BlueCross and BlueShield of Montana Medical Policy/Codes
Measurement of Long Chain Omega-3 Fatty Acids in Red Blood Cell Membranes as a Cardiac Risk Factor
Chapter: Medicine: Tests
Current Effective Date: July 18, 2013
Original Effective Date: July 18, 2013
Publish Date: July 18, 2013
Revised Dates: This policy is no longer scheduled for routine literature review and update.
Description

Epidemiologic studies have reported that subjects who eat a diet high in fish have a reduced risk of sudden cardiac death.  Fish are rich in long chain omega-3 fatty acids, and it has been hypothesized that these fatty acids may be responsible for the beneficial effect.  Long chain omega-3 fatty acids may be detected in the red cell membrane using gas chromatography.  It has been suggested this measurement may be clinically useful as a cardiac risk factor for sudden cardiac death.

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 measurement of long chain omega-3 fatty acids in red blood cell membranes, including but not limited to its use as a cardiac risk factor, experimental, investigational and unproven.

Rationale

A literature search identified many observational studies exploring the relationship between fish consumption and coronary heart disease (CHD) mortality in different populations of patients.  These studies suggest that mortality from CHD may be reduced by including fish as a regular part of the diet.  However, the search did not identify any published articles that explored how the measurement of red blood cell membrane omega-3 fatty acids may be used to improve patient management.  For example, studies establishing the diagnostic parameters of omega-3 fatty acids (i.e. the definition of normal, high and low values), were not identified.  It has been suggested that measurement of omega-3 fatty acids may be incorporated into a cardiac risk panel in patients with a prior cardiac event.  There were no studies that focused on this application of this laboratory test.  Improved risk prediction does not by itself result in better health outcomes; to improve outcomes clinicians must have the tools to translate this information into clinical practice.  At the present time, patients with coronary artery disease are offered the general dietary recommendation to increase fish consumption, a recommendation not based on red blood cell membrane levels of omega-3 fatty acids.

A literature search through August 2007 for policy update did not identify any new published literature that would prompt reconsideration of the policy statement, which remains unchanged.

2009 Update

The Japan Eicosapentaenoic Acid Lipid Intervention Study (JELIS) trial compared fish oil capsules plus statins to statins alone in 18,645 patients with hypercholesterolemia.  In this primary and secondary prevention study, if hypercholesterolemia remained uncontrolled, the dose of the statin could be raised by protocol.  No measurements of the efficacy of fish oil treatment were performed and the dose remained constant throughout the study.  The fish oil plus statin group had 18% (p=0.132) and 19% (p=0.015) fewer non-fatal (primary and secondary, respectively) cardiac events over a mean of 4.6 years compared to the statin only group.

A search of peer reviewed literature through August 2009 identified no new clinical trial publications or any additional information in which prospective measurement of omega-3 fatty acids (Omega-3 Index) was used to direct treatment to prevent or treat cardiac disease.  As noted above, these trials are needed to demonstrate the potential impact of this index on clinical outcomes.  Therefore, the coverage position of this policy is unchanged.

2010 Update

A search of peer reviewed literature through February 2011 identified no new clinical trial publications or any additional information that would change the coverage position of this medical policy.

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

Refer to the ICD-9-CM manual.

Procedural Codes: 0111T
References
  1. Albert, C.M., Campos, H., et al.  Blood levels of long chain n-3 fatty acids and the risk of sudden death.  New England Journal of Medicine (2002) 346:1113-8.
  2. Hu, F. B., Cho, E., et al.  Fish and long chain omega-3 fatty acid intake and risk of coronary heart disease and total mortality in diabetic women.  Circulation (2003) 107:1852-7.
  3. He, K., Song, Y., et al.  Accumulated evidence of fish consumption and coronary heart disease mortality:  a meta-analysis of cohort studies.  Circulation (2004) 109:2705-11.
  4. He, K., Song, Y., et al.  Fish consumption and incidence of stroke:  a meta-analysis of cohort studies.  Stroke (2004) 35:1538-42.
  5. Whelton, S. P., He, J., et al.  Meta-analysis of observational studies on fish intake and coronary heart disease.  American Journal of Cardiology (2004) 93:1119-23.
  6. Mozaffarian, D., Longstreth, W.T., et al.  Fish consumption and stroke risk in elderly individuals: The cardiovascular health study.  Archives of Internal Medicine (2005) 165:200-6.
  7. Yokoyama M, Origasa H, Matsuzaki M et al. Effects of eicosapentaenoic acid on major coronary events in hypercholesterolaemic patients (JELIS): a randomised open-label, blinded endpoint analysis. Lancet 2007; 369(9567):1090–8.
  8. Measurement of Omega-3 Fatty Acids in Red Blood Cell Membranes as a Cardiac Risk Factor.  Chicago, Illinois:  Blue Cross Blue Shield Association Medical Policy Reference Manual (2008 March) Medicine 2.04.40 (Archived).
History
May 2013  New 2013 BCBSMT medical policy.  Measurement of long chain omega-3 fatty acids in red blood cell membranes, including but not limited to its use as a cardiac risk factor, is considered experimental, investigational and unproven. 
BCBSMT Home
®Registered marks of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans. ®LIVE SMART. LIVE HEALTHY. is a registered mark of BCBSMT, an independent licensee of the Blue Cross and Blue Shield Association, serving the residents and businesses of Montana.
CPT codes, descriptions and material only are copyrighted by the American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS Restrictions Apply to Government Use. CPT only © American Medical Association.
Measurement of Long Chain Omega-3 Fatty Acids in Red Blood Cell Membranes as a Cardiac Risk Factor