Automatic External Defibrillators (AEDs) (Wearable and Nonwearable)
© Blue Cross and Blue Shield of Montana
Current Effective Date:
February 01, 2014
Original Effective Date:
May 09, 2008
January 15, 2014
March 1, 2010; October 1, 2011; December 6, 2012; May 27, 2013; January 15, 2014
Sudden cardiac arrest (SCA) is the most common cause of death in patients with coronary artery disease. The automatic implantable cardioverter defibrillator (AICD) has proven effective in reducing mortality for survivors of SCA and for patients with documented malignant ventricular arrhythmias. More recently, the use of AICDs has been potentially broadened by studies reporting a reduction in mortality for patients at risk for ventricular arrhythmias, such as patients with prior MI and reduced ejection fraction. AICDs consist of implantable leads in the heart that connects to a pulse generator implanted beneath the skin of the chest or abdomen. In the past, AICD placement required a thoracotomy, but current technology allows implantation with only a minor surgical procedure, with the cardiac leads placed percutaneously. Potential adverse effects of AICD placement are bleeding, infection, pneumothroax, and delivery of unnecessary counter shocks.
The wearable AED is an external device that is intended to perform the same tasks as an AICD, without requiring invasive procedures. It consists of a vest that is worn continuously underneath the patient's clothing. Part of this vest is the ‘electrode belt’ that contains the cardiac monitoring electrodes, and the therapy electrodes that deliver a counter shock. The vest is connected to a monitor with a battery pack and alarm module that is worn on the patient’s belt. The monitor contains the electronics that interpret the cardiac rhythm and determine when a counter shock is necessary. The alarm module alerts the patient to certain conditions by lights or voice messages. The U.S. Food and Drug Administration (FDA) approved the Lifecor WCD® 2000 system via premarket application approval in December 2001 for “adult patients who are at risk for cardiac arrest and are either not candidates for or refuse an implantable defibrillator.”
A nonwearable AED is a compact device that is used to deliver an electrical shock to a victim of SCA. These units use a microprocessor inside a portable defibrillator to interpret a victim’s heart rhythm through adhesive electrodes. The computer recognizes a VF or VT and either advises the operator whether electrical defibrillation is needed, or automatically delivers electrical therapy.
425.1, 425.4, 427.1, 427.41, 427.42, 427.9
I42.0-I43, I47.0-I47.9, I49.0-I49.02, I50.1-I50.9, Z86.74
93745, E0617, K0606, K0607, K0608, K0609
- Use of a Wearable Defibrillator in terminating Tachyarrhythmia’s in Patients at High Risk for Sudden Death: Results of WEARIT/BIROAD. Pacing and Clinical Electrophysiology (2004 January) 27(6):4-9.
- Wearable Cardioverter-Defibrillators for the Prevention of Sudden Cardiac Death. Chicago, Illinois: Blue Cross Blue Shield Association Medical Policy Reference Manual (2005 June) Medicine 2.02.15.
- Solomon, S. D., Zelenkofske, S., et al. Sudden Death in Patient with Myocardial Infarction and Left ventricular Dysfunction, Heart Failure, or Both. The New England Journal of Medicine (2005 June) 352 (25):2581-8.
- Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). Wearable cardioverter-defibrillator as a bridge to implantable cardioverter-defibrillator treatment. TEC Assessments 2010; Volume 25, Tab 2.
- Epstein AE, Abraham WT, Bianco N, et al. Wearable cardioverter-defibrillator use in patients perceived to be at high risk early post myocardial infarction. J Am Coll Cardiol 2013; available at http://content.onlinejacc.org .
- Zishiri, E.T., Williams, S. et al. Early risk of mortality after coronary artery revascularization in patients with left ventricular dysfunction and potential role of the wearable cardioverter defibrillator. Circ Arrhythm Electrophysiol (2013 Feb) 6(1):117-28
||Updated Policy and added policy guidlines for implantable cardioverter-defibrillator, updated rationale and references. Policy statement change from Not Medically Necessary to Investigational. No coding changes.|
||Policy updated with literature review, reference 14 added. Wording “have all of the following” stricken from medically necessary policy statement. No other changes to policy statement. Removed 93742, E0617, E1399. Added 93292. Changed title from Wearable Cardioverter-Defibrillators and Automated External (AED) to Wearable Cardioverter-Defibrillators as a Bridge to Implantable Cardioverter-Defibrillator Placement.|
||Policy formatting and language revised. Title changed from "Wearable Cardioverter-Defibrillators as a Bridge to Implantable Cardioverter-Defibrillator Placement" to "Automatic External Defibrillators (AEDs) (Wearable and Nonwearable)". Medically Necessary section updated to include specific criteria that must be met to define high risk for sudden cardiac death. Added HCPCs code E0617 and removed CPT code 93292.|
||Document updated with literature review. Coverage unchanged.|