Updated External Infusion Pump Policy - Parenteral Inotropic Therapy FAQs - JA DME

Question 1: Guideline-directed medical therapy (GDMT) is compliance with optimal medical therapy as defined by ACCF/AHA guidelines recommended therapies (primarily Class I recommendations). These include the use of diuretics, ACE inhibitors or ARB antagonists, beta-blockers, aldosterone antagonists, hydralazine & isosorbide dinitrate, and statins, as appropriate. How are we supposed to support the word as appropriate? What if the patient could not take a statin due to allergy/intolerance? Does the record have to indicate as appropriate and why a patient did not take one of these drugs?

Answer: "As appropriate" simply means that the course of action is proper, given the set of circumstances. In the specific example cited above, it is obviously inappropriate to give a statin when the patient is allergic or intolerant. Similarly, if the patient has had a cough associated with ACE inhibitors, the policy's use of "as appropriate" would not require the patient to use that class of drugs. However, in such instances, the contemporaneous patient's medical record should clearly note the reasons for deviating from GDMT.

Question 2: The parenteral inotropic drug can be prescribed by someone other than the evaluating cardiologist. How is a prescriber supposed to evaluate that the initial evaluation was performed by a cardiologist with training in the management of advanced heart failure?

Answer: The prescriber should be familiar with the expertise and training of the consultants utilized for the treatment of their advanced heart failure patients.

Question 3: Are there professional certification letters after an MD name that indicate a cardiologist has training in advanced HF?

Answer: Professional certification letters after the name of the evaluating cardiologist are not a requirement. However, the evaluating cardiologist may indicate "FACC", "Board-Certified in Cardiology" or "Board Certified in Advanced Heart Failure and Transplant Cardiology" on their letterheads, progress notes or other documentation.

Question 4: How can the prescriber obtain proof of the cardiologist's credentials?

Answer: Proof of the evaluating cardiologist's credentials is not required prior to claim submission. Upon an audit, evidence of board certification and or an attestation from the evaluating cardiologist may be requested.

Question 5: What type of records would be used to prove this documentation in the medical record to support a supplier claim?

Answer: As noted in the policy, and in response to the questions above, the contemporaneous patient's medical record must support the claim.