Updates thru 2012

0067T CT Colonography – Added references and comments

70450 CT Head – Added references in several criteria, clarified “suspected infection or abscess”

70480 CT Orbit – Added asymmetric hearing loss to criteria

70486 CT Maxillofacial – Added definitions, references and some images for sinusitis, mucocele and polyps.

73721 MR LE Joint – Added requirement for conservative management prior to imaging for torn menisci in patients 46 or older

74150 CT Abdomen – Added indications “Complex renal cyst” and “Indeterminate renal Mass”

78111 PET – Clarified colorectal PET and Routine standards regarding tumor markers and added glossary note.

70486 CT Maxollofacial – Added reference and note

70551 MRI Brain – Added section on Lyme disease

71555 MRI Chest – Added Pain, acute “ripping, tearing, searing” chest, back or abdominal

72148 MRI L Spine – Added positive Straight Leg raising to indications under Radiculopathy

73721 MRI LE Joint – Added references and notes

74181 MRI Abdomen – Updated section on Cirrhosis added references and comment

74185 MRA Abdomen- Added Pain, acute “ripping, tearing, searing” chest, back or abdominal

78607 SPECT Brain – Added section

78608 PET Brain Metab. – Added section

78609 PET Brain Perf. – Added section

0 – Revised Introduction to include provision for expedited reviews

70486 CT Maxillofacial – Added details about cranial nerve signs and reference.

71250 CT Chest – Added weight loss as an indication, added references in several criteria

72125 CT Cervical – Spine – removed requirements for any working diagnosis if there is loss of bowel or bladder control

72128 CT Thoracic – Spine – removed requirements for any working diagnosis if there is loss of bowel or bladder control

74150 CT Abdomen – Added weightloss as an indication

74181 MRI Abdomen – Added weight loss as an indication

74181 MRI Abdomen – Added weight loss as an indication

77021 – 77022 MRI Giudane Procedures Added automatic approval

72141 – clarified epidural abscess criteria

72146 – clarified epidural abscess criteria

72148 – clarified epidural abscess criteria

70551 – Added references and indications for Mult. Sclerosis

72192 – Added criteria for “night sweats.”

74150 – Added criteria for “night sweats.”

78811 – Added criteria for Solitary Pulmonary Nodule; rearranged Lung criteria.

Added CPT codes for related imaging procedures

Alphabetized Criteria list

Glossary reformatted and expanded

70551 – Added criteria concerned with cranial nerves, added references to MS.

71250 – Added criteria for follow up of Ground Glass Opacities

72192 – Added criteria for Testicular Cancer

72195 – Added criteria for Testicular Cancer

73700 – added criteria for suspected nonunion of known feracture 8-6-09

Glossary – Added Romberg test 7/31

72192 – Added Criteria for Diverticulitis 090109

77058 – added references for implant screening 100509

70496 – Added references and criteria for screening for aneurysm

73706 – Added notes for ABI 111609

74175 – Clarified language and updated references 110509

70490 – several criteria reworded, no substative changes 121609

72131 – several criteria reworded, no substative changes 121609

72192 – Added criteria for aneuryms, RLQ pain, Weight loss, hematuria.

73700 – several criteria reworded, no substative changes 121609

74181 – Revised language, added references 010210

72148 – Added criteria for suspected metastasis 011110

72146 – Added criteria for suspected metastasis 011110

72141 – Added criteria for suspected metastasis 011110

75571 – Added criteria 012810

75572 – Added criteria 012810

75573 – Added criteria 012810

75574 – Added criteria 012810

72131 – Simplified criteria for Loss of bladder or bowel control

78491 – Clarified indications and added referrences 030810

74181 – Added monitoring of Crohn Disease as indication 030810

72125 – Clarified indications for brachial plexopathy 031210

73221 – Added indications for brachial plexopathy 031510

72141 – Clarified indications for brachial plexopathy

General – Updated references for several of the exams in the CT section, added introductory page and remarks.

72131 CT L Spine – Added references and clarified several criteria. 040510

74181 MRI Abdomen – Required US prior to MRI for suspected biliary stone

Added Criteria for Carotid Dissection to CTA and MRA of the carotid and MRI of the brain 041610

70551 – Added references to several indications, also cleared up inconsistencies. 041610

72141 MRI C Spine – Improved consistency of criteria for osteomyelitis and epidural abscess

70450 CT Head – Added criterion for post surgery follow up. 042610

74150 CT Abdomen – Reformatted criteria for abdominal pain 050710

72131 CT Lumbar spine – Updated criteria for Erectile Dysfunction 051710

75574 Coronary Computed Tomographic Arteriography CCTA – Added criteria to CTA and CT Chest sections. 060110

73221 MRI Upper Extremity Joint – Added references 060210

78607 Brain SPECT – Added criteria and references for the diagnosis of dementia 061010

70450 CT Head – Revised criteria for Dementia 061010

78465 Myocardial perfusion Scan – Added criteria adapted from 2009 AHA guideline updates

General added several glossary entries, and corrected formatting errors, distributed updated criteria to Web site. 062810

Added reference to VIDEOS IN CLINICAL MEDICINE Schraeder, Teresa L., Terek, Richard M., Smith, C. Christopher Clinical Evaluation of the Knee
N Engl J Med 2010 363: e5 7/22/10

Vertigo – Added criteria and references to each entry for vertigo, and made them uniform. Also revised dizziness criteria to coincide with those for vertigo recognizing that these terms are used interchagably by many clinicians, and the criteria for imaging are essentially identical. Changes made to CT, and CTA of the head, and MRI and MRA of the brain. 7/22/10

Pulmonary Embolus Suspected Reviewed criteria, added indication and risk factors, updated references. CT, CTA and MRA of the Chest 7/23/2010

CTA of COronary Arteries 75574 – Updated criteria and references. 7/29/2010

Breast Cancer, updated PET criteria and routine surveillance recommendations to conform with latest NCCN Guidelines. 8/11/10

Oncology Guidelines. Updated follow up imaging recommendations for head and neck tumors in 9/10/10

MRI of Brain Deleted superseded Dizziness criteria set from . 9/10/10

CT Abdomen Added reference 10/11/10

PET Lung Added references 10/18/10

CT Chest Reworked Nodules sections to clarify indications for multiple nodules, and added references 10/18/10

MUGA scans, added criteria set with references 10/29/10

MR Chest Added criteria and references for trauma to Brachial Plexus Pathology 11/4/10

MR Upper extremity Joint updated criteria and references for trauma to Brachial Plexus Pathology 11/4/10

PET Body Added size criteria for solitary pulmonary nodules

Myocardial Perfusion Imaging SPECT updated CPT code information. 11/16/10

CT Head Updated references for seizures and several other indications 11/6/10

CT Lower Extremity added criteria for CT Arthrography of knee and ankle, with references. 11/30/10

CT Colonography (Virtual Colonoscopy) 74261 74262 74263 Updated CPT codes, and criteria 11/30/10

MRI Breast reorganized criteria for clarity and added references 12/02/10

PET of the Body added criteria for cancers not specifically addressed. 12/13/10

CT of Abdomen and Pelvis Added criteria sets 12/16/10

Oncology Guideline Testicular Cancer Corrected the omission of guidelines for follow up of nonseminima testicular cancers 12/28/10

CT Lower Extremity Added criteria for Necrotizing Fasciitis 1/12/11

CT Upper Extremity Added criteria for Necrotizing Fasciitis 1/12/11

MRI Brain Added criteria for Trigeminal Neuralgia 1/21/11

MRI Lower Extremity other than Joint Added criteria for Necrotizing Fasciitis 1/12/11

MRI Upper Extremity Joint Added criteria for carpal Tunnel Syndrome 1/23/11

MRI Upper Extremity other than Joint Added criteria for Necrotizing Fasciitis 1/12/11

MRI Breast Updated references 2/14/11

MRI Lumbar Spine corrected omission of criteria for bilateral radiculopathy, now consistent with unilateral 2/25/11

MRS (Magnetic Resonance Spectroscopy) 76390 added instructions regarding being a non covered service for most plans 3/10/11

PET Brain for Metabolism 78608 Added to criteria for dementia to be consistent with CMS

PET Heart 78491 78492 Reviewed and clarified criteria and reference 3/17/11

CT Abdomen Added Elevated Bilirubin as a criterion 4/20/2012

CT C Spine Revised criteria for myelopathy and radiculopathy for clarity 4/20/2012

CT Pelvis Added note to Criteria for obstructive uropathy that CT abdomen and pelvis is preferred, 4/15/11

CTA Pelvis Added symptoms and findings as criteria for PAD 4/12/2012

CT Chest added clarification of criteria for hoarseness 5/11/11

CT Neck added clarification of criteria for hoarseness 5/11/11

CT Thoracic Spine removed “discography” as a sufficient indication 5/12/11

MRI Face Orbit or Neck Added criteria for salivary gland stones and facial pain 5/23/11

MRI Lower Extremity Joint Added criteria for MR arthrography of hip, knee and ankle. 5/13/11

QCT Added brief criteria set 5/26/2012

1.CT Head Added Criterion to Working Diagnosis section on Aneurysm Suspected 6/23/2012

2.CTA Aorta and Runoff Added criteria set 6/8/2012

3.CTA Head Updated criteria and references for Aneurysm Suspected 6/23/2012

4.CTA Lower Extremity Added criteria to Prior Medical History category 6/22/2012

5.CTA Upper Extremity Added criteria to Prior Medical History category 6/22/2012

6.MRA Head Updated criteria and references for Aneurysm Suspected 6/23/2012

7.MRA Lower Extremity Added criteria to Prior Medical History category 6/22/2012

8.MRA Upper Extremity Added criteria to Prior Medical History category 6/22/2012

11.MRI of the Lower Extremity Standardized criteria for tendon tear 6/1/2012

13.MRI of the Upper Extremity Joint Standardized criteria for tendon tear 6/1/2012

15.PET of the Heart Rewrote criteria to include search for “hibernating myocardium.” 6/8/2012

Appendices Removed Section on Mucoceles. 7/5/2012

Numerous typographic and formatting errors and inconsistencies were repaired no clinical criteria were materially changed.

CT Chest added Sarcoidosis to working diagnosis section. 10/18/2012

MRA Pelvis criteria expanded to be consistent with CTA Pelvis 10/7/11

Oncology guidelines Updated and expanded Gastric Cancer Guidelines 10/10/11

CT Head Added “Thunderlap” headache to criteria 11/18/2012

CTA Abdomen Added interval criteria for follow up of abdominal aneurysm repairs 11/18/2012

CTA Pelvis Added criteria to Significant Prior History section 11/29/2012

MRA Head Added “Thunderclap” headache to criteria 11/18/2012

MRA Pelvis Added criteria to Significant Prior History section 11/29/2012

CT Abdomen Removed “Renal Carcinoma” as separate entry from group 5, diagnosis is covered by “Cancer, Intra abdominal (any cell type)” 12/28/2012

CTA Abdomen and Pelvis Created criteria set for new CPT code. 12/28/2012

CTA Pelvis Clarified criteria for aneurysm and updated reference 12/21/2012

MRA Pelvis Clarified criteria for aneurysm and updated reference 12/21/2012

MRI Abdomen Added criteria for use of MRCP as a preoperative tool to exckude choledocholithiasis in cases of cholelithiasis 12/23/2012

Breast MRI Added several syndromes to indications for screening 2/13/2012

Oncology guideline for surveillance go kidney cancer updated 7/30/2012

Added criteria for Ischemic Bowel to Working diagnosis sections of CT Abdomen, CT Pelvis, and CT of Abdomen and Pelvis. Updated references 9/17/2012

72131 CT Lumbar Spine Corrected entry error substituting Sacral for Brachial 11/14/2012

74150 CT Abdomen Deleted redundant requirement for abdominal pain under suspected pancreatitis 11/20/2012