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2013 Updates

A new format is introduced to track changes. Changes will be grouped by examination, with each changes dated rather than by month the change was made. Additions to the indications will be indicated as such, changes in language will be italicized and deletions will be included as boldfaced.

  • A new format is introduced to track changes. Changes will be grouped by examination, with each changes dated rather than by month the change was made. Additions to the indications will be indicated as such, changes in language will be italicized and deletions will be included as boldfaced.

CTA Abdomen 74175

Section 1: Major Symptom or Complaint Added language in italics to each subsection

Abdominal pain after meals (Consider CTA of Abdomen And Pelvis CPT 74174)

Acute Mesenteric Ischemia suspected, History of:
  • Cardiac dysfunction
  • Vascular disease
  • Recent vascular surgery or intervention (including catheter arteriography)
  • Advanced age (>60)
Abdomnal angina suspected
  • Pain occurs 15 to 60 minutes after eating, lasting for several hours
  • May be associated with constipation, flatulence, diarrhea with or without some blood admixture, nausea and vomiting
  • Elliot K. Fishman; From the RSNA Refresher Courses: CT Angiography: Clinical Applications in the Abdomen; RadioGraphics 2001 21: 3S-16S.
  • Odenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004; 164:1054 -1062
  • Park WM, Gloviczki P, Cherry KJ, Hallett JW, Bower TC, Panneton JM, Schleck C, Ilstrup D, Harmsen WS, Noel AA (2002).Contemporary management of acute mesenteric ischemia: Factors associated with survival. J. Vasc. Surg. 35 (3): 445-52.
  • Harkin Denis W, Lindsay Thomas F, “Chapter 86. Mesenteric Ischemia” (Chapter). Hall JB, Schmidt GA, Wood LDH: Principles of Critical Care, 3e: http://www.accessmedicine.com/content.aspx?aID=2296692. accessed 10/20/10
  • Filippo Cademartiri, Rolf H. J. M. Raaijmakers, Jan W. Kuiper, Lukas C. van Dijk, Peter M. T. Pattynama, and Gabriel P. Krestin Multi–Detector Row CT Angiography in Patients with Abdominal Angina Radiographics July 2004 24:969-984; doi:10.1148/rg.244035166
  • Shih, Ming-Chen Paul, Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 1, Role in Diagnosis and Differential Diagnosis Am. J. Roentgenol. 2007 188: 452-46
  • Shih, Ming-Chen Paul, Angle, John F., Leung, Daniel A., Cherry, Kenneth J., Harthun, Nancy L., Matsumoto, Alan H., Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 2, Normal Findings and Complications After Surgical and Endovascular Treatment Am. J. Roentgenol. 2007 188: 462-471
Claudication (Consider CTA of Abdominal Aorta and Runoff CPT 75635)
  • Pain, crampy in nature during or after exercise, relieved by rest
  • Shih, Ming-Chen Paul, Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 1, Role in Diagnosis and Differential Diagnosis Am. J. Roentgenol. 2007 188: 452-46
  • Shih, Ming-Chen Paul, Angle, John F., Leung, Daniel A., Cherry, Kenneth J., Harthun, Nancy L., Matsumoto, Alan H., Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 2, Normal Findings and Complications After Surgical and Endovascular Treatment Am. J. Roentgenol. 2007 188: 462-471
  • Erectile dysfunction (Consider CTA of Abdomen And Pelvis CPT 74174)
Intestinal Angina (Consider CTA of Abdomen And Pelvis CPT 74174) 01/08/2013
  • Pain, crampy in nature during or after exercise, relieved by rest
  • May be associated with constipation, flatulence, diarrhea with or without some blood admixture, nausea and vomiting
  • Elliot K. Fishman; From the RSNA Refresher Courses: CT Angiography: Clinical Applications in the Abdomen; RadioGraphics 2001 21: 3S-16S.
  • Odenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004; 164:1054 -1062
  • Park WM, Gloviczki P, Cherry KJ, Hallett JW, Bower TC, Panneton JM, Schleck C, Ilstrup D, Harmsen WS, Noel AA (2002).Contemporary management of acute mesenteric ischemia: Factors associated with survival. J. Vasc. Surg. 35 (3): 445-52.
  • Harkin Denis W, Lindsay Thomas F, “Chapter 86. Mesenteric Ischemia” (Chapter). Hall JB, Schmidt GA, Wood LDH: Principles of Critical Care, 3e: http://www.accessmedicine.com/content.aspx?aID=2296692. accessed 10/20/10
  • Filippo Cademartiri, Rolf H. J. M. Raaijmakers, Jan W. Kuiper, Lukas C. van Dijk, Peter M. T. Pattynama, and Gabriel P. Krestin Multi–Detector Row CT Angiography in Patients with Abdominal Angina Radiographics July 2004 24:969-984; doi:10.1148/rg.244035166
  • Shih, Ming-Chen Paul, Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 1, Role in Diagnosis and Differential Diagnosis Am. J. Roentgenol. 2007 188: 452-46
  • Shih, Ming-Chen Paul, Angle, John F., Leung, Daniel A., Cherry, Kenneth J., Harthun, Nancy L., Matsumoto, Alan H., Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 2, Normal Findings and Complications After Surgical and Endovascular Treatment Am. J. Roentgenol. 2007 188: 462-471

####### Section 2: Working Diagnosis or Rule Out ######## Added language in italics to each subsection 01/08/2013

  • Aortic Aneurysm Suspected (Consider CTA of Abdomen And Pelvis CPT 74174)
  • Dissection of the aorta, suspected (Consider CTA of Abdomen And Pelvis CPT 74174)
  • Ischemic bowel suspected (Consider CTA of Abdomen And Pelvis CPT 74174)

######### Added indication

  • Thrombosis (clot) suspected in Vena Cava, or other abdominal veins 01/08/2013

######### Section 3: Abnormal Physical Exam Finding

  • Peripheral Vascular Disease (Consider CTA of Abdominal Aorta and Runoff CPT 75635)01/08/2013

######### Section 4: Abnormal Lab or Imaging ########## Added new language and sub criteria to ########### Abnormal aorta or other vessel on prior imaging

  • Interval follow up at greater than 1 year
  • New or worsening symptoms 01/08/2013

########### Section 5: Significant Prior Medical History ############ Added clarification to four renal and hepatic transplant criteria:

  • Preoperative (For either donor or recipient) and interval follow up (of recipient.) 01/08/2013

############ Added ############# Vascular Disease (known from prior imaging or testing)

  • Prior to surgical or other intervention
  • New or worsening symptoms 01/08/2013
  • Breast Reconstruction Planning (DIEP Flap) if Doppler US is inadequate 1/10/2013
  • Interval Follow up of surgical repair of vascular lesion(s) at 6-month intervals. 1/10/2013

############# CTA Abdomen and Pelvis 74174 ############## Section 1: Major Symptom or Complaint Added language in italics to each subsection

  • Added Criteria for Intestinal Angina and Pain after Meals 1/10/2013

############## Section 2: Working Diagnosis or Rule Out

  • Added ((Consider CTA of Abdominal Aorta with Runoff 76135)) to criteria for peripheral Arterial Dis. 1/10/2013
  • Added Renovascular Hypertension (Consider CTA of Abdomen 74175) 1/10/2013

############## Section 3: Abnormal Physical Exam Finding ############### Added

  • ABI 0.9 (Consider CTA of Abdominal Aorta with Runoff 76135)
  • Asymmetric Blood Pressure in Legs (Consider CTA of Abdominal Aorta with Runoff 76135)
  • Asymmetric Pulses in Legs (Consider CTA of Abdominal Aorta with Runoff 76135)
  • Bruit in Leg (Consider CTA of Abdominal Aorta with Runoff 76135)
  • Diminished femoral pulses (Consider CTA of Abdominal Aorta with Runoff 76135)
  • Palpable Arterial Thrill in Legs (Consider CTA of Abdominal Aorta with Runoff 76135)

############### Section 4: Abnormal Lab or Imaging ################ Added new language and sub criteria to ################# Abnormal aorta or other vessel on prior imaging

  • Interval follow up at greater than 1 year
  • New or worsening symptoms 01/10/2013

################# Section 5: Significant Prior Medical History

  • Interval Follow up of surgical repair of vascular lesion(s) at 6-month intervals. 1/10/2013

################# CTA Abdominal Aorta and Bilateral Iliofemoral Runoff 75635 ################## Section 1: Major Symptom or Complaint Added language in italics to each subsection

  • Revised criteria for Suspected Peripheral Arterial Disease to be consistent throughout 1/18/2013

################### Revised criteria for Leriche Sundrome to require that the three elements are present 1/18/2013

  • Removed criterion of “Peripheral Arterial Disease suspected” as it is not necessary 1/18/2013
  • Added criterion to Localized Skin Discoloration “Suspected AVM” 1/23/2013
  • Section 2: Working Diagnosis or Rule Out
  • Section 3: Abnormal Physical Exam Finding
  • Section 4: Abnormal Lab or Imaging
  • Section 5: Significant Prior Medical History

################### CTA Brain 70496 #################### Section 1: Major Symptom or Complaint Added language in italics to each subsection

  • Cognitive Changes, Memory loss, and Mental Status Changes revised criteria and updated references 2/21/2013
  • Dizziness revised by adding: Prior MRI or CT nondiagnostic 2/19/2013

##################### Headache

  • Changed Pattern: added for clarity: (Chronic headache with new features) 2/20//2013
  • Pregnancy, new onset during Added 2/20/2013
  • Vertigo revised by adding: Prior MRI or CT nondiagnostic 2/19/2013

##################### Section 2: Working Diagnosis or Rule Out ###################### Vertebrobasilar Insufficiency: updated references 2/20/2013

  • Added italicized words: Weakness involving structures on one or both sides of the body 2/20/2013

###################### Cerebral Venous Thrombosis

  • Changed indication for Sinusitis etc to Infections: Sinusitis, middle ear or systemic 2/21/2013
  • Added an indication for Weakness 2/21/2013
  • Added new risk factor: Pregancy MRA PREFERRED
  • Added a reference: (Stam) 2/21/2013
  • Section 3: Abnormal Physical Exam Finding

####################### Section 4: Abnormal Lab or Imaging

  • Added: Evidence of Carotid Stenosis on prior imaging 2/21/2013
  • Added: Stroke or Cerebral Infarction 2/21/2013
  • Section 5: Significant Prior Medical History
  • CT Chest 71250 Added criteria for low dose screening of smokers 10/28/2013

####################### CT Spine, all levels ######################## Added as an indication for CT Imaging to Significant Prior Medical History presented as primary indication

  • “Prior to Surgical Intervention, as a road map for the surgeon” 9/4/13

######################## MRA (Magnetic Resonance Angiogram) Head 70544 70545 70546

  • Consolidated criteria to match CTA brain 2/21/2013

######################## MRI Abdomen 74181 74182 74183 ######################### Section 4: Abnormal Lab or Imaging added:

  • Dilated Biliary tree (bile ducts) on prior imaging (MRCP requested) 9/30/13

######################### Oncology Guideline: Kidney Cancer

  • Updated Surveillance imaging to allow imaging at 6 month intervals for 2 years, and then annually. 1/29/2013

######################### Oncology Guidelines: Prostate Cancer

  • Updated post therapy section to include recurrence after radiation therapy 5/7/2013

######################### MRI Cervical Spine 72141 72142 72156

  • Added a criterion for Multiple Sclerisis (suspected) to Working Diagnosis section to allow for use to meet McDonald diagnostic criteria for Multiple Sclerosis 12/17/13
  • Added reference to Multiple Sclerosis in the Prior Medical History section 12/17/13

References

  • Elliot K. Fishman; From the RSNA Refresher Courses: CT Angiography: Clinical Applications in the Abdomen; RadioGraphics 2001 21: 3S-16S.
  • Odenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004; 164:1054 -1062
  • Park WM, Gloviczki P, Cherry KJ, Hallett JW, Bower TC, Panneton JM, Schleck C, Ilstrup D, Harmsen WS, Noel AA (2002).Contemporary management of acute mesenteric ischemia: Factors associated with survival. J. Vasc. Surg. 35 (3): 445-52.
  • Harkin Denis W, Lindsay Thomas F, “Chapter 86. Mesenteric Ischemia” (Chapter). Hall JB, Schmidt GA, Wood LDH: Principles of Critical Care, 3e: http://www.accessmedicine.com/content.aspx?aID=2296692. accessed 10/20/10
  • Filippo Cademartiri, Rolf H. J. M. Raaijmakers, Jan W. Kuiper, Lukas C. van Dijk, Peter M. T. Pattynama, and Gabriel P. Krestin Multi–Detector Row CT Angiography in Patients with Abdominal Angina Radiographics July 2004 24:969-984; doi:10.1148/rg.244035166
  • Shih, Ming-Chen Paul, Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 1, Role in Diagnosis and Differential Diagnosis Am. J. Roentgenol. 2007 188: 452-46
  • Shih, Ming-Chen Paul, Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 1, Role in Diagnosis and Differential Diagnosis Am. J. Roentgenol. 2007 188: 452-46
  • Elliot K. Fishman; From the RSNA Refresher Courses: CT Angiography: Clinical Applications in the Abdomen; RadioGraphics 2001 21: 3S-16S.
  • Odenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med 2004; 164:1054 -1062
  • Park WM, Gloviczki P, Cherry KJ, Hallett JW, Bower TC, Panneton JM, Schleck C, Ilstrup D, Harmsen WS, Noel AA (2002).Contemporary management of acute mesenteric ischemia: Factors associated with survival. J. Vasc. Surg. 35 (3): 445-52.
  • Harkin Denis W, Lindsay Thomas F, “Chapter 86. Mesenteric Ischemia” (Chapter). Hall JB, Schmidt GA, Wood LDH: Principles of Critical Care, 3e: http://www.accessmedicine.com/content.aspx?aID=2296692. accessed 10/20/10
  • Filippo Cademartiri, Rolf H. J. M. Raaijmakers, Jan W. Kuiper, Lukas C. van Dijk, Peter M. T. Pattynama, and Gabriel P. Krestin Multi–Detector Row CT Angiography in Patients with Abdominal Angina Radiographics July 2004 24:969-984; doi:10.1148/rg.244035166
  • Shih, Ming-Chen Paul, Hagspiel, Klaus D. CTA and MRA in Mesenteric Ischemia: Part 1, Role in Diagnosis and Differential Diagnosis Am. J. Roentgenol. 2007 188: 452-46