BlueCross and BlueShield of Montana Medical Policy/Codes
Acoustic Respiratory Management (ARM)
Chapter: Medicine: Treatments
Current Effective Date: October 25, 2013
Original Effective Date: October 25, 2013
Publish Date: October 25, 2013
Description

Acoustic respiratory management (ARM) is a method to record breath sounds and document wheeze rate measurements and cough for the diagnosis and/or management of asthma, chronic cough and other respiratory disorders.  ARM is noted to evaluate the wheeze rate during broncho-dilatation, wheeze reversibility and bronchial challenge testing.  ARM may also include the continuous measurement during emergencies, ambulatory evaluation for wheeze and cough, and sleep testing to verify the symptoms of nocturnal asthma and cough-variant asthma.  ARM is noted to be useful for patients who cannot perform currently available lung function tests.

KarmelSonix Ltd. (ASX: KSX) obtained U.S. Food and Drug Administration (FDA) marketing clearance for the WheezoMeter™, an acoustic respiratory monitoring tool that measures a patient's wheeze rate before and after tests with a bronchodilator to demonstrate the effectiveness of asthma treatments, and the WHolter™, a monitoring tool for both the severe asthmatic patient and tests for the difficult-to-diagnose patient (especially for nocturnal asthma and cough).

The WheezoMeter is handheld for clinical or home use.  The WHolter is an ambulatory acoustic recorder for continuous 24 hour data collection and recording.

Policy

Each benefit plan, summary plan description or contract defines which services are covered, which services are excluded, and which services are subject to dollar caps or other limitations, conditions or exclusions.  Members and their providers have the responsibility for consulting the member's benefit plan, summary plan description or contract to determine if there are any exclusions or other benefit limitations applicable to this service or supply.  If there is a discrepancy between a Medical Policy and a member's benefit plan, summary plan description or contract, the benefit plan, summary plan description or contract will govern.

Investigational

Blue Cross and Blue Shield of Montana (BCBSMT) considers acoustic respiratory management (ARM), including the measurement, recording and interpretation of data, experimental, investigational and unproven for the diagnosis and/or management of asthma, chronic cough and other respiratory disorders.

Rationale

A small observational study WheezoMeter™ Exploratory (WM) Field “Study” is currently underway.  The purpose of the study is to determine whether Wz% and change in Wz% correlate with symptoms and change in symptoms at least as well as FEV1 and change in FEV1.0.  Additional information to be obtained from the study will be to determine whether there is a symptom threshold at which a patient seeks rescue medications and if so, to determine the value of Wz% and FEV1.0 at this point (Wz%, FEV1.0 thresholds). The study will also provide information on the within patient and whole group correlations between Wz% and FEV.

A search of peer reviewed literature was conducted through December 2010.  No significant studies or clinical trial publications were identified to evaluate the efficacy of acoustic respiratory management for the diagnosis and/or management of asthma, chronic cough and other respiratory disorders.

Coding

Disclaimer for coding information on Medical Policies

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

The presence or absence of procedure, service, supply, device or diagnosis codes in a Medical Policy document has no relevance for determination of benefit coverage for members or reimbursement for providers. Only the written coverage position in a medical policy should be used for such determinations.

Benefit coverage determinations based on written Medical Policy coverage positions must include review of the member’s benefit contract or Summary Plan Description (SPD) for defined coverage vs. non-coverage, benefit exclusions, and benefit limitations such as dollar or duration caps.

ICD-9 Codes

Experimental, investigational and unproven for all codes.

Procedural Codes: 0243T, 0244T
References
  1. Lea Bentur, Raphael Beck, Drora Berkowitz, Jamal Hasanin, Irit Berger, Noam Gavriely. Pediatric Asthma, Allergy & Immunology. Winter 2004, 17(4):262-71. doi:10.1089/pai.2004.17.262.
  2. U.S. National Institutes of Health/Clinical Trials.  WheezoMeter™ Exploratory (WM) Field Study.  http://clinicaltrials.gov/show/NCT01156818  (accessed on December 2010).
  3. KarmelSonix Ltd USA 8599 Haven Avenue, Suite 302 Rancho Cucamonga, CA 91730,  USA.  Product Information. (accessed on 2010 December).
History
October 2013  New 2013 BCBSMT medical policy.  Acoustic respiratory management (ARM), including the measurement, recording and interpretation of data, is considered experimental, investigational and unproven for the diagnosis and/or management of asthma, chronic cough and other respiratory disorders. 
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Acoustic Respiratory Management (ARM)