Cardiac Connections Pre-authorization Program Discontinuing

Cardiac Connections pre-authorization program discontinuing as of 1/1/2017

Following an internal assessment of cardiac diagnostic testing utilization, Independent Health will discontinue the NIA Cardiac Connections radiology program as of Jan. 1, 2017. This means that physicians will no longer need to contact NIA for prior authorization or submit patients’ medical records for certain cardiac diagnostic tests (see chart below).

The Cardiac Connections program has helped physicians understand and incorporate best-practice standards of test ordering into their diagnostic assessments. We will closely monitor the ongoing use of these tests by individual providers and will reinstitute the Cardiac Connections program if testing patterns increase.

Please note:

  • Independent Health will continue to require prior authorization for the services indicated in the second chart below; however, we will not require the submission of medical charts.
  • In addition, NIA will continue to manage pre-authorization for advanced radiology and oncology. Ordering physicians should continue to request pre-authorization for these services through RADMD. Over 70 percent of our primary care physician network is in total-cost-of-care contracts as we move toward value-based payment methods. We will continue to share individual cardiology group performance to the primary care physicians, who are interested in redirecting referrals only to the higher-performing specialists. As such, inappropriate use of cardiac imaging will be apparent to them on a practice-level basis.
Procedure codes no longer requiring prior authorization
78451 Myocardial perfusion imaging, tomographic
78452 Myocardial perfusion imaging, tomographic multiple studies
78453 Myocardial perfusion imaging, planar
78454 Myocardial perfusion imaging, planar, multiple studies
78466 Myocardial imaging, infarct avid, planar; qualitative or quantitative
78468 Myocardial imaging, infarct avid, planar; qualitative or quantitative with ejection fraction by first pass technique
78469 Myocardial imaging, infarct avid, planar; qualitative or quantitative, tomographic SPECT with or without quantification
78481 Cardiac blood pool imaging (planar), first pass technique; single study
78483 Cardiac blood pool imaging (planar), first pass technique; multiple studies
93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display
93321 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display, follow-up or limited study
93325 Doppler echocardiography color flow velocity mapping
93350 Echocardiography, transthoracic, real-time with image documentation (2D)
93351 Echocardiography, transthoracic, real-time with image documentation (2D), including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional
93352 Use of echocardiographic contrast agent during stress echocardiography
Some Services continue to require prior authorization
The following services will continue to require prior authorization by NIA through RadMD.
Codes that still require prior authorization by NIA through RadMD
75574 Computed tomographic angiography, heart, coronary arteries and bypass grafts
78499 Unlisted, cardiovascular procedure, diagnostic nuclear medicine
78459 Myocardial imaging, positron emission tomography (PET), metabolic evaluation
78491 Myocardial imaging, positron emission tomography (PET), perfusion; single study at rest or stress
78492 Myocardial imaging, positron emission tomography (PET), perfusion; multiple studies at rest or stress