Diagnosis: palpitations
Treatment: Mobile heart monitor
The insurer denied Mobile Cardiac Electrocardiographic (Heartbeat Tracing) Recording in Real Time Services.

The health plan's determination is upheld.

The patient is a man who was evaluated for occasional "fluttering" of his heart, which usually lasted a few seconds and sometimes lasted a few minutes. The frequency of these episodes was not specified. He also complained of occasional non-exertional chest discomfort. His past medical history was unremarkable. Ambulatory electrocardiographic monitoring with mobile cardiac outpatient telemetry (MCOT) was prescribed.

Mobile Cardiac Electrocardiographic (Heartbeat Tracing) Recording in Real Time Services was not medically necessary for this patient. The mobile cardiac outpatient telemetry (MCOT) device that this patient wore are capable of continuously monitoring the patient's rhythm and immediately transmitting any detected abnormal rhythm to a remote station that is manned by technicians at all times. Their diagnostic yield compares favorably to that of other recording devices. For example, in the report by Rothman, et al, 266 patients, from 17 centers, with syncope, presyncope, or palpitations, were randomized to recording with either an MCOT device or a standard loop recorder. The diagnostic yield in the MCOT group was 88% (percent), significantly higher than the 75% yield in the loop recorder cohort. However, it should be noted that only a small percentage of patients in this study had event monitors that had an autoactivation function. There are no published reports directly comparing the yield of standard event monitors with an autoactivation function with monitors with MCOT function.

There is no documentation that this patient was at high risk for a potentially life-threatening arrhythmia, has had a stroke or has a history of atrial fibrillation. Thus, while ambulatory electrocardiographic monitoring was appropriate, MCOT was not medically necessary. Moreover, since the physician's note did not document the frequency of this patient's palpitations, it cannot be determined monitoring was necessary.