Compliance Issues Related to Cardiopulmonary Exercise Testing - Medicare RAC Audits & Appeals Services
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Compliance Issues Related to Cardiopulmonary Exercise Testing

compliance risks

While Cardiopulmonary Exercise Testing is considered the gold standard of exercise testing, it is not appropriate for all patients.

Over recent decades, advancements in medicine and technology have extended the expected lifespan. However, while newly available medical testing can help to diagnose serious health conditions, practitioners must be careful when using new techniques.

Cardiopulmonary exercise testing, or CPET, is a test designed to assess how patients’ bodies respond to physical stress. Often, a CPET lab is used when a patient presents with unexplained shortness of breath. This testing can help practitioners determine if a patient’s symptoms are related to cardiac disease or pulmonary disease.

What Does a CPET Lab Look Like?

During a CPET, the patient sits on a bicycle and pedals. Patients are told that the test will be physically strenuous, and to give it their best effort. Initially, there is little pedal resistance. However, more resistance is added over time, making it more difficult to pedal. While CPET protocol varies depending on the facility, the test measures a patient’s blood-oxygen level as they continue to exercise, looking for a drop in oxygen levels. CPET gives practitioners an idea of the patient’s heart and lung function.

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Within a few weeks of the CPET, patients are brought in for a follow-up visit. At this visit, a doctor will review the results of the test to determine:

  • Whether the patient exhibits normal exercise capacity;
  • Whether the patient’s cardiovascular response was normal;
  • Whether the patient’s ventilatory response was normal; and
  • Whether the patient had a normal gas exchange.

The results of a CPET can help doctors determine the underlying cause of a patient’s shortness of breath. It can also be a useful tool in evaluating a patient’s exercise threshold.

When Is CPET Used?

Perhaps the most common use for CPET is to diagnose a patient with pulmonary hypertension, which is high blood pressure in the arteries in the heart and lungs. Often, patients with pulmonary hypertension present with non-specified shortness of breath with no known cause, and CPET can help shed light on a patient’s overall heart and lung function.

A practitioner may also order a CPET for a patient for a variety of other reasons. Typically, a CPET is ordered when a patient presents with unexplained shortness of breath. However, shortness of breath can stem from a variety of conditions. Thus, common reasons for ordering a CPET include:

  • Preoperative evaluation;
  • Possible respiratory diseases;
  • Possible cardiovascular diseases;
  • Evaluation of exercise tolerance;
  • Exercise Prescription forPulmonary Rehabilitation; and
  • Evaluation of impairment or disability.

Importantly, there are also certain situations when a CPET may not be appropriate. CPET is physically strenuous, and many labs require a letter from a patient’s primary care provider, stating that the patient is capable of completing the test. Contraindications for a CPET include:

  • Myocardial infarction (heart attack);
  • Unstable angina;
  • Syncope;
  • Thrombosis of the lower extremities;
  • Pulmonary edema; and
  • Active endocarditis.

Additionally, CPET should not be ordered for any patient who was recently sick with any significant illness.

Preparation for a CPET

While there is little patient preparation needed for a CPET, and protocol vary by facility, practitioners often inform patients they should:

  • Eat only a light meal the day of the test;
  • Avoid exercising the day of the test;
  • Avoid alcohol, caffeine, and carbonated beverage the day of the test; and
  • Continue taking all prescription medications (unless previously discussed with the prescribing physician).

As is the case with all medical tests, CPET results are only useful if the test is administered correctly, and the data properly interpreted. Healthcare professionals may be liable for poor patient outcomes if they do not take the necessary precautions, ensuring a safe test and accurate results. Not only can a poor patient outcome result in a medical malpractice lawsuit, but it can also lead to disciplinary proceedings.

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