Blue Cross of Idaho Logo

Express Sign-on

Thank you for registering with Blue Cross of Idaho

If you are an Individual or Family Member under age 65, please register here.

If you are an Medicare or Medicare Supplement member, please register here.

New Options for Affordable Health Insurance

MP 2.02.20 Archived - Correlated Audioelectric Cardiography

Medical Policy
Section
Medicine
 
Original Policy Date
7/15/04
 
Last Review Status/Date
Archived /8:2009
Issue
9:2008
Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.


Description

Correlated audioelectric cardiography describes the correlated display of EKG tracings and a visual display of the acoustic heart sounds, recorded from an acoustic sensor placed on the chest. The recordings can then undergo computer analysis. The Audicor system is a medical device that has received marketing clearance from the U.S. Food and Drug Administration (FDA) through the 510(k) process specifically for correlated audioelectric cardiography. According to the FDA label, the intended use is as follows: “The Audicor Upgrade System, when used with Audicor Sensors in the V3 and V4 positions on the chest wall, is intended for use in acquiring, analyzing and reporting ECG and heart sounds (phonocardiograph) data and to provide interpretation of the data for consideration by physicians.”

In January 2007 through the 510(k) process, the FDA cleared the Audicor 200 System, which is used with the Audicor sensors on the chest wall for use in acquiring, analyzing, and reporting ECG and heart sound data and to provide interpretation in an integrated report for consideration by physicians.


Policy

Correlated audioelectric cardiography is considered investigational.


Policy Guidelines

A series of 3 Category III CPT codes, effective July 2004, specifically describe correlated audioelectric cardiography. These codes are structured similarly to codes for EKG, in which the service is coded as a bundled service (i.e., tracing, interpretation, and report) or unbundled (i.e., tracing coded separately from interpretation and report.)

0068T : Acoustic heart sound recording and computer analysis; with interpretation and report

0069T : acoustic heart sound recording and computer analysis only

0070T: interpretation and report only

Due to evolution of this technology, these analyses can now be performed using only a single-lead EKG. Therefore, the status of the codes was changed in January 2008 and it is no longer required that these services be reported with an EKG code.


Benefit Application

BlueCard/National Account Issues

State or federal mandates (e.g., FEP) may dictate that all devices approved by the U.S. Food and Drug Administration (FDA) may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.


Rationale

A literature search identified 2 articles that focused on the technical feasibility of correlated audioelectric cardiography. (1, 2) For example, Marcus and colleagues reported on a prospective study of 90 patients undergoing elective left-sided catheterization who also underwent correlated audioelectric cardiography, transthoracic echocardiography and EKG within a 4-hour period. (2) The main outcome measures were diagnostic test characteristics of the phonocardiographic recording using markers of left ventricular function (i.e., left ventricular end diastolic pressure, left ventricular ejection fraction, and serum levels of beta natriurietic peptide [BNP]) as the gold standard. The authors reported that diastolic heart sounds (i.e., S3 and S4) had poor sensitivity for left ventricular dysfunction. However, the phonocardiographic S3 was found to be specific for left ventricular dysfunction, ranging from 87%–92%, suggesting that if present, S3 can be useful to rule in a diagnosis of ventricular dysfunction.

No published studies were identified that focused on how correlated audioelectric cardiography could be used in the management of the patient, specifically, as an alternative or adjunct to physical exam and heart auscultation. It is suggested that correlated audioelectric cardiography might be primarily used in emergency room settings as an aid in evaluating patients with acute chest pain. For example, myocardial infarction is frequently associated with an S3 or S4 heart sound. The acoustical recording and computer analysis might facilitate recognition of these heart sounds.

2007 Update

The policy was updated with a literature search using MEDLINE through June 2007. Published studies continue to report on data obtained with this technology. (3, 4) For example, Collins reports that an electronic third-heart sound (S3) has a higher sensitivity than that obtained by auscultation (34% vs. 16%) with similar specificity in detecting patients with heart failure. (3) However, published studies have still not identified how use of correlated audioelectric cardiography impacts patient management and patient outcomes compared to current alternative approaches; thus the policy statement is unchanged.

2008 Update
The policy was updated with a literature search using MEDLINE through July 2008. None of the studies identified demonstrated improved clinical outcomes as a result of this technique. One study reported its potential usefulness in distinguishing supraventricular tachycardia (SVT) from ventricular tachycardia (VT). (5) This study from Europe evaluated S1 intensity and variability in 17 episodes of VT and 22 episodes among 57 patients. Another study reported on results from this testing in 100 patients with left ventricular dysfunction who were undergoing cardiac catheterization. (6) The clinical evidence for this test is limited. The impact of this testing on outcomes is uncertain; this remains investigational.

References:

  1. Arand P, Burton D, Myers R et al. Diagnostic performance of a computerized algorithm for augmenting the ECG with acoustical data. J Electrocardiol 2003; 36(4 suppl):169.
  2. Marcus GM, Gerber IL, McKeown BH et al. Association between phonocardiographic third and fourth heart sounds and objective measures of left ventricular function. JAMA 2005; 293(18):2238-44.
  3. Collins SP, Lindsell CJ, Peacock WF et al. The combined utility of an S3 heart sound and B-type natriuretic peptide levels in emergency department patients with dyspnea. J Card Fail 2006; 12(4):286-92

  4. Shapiro M, Mohyers B, Marcus GM et al. Diagnostic characteristics of combining phonocardiographic third heart sound and systolic time intervals for the prediction of left ventricular dysfunction. J Card Fail 2007; 13(1):18-24.

  5. Kobza R, Roos M, Toggweiler S et al. Recorded heart sounds for identification of ventricular tachycardia. Resuscitation, 2008 Jul 23. [Epub ahead of print].

  6. Moyers B, Shapiro M, Marcus GM et al. Performance of phonoelectrocardiographic left ventricular systolic time intervals and B-type natriuretic peptide levels in the diagnosis of left ventricular dysfunction. Ann Noninvasive Electrocardiol 2007; 12(2):89-97.

 

Codes

Number

Description

CPT 

0068T 

Acoustic heart sound recording and computer analysis; with interpretation and report  

 

0069T 

Acoustic heart sound recording and computer analysis only  

 

0070T 

Interpretation and report only

ICD-9 Diagnosis    Investigational for all codes


Index

Acoustic Heart Sound Recording
Correlated Audioelectric Cardiography


Policy History

Date Action Reason
07/15/04 Add policy to Medicine section, Cardiology subsection New policy
05/23/05 Replace policy Policy updated with literature search; no change in policy statement
04/25/06 Replace policy Policy updated with literature search; no change in policy statement; reference number 2 added
09/18/07 Replace policy Policy updated with literature search; no change in policy statement; Reference numbers 3 and 4 added
09/11/08 Replace policy  Poilcy updated with literature search, reference numbers 5 and 6 added. No change in policy statement.
08/2009 policy archived  


Search for Policies

Policy Feedback