Name These Guidelines
These guidelines are used review requests to further evaluate abnormalities found on mammogram.
What are BR-1 and BR-5?
These imaging studies would be indicated initially for breast pain.
What are mammogram and ultrasound (BR-7)?
To evaluate or confirm breast implant rupture _____ or _____ would be indicated prior to Breast MRI. (Non-Aetna)
What is mammography or ultrasound? (BR-5)
One of these four risk estimator models can be used when the CR is reviewing a case for high risk screening for Breast MRI.
What is Gail, Claus, Tyrer-Cuzick (IBIS) or BRCAPRO? (BR-5)
Which CPT codes can be used for breast imaging if there is clinical reason or concerns regarding the use of gadolinium contrast.
What is MRI Breast Bilateral wo CPT 77047
This GL can be used when a radiologist recommends a MRI for inconclusive or conflicting findings on mammography or US of a finding that is not a discrete palpable mass.
What is BR-5?
Before sending a breast imaging request to the MD for review for a case with a member in the state of New Jersey, the CR should check this resource in one of these GLs.
What are the State Specific Mandates in BR-1, BR-2, BR-4 and BR-5 (State Mandate Pearl)?
For BI-RADS 3 lesions, the original study is repeated at 6 months. If imaging remains at a BI-RADS 3, the original study can be repeated at ______, ______ and _____ months from the date of initial imaging.
What is 12, 18 and 24 (BR-1, BR-4, BR-5)?
If a client has two or more first degree relatives with breast with the youngest age of diagnosis being age 34, annual Breast MRI screening would begin at age ___.
What is 25? (BR-5)
This CPT code should be used to evaluate a palpable breast mass or other clinical finding (such as skin change, pain, nipple inversion).
What is breast ultrasound CPT 76641 or 76642 x1? (BR-1)
These GLs can be used to review for repeat MRI at least 6 months after an MRI directed breast biopsy.
What are BR-2 and BR-5?
This study should be used prior to MRI to evaluate pathologic nipple discharge.
What is a Diagnostic Mammogram and Breast Ultrasound? (BR-6)
Should BI-RADS 3 follow up imaging become a BI-RADS 1 or 2 finding, imaging reverts to this.
What is routine per individuals risk profile (BR-1, BR-4 and BR-5)?
MRI Breast surveillance (annual) is indicated for patients with a personal history of breast cancer diagnosed before this age.
What is 50? (BR-5)
This CPT code can be used to evaluate women with clinically suspicious lymph nodes.
What is axilla ultrasound (CPT 76882)? (BR-1)
This GL can be used to review for Molecular breast imaging (MBI).
What is BR-8?
This imaging study can be used to evaluate women with clinically suspicious axillary lymph nodes along with FNA or biopsy.
What is axilla ultrasound (CPT 76882)? (BR-1)
Further diagnostic pathway for suspicious clinical or imaging findings in males with suspected breast cancer usually requires this.
What is tissue diagnosis? (BR-9)
MRI screening to begin at diagnosis but not prior to age 25 for a client with a history of _____. (Hint: three answers - cell type)
What are Atypical ductal hyperplasia (ADH), Atypical lobular hyperplasia (ALH) or Lobular carcinoma in situ (LCIS)? (BR-5)
The use of either of these two CPT codes ordered in conjunction with MRI Breast is not necessary since the CAD software automatically performs 3D imaging.
What is 3D Rendering CPT 76376 and CPT 76377? (BR-2)
This GL can be used for CTA or MRA of the body part from which free tissue transfer flap is being taken.
What is BR-3?
This should be performed prior to additional imaging of a BI-RADS 4 or 5 lesion on mammogram and/or ultrasound.
What is a biopsy? (BR-4)
For pathologic nipple discharge, this study can be done if both the diagnostic mammogram and US are negative or inconclusive.
What is a MRI Breast Bilat wwo (BR-6)?
Breast screening should start 8-10 years post therapy or at age 25, whichever comes first if the member has this type of history.
What is history of radiation to the chest between ages 10 and 30? (BR-5)
This imaging can be used for tissue sampling of the breast via ultrasound.
What is US guided breast biopsy CPT 19083? (BR-1)