Electroconvulsive therapy (ECT) is a treatment for certain disorders in which a small amount of electrical current is passed through the brain while the patient is under general anesthesia. Application of the current causes a brief seizure that appears to create chemical changes in the brain resulting in therapeutic effects. ECT is most commonly used to treat severe depression, and is also used to treat patients with severe bipolar disorder, schizophrenia, or schizoaffective disorder. ECT may also be used to treat neuroleptic malignant syndrome (NMS). This syndrome is caused by a reaction to antipsychotic drugs that affect central dopaminergic neurotransmission. NMS is a potentially life-threatening condition characterized by fever, altered mental status, muscle rigidity, and autonomic dysfunction with symptoms ranging from mild to severe. Malignant catatonia is also a rare, life-threatening condition which can occur in the setting of an underlying neuropsychiatric syndrome or general medical illness and shares clinical and pathophysiological features and medical comorbidities with NMS. ECT is reserved for patients with NMS or malignant catatonia who have not responded to other treatment.
Adverse effects of ECT may include cognitive impairment of varying duration and frequency: acute confusion, anterograde amnesia, and retrograde amnesia. Acute confusion is the result of both the seizure and the anesthesia and typically resolves in 10 to 30 minutes. Anterograde amnesia is the decreased ability to retain newly acquired information. It typically resolves within two weeks after completing a course of ECT. Retrograde amnesia involves forgetting recent memories for events that occur during the course of treatment and a period of weeks to months prior ECT. Some patients report persistent memory loss. Various techniques are used to minimize these effects.
Definitions
Initial Course: Multiple sessions of electroconvulsive therapy in a treatment-naïve patient usually given at the rate of one treatment three times per week. While there is no standard number of treatments, most patients achieve remission for major depressive disorder with 4 to 20 treatments.
Continuation/Maintenance ECT: Continuation/Maintenance ECT is the practice of providing a single ECT treatment, at an interval of one to eight weeks, after remission. The purpose is to prevent relapse of the mood or psychotic episode that prompted the acute course of ECT.
Therapeutic Agent Classification: Drug class refers to agents with a similar chemical structure, mechanism of action, or pharmacological effects. One drug may belong to several classes. Drug classes for treatment of depression include but are not limited to the following:
I. Initial Course
Electroconvulsive therapy (ECT) may be considered MEDICALLY NECESSARY AND APPROPRIATE when ALL of the following are met:
II. Continuation/Maintenance ECT
Continuation/maintenance ECT may be considered MEDICALLY NECESSARY AND APPROPRIATE when ALL of the following are met:
III. Reinitiating Treatment
Patient must meet criteria in Section I to reinitiate treatment after the completion of continuation/ maintenance ECT.
IV. Investigative Uses
All other indications or procedures using ECT are considered EXPERIMENTAL/INVESTIGATIVE due to the lack of clinical evidence demonstrating an impact on improved health outcomes, including but not limited to:
Documentation Submission:
Documentation supporting the medical necessity criteria described in the policy must be included in the prior authorization, when prior authorization is required. In addition, the following documentation must also be submitted:
Initial Review
Renewal Review
No additional statements.
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Acknowledgements:
CPT® codes copyright American Medical Association® 2023. All rights reserved.
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