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.
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.
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.
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.