Name That Guideline
This guideline may be used to process an imaging request for LUQ abdominal pain.
What is AB-2.4?
In the absence of red flags, this initial imaging study is required for the evaluation of generalized abdominal pain in males, prior to authorization of advanced imaging.
What is an abdominal and/or pelvic US?
(AB-2.8)
Any one of these four studies, may be indicated to follow-up a known abdominal abscess.
(Provide the names of all four studies)
What are a limited abdominal US, CT abdomen with contrast, CT pelvis with contrast, and CT abdomen and pelvis with contrast?
(AB-3.1)
You will need to reroute a study request for an indication of heart transplant evaluation, to this specialty.
CR: What is the Cardiology specialty?
(AB-42.7, reroutes you to CD-1.6: Transplant Patients)
This imaging study, as represented by CPT code 78226 or 78227, can be considered in those with RUQ abdominal pain with a normal or non-diagnostic recent US.
What is a HIDA scan?
(AB-2.3)
This guideline may be used to process an imaging request for HCC screening in a member with non-alcoholic fatty liver disease.
What is AB-26.1?
This imaging study must be performed as the initial imaging to evaluate for a suspected inguinal or femoral hernia without incarceration or strangulation.
What is a pelvic ultrasound?
(AB-12.1)
This imaging study may be indicated to observe a known renal stone found initially on CT.
*Please include the modality/anatomy/contrast level in your answer
What is a CT abdomen and pelvis without contrast?
(AB-4.2)
You will need to reroute a study request, whose indication was only for a complaint of indeterminate groin pain, to this specialty.
What is the Ortho specialty?
(AB-12.4, reroutes you to MS-23: Pelvis)
This imaging study, as represented by CPT code 74178, might be indicated evaluate hematuria and flank pain.
What is a CT Urogram
(AB-39.3)
This guideline may be used to process imaging requests ordered to evaluate for irritable bowel syndrome?
What is AB-21.4?
This is the primary study in the evaluation of an upper GI bleed with no abdominal pain.
What is an endoscopy?
(AB-22.1)
Either of these two imaging studies may be indicated to follow a 3cm indeterminate adrenal lesion found on a CT abdomen, in an asymptomatic member with no history of cancer.
*Provide both studies and include the modality/anatomy/contrast level in your answer.
What are a CT abdomen with and without contrast or an MRI abdomen without contrast (aka chemical shift MRI-especially in those where CT is contraindicated)?
(AB-16.1)
You will need to reroute a study request for an indication of lower extremity edema, to this specialty.
What is the Cardiology specialty?
(AB-14, reroutes you to the PVD Guidelines)
This imaging study, as represented by CPT code 76391, might be indicated in members with non-alcoholic fatty liver disease and at least 1 high risk factor.
What is Magnetic Resonance Elastography Liver(MRE)?
(AB-45)
This guideline may be used to process imaging requests ordered to evaluate inguinal lymphadenopathy.
What is AB-8.2?
Prior to advanced imaging, females with hematuria and UTI that are 40 years of age and under, must receive at least a 3 day regimen of antibiotics followed by a repeat of this laboratory study.
What is a urinalysis?
-Note: the repeat UA must show that the hematuria is still present.
(AB-39.1: Hematuria with Urinary Tract Infection)
This imaging study may be indicated to evaluate for suspected small bowel bleeding, following a negative upper endoscopy, negative lower endoscopy, and negative video capsule endoscopy (VCE).
What is a CT enterography?
Note: If there is a contraindication to CTE, MRE (74183 or 74183 and 72197) may be performed.
(AB-22.2)
You will need to reroute a study request for an indication of known pheochromocytoma or paraganglioma, to this specialty.
What is the Oncology specialty?
This imaging study, as represented by CPT code 74263, may not be indicated in those individuals that have had a FIT-DNA (Cologuard) Screening for Colorectal Cancer within the last 3 years.
What is a Screening CT Colonography?
(AB-25.1)
This guideline may be used to process imaging requests ordered to evaluate gallbladder polyps.
What is AB-28.1?
Once splenomegaly is confirmed via abdominal ultrasound, the following laboratory and imaging studies are indicated prior to considering advanced imaging for splenomegaly.
What are CBC, evaluation of the peripheral blood smear, LFTs, UA, CXR, HIV testing?
Note: Etiology of the splenomegaly, following these studies, must remain unexplained in order for the advanced imaging to be authorized.
(AB-34.1)
Either of these three imaging studies may be indicated to evaluate a 1cm liver lesion found on US in a member with a history of Hepatitis B.
*Provide all three studies.
What are a CT abdomen with contrast (74160), CT abdomen with and without contrast (74170), or MRI abdomen with and without contrast (74183)?
Note: Multiphase CT for liver lesion evaluation = 74160 or 74170
(AB-26.1)
You will need to reroute a study request for an indication of suspected abdominal aortic aneurysm, to this specialty.
What is the Cardiology specialty?
(AB-17.1 reroutes you to PVD-6: Aortic Disorders, Renal Vascular Disorders, and Visceral Artery Aneurysms)
This imaging study, as represented by CPT code 73718, may be indicated every 12 months in those individuals with Gaucher Disease that are on enzyme therapy.
What is a MRI lower extremity without contrast?
(AB-11.1)