In their new guidelines, the American College of Physicians (ACP) advises that adults who are at lower risk for heart disease need not undergo screening tests such as EKGs and other cardiac stress tests. Cardiac screening tests help physicians identify whether their patients are at increased risk for heart disease. Billable screening tests may do more harm than good if ordered when they are not needed. ACP guidelines say their research reveals that these tests are overused in patients who don’t require them.
The guidelines published in the Annals of Internal Medicine mainly focus on cardiac screening with an electrocardiogram (EKG or ECG), a stress echocardiogram (echo), or myocardial perfusion imaging (MPI). While resting EKG or ECG makes use of small monitors on the chest to test the heart’s electrical activity when the patient is resting, stress EKG or ECG tests the heart’s electrical activity when the patient exercise. Stress echo makes use of ultrasound to watch how the heart moves during exercise. In case of MPI test, a radioactive liquid called tracer is injected into a vein of the patient which allows physicians to see how well the blood flows to the heart’s muscle.
ACP research shows that about 90% of low-risk adults having no symptoms will have a cardiac event including heart attack in the next 10 years. So, applying screening tests mentioned earlier on low-risk patients will bring more harm than good. First of all, there are risks from the screening tests themselves such as exposure to radiation, bad reaction to an injection or problems during exercise. The screening tests may also show false-positive results (results that show a non-existent problem), which lead to more unwanted tests that may prove risky and more complicated. There are risks when the testing shows up true-positive results (results that show a real problem) such as health insurance denials or higher costs. The greatest harms occur from follow-up testing and procedures after a false-or true-positive result, which include added anxiety, losing the time dedicated for work or family, unnecessary treatment and so on.
As the clinicians and patients believe stress tests generally bring more benefits than potential harms, many unnecessary screening tests are conducted for low-risk adults. ACP recommends both clinicians and patients should focus on reducing risk for a cardiac event rather than hurrying for a screening test. The risk factors include high cholesterol and blood pressure, diabetes, smoking and being overweight. Lifestyle changes such as maintaining a healthy weight, regular exercise, lowering blood pressure, maintaining healthy cholesterol levels and not smoking can greatly reduce the risk. They are very cost-effective while physician practices can gain reimbursement through office visit and counseling. Medicare (Part B coverage) covers a behavioral-focused, cardiovascular disease risk reduction visit once in a year, which includes a blood pressure check and counseling that discusses healthy diet and need for aspirin therapy.
Medicare Part B covers an Annual Wellness Visit once a year that includes a health risk assessment, which helps you to come up with a personalized prevention plan for a healthier life. The visit may also include review of medical and family history of the patient, developing or updating the list of current providers and other routine measurements, detection of any cognitive impairment, personalized health advice, list of risk factors and treatment options. Physicians can use the following HCPCS codes on their medical claims.
- G0438: Annual wellness visit; includes a personalized prevention plan of service (pps), initial visit
- G0439: Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit
Additional tests or services performed during this visit are not covered under an Annual Wellness Visit.