Diagnosis: Abnormal Heart Rhythms
Treatment: Mobile cardiac outpatient telemetry
The insurer denied coverage for mobile cardiac outpatient telemetry
The denial is upheld

This adult presented to his physician complaining of recurrent palpitations. Symptoms were intermittent in nature. Prior evaluation, at an urgent care facility, failed to capture ECG (electrocardiogram) tracings while the patient was symptomatic. His physician ordered a two-week mobile telemetry recorder to correlate symptoms with heart rhythm. Results revealed frequent premature atrial beats and runs of supraventricular tachycardia as well as occasional premature ventricular beats and non-sustained ventricular tachycardia lasting up to 12 beats in duration with a maximum rate of 203 bpm (beats per minute). The patient presented to his physician complaining of recurrent palpitations without syncope or near syncope. A mobile cardiac outpatient live telemetry monitor was placed and revealed non sustained arrhythmia. It was medically necessary to utilize an external ECG monitor in this case (Reference 1,2). However, it was not medically necessary to have mobile telemetry. Studies have demonstrated that mobile telemetry monitors are important in cases where patients are at risk for developing high degree atrioventricular (AV) block such as following transcatheter aortic valve replacement (TAVR) procedures (Reference 3). Current guidelines do not recommend Mobile telemetry over standard external multiday holter monitoring (Reference 2). In conclusion, continuous mobile telemetry monitoring was not medically necessary in this case.

Based on the above, the insurer's denial must be upheld. The health care plan did act reasonably and with sound medical judgment and in the best interest of the patient. The medical necessity for mobile cardiac outpatient telemetry services is not substantiated.