Name That Guideline
This guideline may be used to process imaging requests ordered to evaluate for a cough.
What is CH-3.1?
The following study should be performed initially in the evaluation of non-cardiac chest pain.
What is a chest x-ray?
(CH-4.1)
Either of these two imaging studies can be used to follow-up an indeterminate neck ultrasound performed in the evaluation of supraclavicular lymphadenopathy. (provide both studies)
*Please include the modality/anatomy/contrast level in your answer.
What are a CT Neck with contrast or CT Chest with contrast?
(CH-2.1)
You will need to reroute a study request for an indication of pulmonary hypertension to this specialty.
What is the Cardiology specialty?
(CH-26, reroutes you to CD 8.1)
This imaging study, as represented by CPT code of 71271, may be indicated to screen for lung cancer.
What is a Low Dose Chest CT?
(CH-33.1/Medicare NCD 210.14)
An imaging request to evaluate for suspected sarcoidosis would be best reviewed using this guideline.
What is CH-15.1?
This is the initial study that would be indicated to evaluate for palpable or suspected lymphadenopathy of the supraclavicular region.
What is an ultrasound of the neck?
(CH-2.1)
This imaging study may be indicated once, to follow-up a lung nodule greater than or equal to 8mm as noted on dedicated advanced chest imaging.
What is a PET/CT (CPT® 78815)?
(CH-16.4)
You will need to reroute a study request for an indication of lung nodule evaluation in a member with a personal history of cancer (other than basal and squamous cell cancer), to this specialty.
What is the Oncology specialty?
This imaging study, as represented by CPT code of 71275, may be indicated to evaluate for hemoptysis in a member with an abnormal chest x-ray.
What is a CTA Chest?
(CH-6.1)
This guideline may be used to process imaging requests ordered to screen for lung cancer in a Medicaid member.
What is CH-33.1?
At least one of these two imaging studies are required prior to approving advanced imaging for an elevated hemidiaphragm. (provide both studies)
What are chest x-rays and fluoroscopic examination ("sniff test")?
(CH-30.1)
Either of these studies can be used to further evaluate a lung opacity incidentally noted on an MRI of the Spine. (provide both studies)
*Please include the modality/anatomy/contrast level in your answer.
What is a CT Chest without contrast (CPT® 71250) or CT Chest with contrast (CPT® 71260)?
(CH-16.1)
An imaging study requested for evaluation of cardiac manifestations of known pulmonary sarcoidosis, should be forwarded to this specialty.
What is the Cardio specialty?
This imaging study, as represented by CPT code of 78815, may be indicated to image a distinct lung nodule ≥8 mm on dedicated advanced chest imaging.
What is a PET/CT ?
(CH-16.4)
This guideline may be used to process imaging requests ordered to evaluate a finding of a lung density seen initially on a CT abdomen.
What is CH-16.1?
Both of these studies would be required prior to approving an advanced imaging request to evaluate for suspected ILD in a member with pulmonary symptoms and no connective tissue disease diagnosis.
What are chest x-ray and pulmonary function studies?
(CH-11.1)
This study may be indicated to follow-up a Lung-RADS 3 nodule initially found on a LDCT for lung cancer screen (CPT code 72171)
*Please include the modality/anatomy/contrast level/CPT code in your answer.
What is a CT Chest without contrast (CPT® 71250)?
(CH-33.3)
An imaging study requested for an indication of a chest wall mass, which chest x-ray reveals to be an obvious lipoma or clearly benign, should be forwarded to this specialty.
What is the Ortho-Spine specialty?
(CH-22.1-reroutes you to MS-10:Soft Tissue Mass or Lesion of Bone)
This imaging study, as represented by CPT code of 71552, may be indicated to evaluate for a chest wall mass when chest x-ray or chest ultrasound fail to show an obvious lipoma and or clearly benign entity.
What is an MRI of the chest with and without contrast?
(CH-22.1)
An imaging request to evaluate for a lung nodule first found incidentally on a LDCT, would be best reviewed using this guideline.
What is CH-33.3?
This imaging study should be completed prior to approving a request for advanced imaging for the initial evaluation of Subclavian Steal Syndrome.
What is a carotid duplex study (CPT® 93882)?
(CH-27.1)
This imaging study may be indicated to rule out liver or abdominal process, following a negative CT Chest, to evaluate an elevated hemidiaphragm.
*Please include the modality/anatomy/contrast level in your answer.
What is a CT abdomen with contrast (CPT® 74160)?
(CH-30.1)
An imaging study requested to screen for a TAA in a member with a known bicuspid aortic valve should be forwarded to this specialty.
What is the Cardiology specialty?
This imaging study, as represented by CPT code of 76380, can be considered in those with a cough (no chest x-ray required), when there is suspicion of Upper Airway Cough Syndrome (UACS) secondary to rhinosinus disease.
What is a Limited Sinus CT without contrast?
(CH-3.1)