Adult Additional Clinical
Source: fax/MDO
Reason: annual follow up of a prolactinoma
LOV and Neuro exam: 2 days ago WNL
Symptoms: none
Imaging: MRI 14 months showed 3mm prolactinoma
Labs: Prolactin level 2 days ago WNL for laboratories range
What Clinical is missing for an approval?
Is the member on dopamine agonist therapy?
What row would be used for an adenoma and prolactin level drawn last week was elevated per the testing laboratories range?
What is prolactinoma?
This GL would be used for a 8 year old male with facial hair.
What is HD-15.5 Precocious Puberty
Source: Will Ferrel/mdo
LOV: 5 days ago
Reason: Abnormal Lab values
Neuro exam: decreased alertness
Labs: Thyroid function labs, FSH, LH, and testosterone ordered.
What Clinical is missing for an approval?
What are the values of the abnormal labs?
Source: Bruce Wayne/MDO
Reason: prolactinoma
LOV: today
Neuro exam: today- showed no abnormalities
PE: bilateral galactorrhea
Symptoms: new onset of galactorrhea
Imaging: MRI 4 months showed stable prolactinoma
What Clinical is missing for an approval?
Is the member on dopamine agonist therapy?
What row would be most appropriate for a male with low testosterone?
What is male hypogonadism?
This GL would be most appropriate for a pediatric member with a growth hormone deficiency.
What is PEDHD- 15.3 Isolated Growth Hormone Deficiency?
Source: Web
Reason: DI
LOV: 1 month ago
Labs: 1 month ago serum osmolality 450, urine osmolality 220.
What Clinical is missing for an approval?
Has a neurological exam been completed?
Source: Spike Lee/MDO
Reason: adenoma
LOV: 6 months ago
Neuro exam: intact
Imaging: Last MRI showed an 11x8mm pituitary adenoma.
Treatment: Adenoma was partially resected 1.5 years ago.
What Clinical is missing for an approval?
What date was the last imaging completed?
What row would be most appropriate for a member with multiple low pituitary lab values?
What is panhypopituitarism?
What GL would be most appropriate for a member with multiple low pituitary lab values?
What is PEDHD -15.2 Panhypopituitarism?
Source: Carolina Texas/site
Reason: Growth Hormone deficiency
LOV: 2 weeks ago
Neuro exam: no abnormalities
PE: Patient is at the 12% for height and age
Labs: decreased growth hormone level
What Clinical is missing for an approval?
What stimulation agents were used?
Source: Hulk Hogan/MDO
Reason: Pituitary abnormality
LOV: 1 month ago
Imaging: CT Head with contrast completed last month that found a pituitary lesion. MRI head wwo contrast recommended.
What Clinical is missing for an approval?
Why or for what reason was the original CT completed?
What row would be most appropriate for a incidental finding of a pituitary lesion on prior imaging?
What is HD-19.1, 3rd arrow?
What GL would be most appropriate for a incidental finding of a pituitary lesion on prior imaging?
What is HD-19.1, third arrow?
Source: Tina Faye/site
Reason: Early puberty
LOV: 5 days ago
Neuro exam: normal
PE: 9 yr old female with breath growth
Imaging: US pelvis completed 4 days ago – normal study
What Clinical is missing for an approval?
Has an ultrasound of the abdomen been completed?
Source: Keanu Reeves/MDO
Reason: Post-op follow-up
LOV: last week
Hx: member is post-op resection of a Rathke’s cleft cyst 2 months ago.
What Clinical is missing for an approval?
Is the provider a neurosurgeon?
What location would be most appropriate for post-operative follow up of a pituitary surgery?
What is HD-19.2, 1st arrow?
What GL would be most appropriate for follow up of microadenoma?
What is HD-19.2, microadenoma?
Source: Fax/mdo
Reason: Adenoma follow-up
Imaging: MRI Brain wwo completed 2 years ago noting adenoma. MRI brain wwo recommended for annual follow up
Treatment: No treatment has been completed for the adenoma
What Clinical is missing for an approval?
What was the size of the adenoma?