTION OF CORONARY ARTERY
414.19	OTHER ANEURYSM OF HEART
414.8	OTHER SPECIFIED FORMS OF CHRONIC ISCHEMIC HEART DISEASE
414.9	CHRONIC ISCHEMIC HEART DISEASE UNSPECIFIED
424.1	AORTIC VALVE DISORDERS
427.41	VENTRICULAR FIBRILLATION
427.42	VENTRICULAR FLUTTER
441.01	DISSECTION OF AORTA THORACIC
745.10	COMPLETE TRANSPOSITION OF GREAT VESSELS
745.11	DOUBLE OUTLET RIGHT VENTRICLE
745.12	CORRECTED TRANSPOSITION OF GREAT VESSELS
745.19	OTHER TRANSPOSITION OF GREAT VESSELS
745.2	TETRALOGY OF FALLOT
745.3	COMMON VENTRICLE
745.4	VENTRICULAR SEPTAL DEFECT
745.5	OSTIUM SECUNDUM TYPE ATRIAL SEPTAL DEFECT
745.60	ENDOCARDIAL CUSHION DEFECT UNSPECIFIED TYPE
745.61	OSTIUM PRIMUM DEFECT
745.69	OTHER ENDOCARDIAL CUSHION DEFECTS
745.7	COR BILOCULARE
745.8	OTHER BULBUS CORDIS ANOMALIES AND ANOMALIES OF CARDIAC SEPTAL CLOSURE
745.9	UNSPECIFIED DEFECT OF SEPTAL CLOSURE
746.00	CONGENITAL PULMONARY VALVE ANOMALY UNSPECIFIED
746.01	ATRESIA OF PULMONARY VALVE CONGENITAL
746.02	STENOSIS OF PULMONARY VALVE CONGENITAL
746.09	OTHER CONGENITAL ANOMALIES OF PULMONARY VALVE
746.1	TRICUSPID ATRESIA AND STENOSIS CONGENITAL
746.2	EBSTEIN'S ANOMALY
746.3	CONGENITAL STENOSIS OF AORTIC VALVE
746.4	CONGENITAL INSUFFICIENCY OF AORTIC VALVE
746.5	CONGENITAL MITRAL STENOSIS
746.6	CONGENITAL MITRAL INSUFFICIENCY
746.7	HYPOPLASTIC LEFT HEART SYNDROME
746.81	SUBAORTIC STENOSIS CONGENITAL
746.82	COR TRIATRIATUM
746.83	INFUNDIBULAR PULMONIC STENOSIS CONGENITAL
746.84	CONGENITAL OBSTRUCTIVE ANOMALIES OF HEART NOT ELSEWHERE CLASSIFIED
746.85	CORONARY ARTERY ANOMALY CONGENITAL
746.86	CONGENITAL HEART BLOCK
746.87	MALPOSITION OF HEART AND CARDIAC APEX
746.89	OTHER SPECIFIED CONGENITAL ANOMALIES OF HEART
746.9	UNSPECIFIED CONGENITAL ANOMALY OF HEART
747.0	PATENT DUCTUS ARTERIOSUS
747.10	COARCTATION OF AORTA (PREDUCTAL) (POSTDUCTAL)
747.11	INTERRUPTION OF AORTIC ARCH
747.20	CONGENITAL ANOMALY OF AORTA UNSPECIFIED
747.21	CONGENITAL ANOMALIES OF AORTIC ARCH
747.22	CONGENITAL ATRESIA AND STENOSIS OF AORTA
747.29	OTHER CONGENITAL ANOMALIES OF AORTA
747.3	CONGENITAL ANOMALIES OF PULMONARY ARTERY
747.40	CONGENITAL ANOMALY OF GREAT VEINS UNSPECIFIED
747.41	TOTAL ANOMALOUS PULMONARY VENOUS CONNECTION
747.42	PARTIAL ANOMALOUS PULMONARY VENOUS CONNECTION
747.49	OTHER ANOMALIES OF GREAT VEINS
786.05	SHORTNESS OF BREATH
786.50	UNSPECIFIED CHEST PAIN
786.51	PRECORDIAL PAIN
786.59	OTHER CHEST PAIN
793.2	NONSPECIFIC ABNORMAL FINDINGS ON RADIOLOGICAL AND OTHER EXAMINATION OF OTHER INTRATHORACIC ORGANS
794.30	UNSPECIFIED ABNORMAL FUNCTION STUDY OF CARDIOVASCULAR SYSTEM
794.31	NONSPECIFIC ABNORMAL ELECTROCARDIOGRAM (ECG) (EKG)

Diagnoses that Support Medical Necessity

N/A

ICD-9 Codes that DO NOT Support Medical Necessity

• Use of any ICD-9-CM code not listed in the “ICD-9-CM Codes that
Support Medical Necessity” section of this LCD will be denied.

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation

Diagnoses that DO NOT Support Medical Necessity

General Information

Documentation Requirements

1. Each claim must be submitted with ICD-9-CM codes that reflect the
condition of the patient, and indicate the reason(s) for which the
service was performed. Claims submitted without ICD-9-CM codes will
be returned.
2. The documentation of the study requires a formal written report, with
clear identifying demographics, the name of the interpreting provider,
the reason for the tests, an interpretive report and copies of
images. The computerized image reconstruction data should also
be maintained.
3. Documentation must be available to Medicare upon request.

Appendices

N/A

Utilization Guidelines

Repeated studies should not be performed unless sufficient time has passed since the prior exam for a clinically significant progression of pathology to have occured.

Sources of Information and Basis for Decision

LCDs from Empire, AdminaStar, Arkansas BCBS, Cahaba, CIGNA, HealthNow and NHIC
1. Integrated Approaches to Evaluating Coronary Artery Disease and Ischemic Heart Disease by Richard D. White, MD, and Randolph M. Setser, DSc, The American Journal of Cardiology, Vol 90 (10C), November 21, 2002.
2. Clinical Utility of Computed Tomography and Magnetic Resonance Techniques for Noninvasive Coronary Angiography by Matthew J. Budoff, MD, Stephen Achenbach, MD, Andre Duerinckx, MD, Torrance, California; Dallas, Texas; and Erlangen, Germany. The American Journal of Cardiology, Vol 42, No. 11, December 2003.
3. Detection of Coronary Artery Stenoses With Thin-Slice Multi-Detector Row Spiral computed Tomography and Multiplanar Reconstruction by Dieter Ropers, MD; Ulrich Baum, MD; Karsten Pohle, MD; Kathrina Anders, MD; Stefan Ulzheimer, PhD; Bernd Ohnesorge, PhD; Christian Schlundt, MD; Werner Bautz, MD; Werner G. Daniel, MD; Stephan Achenbach, MD. Circulation Journal, February 11, 2003.
4. Noninvasive Assessment of Coronary Artery Disease by Multislice Spiral Computed Tomography Using a New Retrospectively ECG-Gated Image Reconstruction Technique – Comparison With Angiopgraphic Results by Uichi Sato, MD; Naoya Matsumoto, MD; Masahiko Kato, MD; Fumio Inoue, MD; Toshiyuki Horie, MD; Junji Kusama, MD; Akihiro Yoshimura, MD; Takako Imzeki, MD; Takahiro Fukui, DM; Satoru Furuhashi, MD; Motoichiro Takahashi, MD; Katsuo Kammatsuse, MD. Circulation Journal, Vol.67, May 2003.
5. Detection of Coronary Artery Stenoses by Contrast-Enhanced, Retrospectively Electrocardiographically-Gated, Multislice Spiral Computed Tomograhy by Stephan Achenbach, MD; Tom Giesler, MD; Dieter Ropers, MD; Stefan Ulzheimer, MS; Hans Derlien; Christoph Schulte, MD; Evelyn Wenkel, MD; Werner Moshage, MD; Werner Bautz, MD; Werner G. Daniel, MD; Willi A. Kalender, PhD; Ulrich Baum, MD. Circulation Journal, May 29, 2001.
6. Non-Invasive Coronary Angiography with High Resolution Multidetector-row Computed Tomography by A. F. Kopp, S. Schroeder, A. Kuettner, A. Baumbach, C. Georg, R. Juzo, M. Heuschmid, B. Ohnesorge, K. R. Karsch and C. D. Claussen, The European Society of Cardiology, Published by Elsevier Science Ltd. in the European Heart Journal (2002)23, 1714-1725.
7. Non-invasive Characterisation of Coronary Lesion Morphology by Multislice Computed Tomography: a promising new technology for risk stratificaiton of patient with coronary artery disease by Stepehn Schroeder, Andreas F. Kopp, Angreas Baumbach, Axel Kuettner, Christian Georg, Bernd Ohnesorge, Christian Herdeg, Claus D. Claussen, Karl R Karsch. @ http://heart.bmjjournals.com/cgi/contebt/full/85/5/576a
8. 3D Assessment of myocardial Perfusion Parameter Combined with 3D Reconstructed coronary Artery Tree from Digital Coronary Angiograms by T.H. Schindler, N. Magosaki, M. Jeserich, E. Nitzsche, U. Oser, T. Abdollahnia, M. Nageleisen, M. Zehender, H. Just & Y, Solzbah. International Journal of Cardiac Imaging 16: 1-12, 2000.
9. Aortoiliac and Renal Arteries: Prospective Intraindividual comparison of Contrast-enhanced Three-dimentional MR Angiography and Multi-Detector Row CT angiography, by J. K. Willmann, MD, S. Wildermuth, MD, T. Pfammatter, MD, J. E. Roos, MD, B. Seifert, PhD, P. R. Hilfiker, MD, B. Marincek, MD, D. Weishaupt, MD. Radiology, Volume 226, Number 3, pages 798-811.
10. Multi-Slice CT Angiography in Diagnosing Total Versus Near Occlusions of the Internal Carotid Artery – Comparison With Catheter Angiography, by Chi-Jen Chen, MD, Tsong-Hai Lee, MD, PhD, Hui-Ling Hsu, MD, Ying-Chi Tseng, MD, Shinn-Kuang Lin, MD, Li-Jen Wang, MD, Yon-Cheong Wong, MD. Stroke available at http://strokeaha.org
11. Detection of Plaque Instability Predictors by Multislice Computed Tomography, Comparison with Intravascular Ultrasound, study by P. M. Carrascosa, Sr., Carlos Capunay, Sr., Peter Johnson, Sr., Pablo Garcia Merletti, Sr., Raul Pissiis, Sr., Jorge Manuel Carrascosa, Sr., Diagnostico Maipu, Buenos Aires, Argentina, Presentation March 7, 2004, American College of Cardiology, National Scientific Sessions.
12. Non-Invasive Assessment of In-Stent Restenosis by 16-Slice Computed Tomography, study by O. Kuboyama, T. Kakuta, S. Kimura, T. Yonestsu, K. Susuki, Y. Nagata, M. Goya, Y. Lesaka, H. Fujiwara, M. Isobe, Tsuchiura Kyodo Hospital, Tsuchiura, Japan. Presentation March 9, 2004, American College of Cardiology, National Scientific Sessions.
13. Comparison of Retrospectively Electorcariogram-Gated, Multislice spiral Computed Tomography and Selective Coronary angiography in the analysis of Stent Permeability after Left Main or Ostial Coronary Artery Angioplasty, study by E. Maupas, D. Carrie, M. Elbaz, M. Bennaceur, H. Rousseau, F. Joffre, J. Puel, Rangueil Hospital, Toulouse, France. Presentation March 7, 2004, American College of Cardiology, National Scientific Sessions.
14. Comparison of 16-Slice Submillimeter Multidetector Spiral Computed Tomography with Conventional Angiography for Diagnosis of Coronary Artery Disease, study by D. F. Bush, J. M. Miller, J. C. Lima, E. P, Shapiro, John Hopkins Bayview Medical Center, Baltimore, MD. Presentation March 7, 2004, American College of Cardiology, National Scientific Sessions.

• Model Local Coverage Determination (LCD) Work Group for Cardiac Computed Tomography (CCT) and Computed Tomography Coronary Angiography (CTCA), comprising of the American College of Cardiology (ACC), Carrier Advisory Committee (CAC), American College of Radiology (ACR), American Society of Nuclear Cardiology (ASNC), North American Society for Cardiac Imaging (NASCI) Society of Cardiac Angiography and Intervention (SCAI) and Society of Cardiovascular CT (SCCT), which had the following sources:-
1. American College of Cardiology Foundation (ACCF)/American Heart
Association (AHA) Clinical Competence Statement on Cardiac Imaging with Computed Tomography and Magnetic Resonance. JACC, Vol. 46, No. 2, 2005 pg 383-402.
2. American College of Radiology Clinical Statement on Noninvasive Cardiac
Imaging. Radiology 2005; 235:723–727.
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