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Clinical Policy Bulletin:
Obstetrical Hypertension Programs
Number: 0368


Policy

Aetna considers obstetrical hypertension programs experimental and investigational because they have not been proven to be more effective than member self-management performed in concert with supervision by an obstetrician in reducing fetal or maternal morbidity and mortality.



Background

Obstetrical hypertension programs offer a “package” approach to the outpatient care of the hypertensive pregnant patient.  These programs typically use a device to measure blood pressure and pulse, and to transmit measurements of daily weight, fetal movement count, and urine proteinuria.  The programs do not assure patient compliance with physician instructions regarding the ambulatory management hypertension.

For mild preeclampsia, conservative management is recommended by the American College of Obstetricians and Gynecologists (ACOG) for any woman not undergoing delivery.  Conservative management involves monitoring the patient's blood pressure, proteinuria, renal and hepatic function, platelet counts, and serial sonography for fetal growth.  The frequency with which these parameters are monitored should depend on gestational age and circumstance of the patient and fetus. Inpatient or outpatient management may be appropriate.
 
CPT Codes / HCPCS Codes / ICD-9 Codes
HCPCS codes not covered for indications listed in the CPB:
S9211 Home management of gestational hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)
S9212 Home management of postpartum hypertension, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)
S9213 Home management of preeclampsia, includes administrative services, professional pharmacy services, care coordination and all necessary supplies and equipment (drugs and nursing visits coded separately); per diem (do not use this code with any home infusion per diem code)
ICD-9 codes not covered for indications listed in the CPB:
642.03 Benign essential hypertension complicating pregnancy, childbirth, and the puerperium, antepartum condition or complication
642.13 Hypertension secondary to renal disease, complicating pregnancy, childbirth, and the puerperium, antepartum condition or complication
642.23 Other pre-existing hypertension complicating pregnancy, childbirth, and the puerperium, antepartum condition or complication
642.33 Transient hypertension complicating pregnancy, childbirth, and the puerperium, antepartum condition or complication
642.43 Mild or unspecified pre-eclampsia complicating pregnancy, childbirth, and the puerperium, antepartum condition or complication
642.53 Severe pre-eclampsia complicating pregnancy, childbirth, and the puerperium, antepartum condition or complication
642.63 Eclampsia complicating pregnancy, childbirth, and the puerperium, antepartum condition or complication
642.73 Pre-eclampsia or eclampsia superimposed on pre-existing hypertension complicating pregnancy, childbirth, and the puerperium, antepartum condition or complication
642.93 Unspecified hypertension complicating pregnancy, childbirth, and the puerperium, antepartum condition or complication


The above policy is based on the following references:
  1. No authors listed. National High Blood Pressure Education Program Working Group Report on High Blood Pressure in Pregnancy. Am J Obstet Gynecol. 1990;163(5 Pt 1):1691-1712.
  2. American College of Obstetrics and Gynecology (ACOG). Chronic hypertension in pregnancy. ACOG Practice Bulletin No. 29. Washington, DC: ACOG; July 2001.
  3. Mathews DD. A randomized controlled trial of bed rest and sedation or normal activity and non-sedation in the management of non-albuminuric hypertension in late pregnancy. Br J Obstet Gynaecol. 1977;84(2):108-114.
  4. Crowther CA, Bouwmeester AM, Ashurst HM. Does admission to hospital for bed rest prevent disease progression or improve fetal outcome in pregnancy complicated by non-proteinuric hypertension . Br J Obstet Gynaecol. 1992;99(1):13-17.
  5. Sibai BM, Barton JR, Akl S, et al. A randomized prospective comparison of nifedipine and bed rest versus bed rest alone in the management of preeclampsia remote from term. Am J Obstet Gynecol. 1992;167(4 Pt 1):879-884.
  6. Roberts JM. Pregnancy-related hypertension. In: Maternal Fetal Medicine. 3rd ed. RK Creasy, R Resnik, eds, Philadelphia, PA: WB Saunders Co.; 1994:804-843.
  7. Scott JR. Hypertensive disorders of pregnancy. In: Danforth's Obstetrics and Gynecology. 7th ed. JR Scott, PJ Disaia, CB Hammond, WN Spellacy, eds, Philadelphia, PA: JB Lippincott Company; 1994:351-365.
  8. Maxwell CV, Amankwah KS. Alternative approaches to preterm labor. Semin Perinatol. 2001;25(5):310-315. 
  9. Mulrow CD, Chiquette E, Ferrer RL, et al. Management of chronic hypertension during pregnancy. Evidence Report/Technology Assessment 14. Rockville, MD: Agency for Healthcare Research and Quality (AHRQ); 2000.
  10. Ferrer RL, Sibai BM, Mulrow CD, et al. Management of mild chronic hypertension during pregnancy: A review. Obstet Gynecol. 2000;96(5 Pt 2):849-860.
  11. Bergel E, Carroli G, Althabe F. Ambulatory versus conventional methods of blood pressure monitoring during pregnancy. Cochrane Database Syst Rev. 2002;(2):CD001231.
  12. Shireen M, Edgardo A, Guillermo C. Bed rest with or without hospitalisation for hypertension during pregnancy. Cochrane Database Syst Rev. 2005;(4):CD003514.
  13. Abalos E, Duley L, Steyn DW, Henderson-Smart DJ. Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. Cochrane Database Syst Rev. 2007;(1):CD002252.


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Copyright Aetna Inc. All rights reserved. Clinical Policy Bulletins are developed by Aetna to assist in administering plan benefits and constitute neither offers of coverage nor medical advice. This Clinical Policy Bulletin contains only a partial, general description of plan or program benefits and does not constitute a contract. Aetna does not provide health care services and, therefore, cannot guarantee any results or outcomes. Participating providers are independent contractors in private practice and are neither employees nor agents of Aetna or its affiliates. Treating providers are solely responsible for medical advice and treatment of members. This Clinical Policy Bulletin may be updated and therefore is subject to change.
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