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Impedance Cardiography in Hypertension

Section: Diagnostic Medical
Effective Date: November 01, 2019
Revised Date: October 05, 2019
Last Reviewed: September 26, 2019

Description

Impedance cardiography (ICG), also referred to as thoracic electrical bioimpedance (TEB), is a noninvasive means of determining cardiac output in which the stroke volume of each cardiac contraction is determined by measuring beat-to-beat changes in the electrical impedance of the chest and neck.

Criteria

ICG may be considered medically necessary for individuals with drug-resistant hypertension when BOTH of the following criteria are met:

  • Unable to attain target clinic blood pressure of lower than 140/90; and
  • Taking three (3) classes of antihypertensive medications, including a diuretic.

ICG for all other types of HTN may be considered experimental/investigational and therefore non-covered due to lack of supporting published peer reviewed literature.

Procedure Codes

93701

Diagnosis Codes

G93.2H40.051H40.052H40.053H40.059I10I11.0
I11.9I12.0I12.9I13.0I13.10I13.11I13.2
I15.0I15.1I15.2I15.8I15.9I16.0I16.1
I16.9I27.0I27.20I27.21I27.22I27.23I27.24
I27.29I67.4I87.301I87.302I87.303I87.309I87.311
I87.312I87.313I87.319I87.321I87.322I87.323I87.329
I87.331I87.332I87.333I87.339I87.391I87.392I87.393
I87.399I97.3K76.6O10.011O10.012O10.013O10.019
O10.02O10.03O10.111O10.112O10.113O10.119O10.12
O10.13O10.211O10.212O10.213O10.219O10.22O10.23
O10.311O10.312O10.313O10.319O10.32O10.33O10.411
O10.412O10.413O10.419O10.42O10.43O10.911O10.912
O10.913O10.919O10.92O10.93O11.1O11.2O11.3
O11.4O11.5O11.9O13.1O13.2O13.3O13.4
O13.5O13.9O16.1O16.2O16.3O16.4O16.5
O16.9O19.93P29.2P29.30R03.0

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