Home Updates Updates thru 2012 ↓ Download PDF

Updates thru 2012

2009

2 February 2009

  • 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.

3 March 2009

  • 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

4 April 2009

  • 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

5 May 2009

70450 – Added to Headache: “Exercise or exertion lead to headache”

  • Added criteria to “altered level of consciousness”

70551 – Added to Headache: “Exercise or exertion lead to headache”

  • Added criteria to “altered level of consciousness”
  • 72141 – clarified epidural abscess criteria
  • 72146 – clarified epidural abscess criteria
  • 72148 – clarified epidural abscess criteria

6 June 2009

  • 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

7 July 2009

  • 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

74150 –

  • Added criteria for Testicular Cancer
  • Added requirement for microscopic confirmation of hematuria

74181 –

  • Added criteria for Complex Renal Cysts
  • AAdded criteria for Testicular Cancer
  • Added kidney tumors as indication
  • Added requirement for microscopic confirmation of hematuria

78111 –

  • Added initial work up of thymic tumors as an indication
  • Revised criteia for Testicular malignancies

Oncology Routine Imaging Guidelines –

  • Added Kidney and Thymic malignancies
  • Minor revisions and new references for Testicular malignancies

8 August 2009

  • 73700 – added criteria for suspected nonunion of known feracture 8-6-09
  • Glossary – Added Romberg test 7/31

9 September 2009

  • 72192 – Added Criteria for Diverticulitis 090109

74150 – Added

  • Criteria for Diverticulitis 090109
  • Criteria for truma 092509

10 October 2009

  • 77058 – added references for implant screening 100509

11 November 2009

  • 70496 – Added references and criteria for screening for aneurysm

70498 –

  • Added vertebrobassilar insufficiency as an indication 110609
  • Deleted “cardiac irregularities” as too vague to be helpful as a risk factor for ICA.
  • Deleted “Risk Factors” as not useful in determining appropriateness.
  • Updated several references

71275 –

  • Added criteria and reference for Coarctation 111609
  • Clarified language and updated references 110609

72191 –

  • Added explanatory note to PAD 111709
  • Clarified PAD 111609
  • 73706 – Added notes for ABI 111609
  • 74175 – Clarified language and updated references 110509

12 December 2009

70450 –

  • Amnesia, added Suspect Stroke or TIA 121609
  • several criteria reworded, no substative changes 121609

70486

  • “Pain” removed as a free statnding indication as too vague. 121609
  • 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

2010

1 January

  • 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

2 February

  • 72131 – Simplified criteria for Loss of bladder or bowel control

3 March

  • 78491 – Clarified indications and added referrences 030810
  • 74181 – Added monitoring of Crohn’s 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.

4 April

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

All studies –

  • Updated and added references
  • Updated criteria for Suspected Osteomyelitis, throughout.
  • Updated criteria for Suspected Radiculopathy throghout.

73200 – CT Upper Extremity – Added references and updated criteria for

  • Compartment Syndrome
  • 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

Oncology Imaging

  • Added CT Neck and MUG to work up of Lymphoma
  • Updated Hepatocellualr Carcinoma

5 May

  • 74150 CT Abdomen – Reformatted criteria for abdominal pain 050710

72148 MRI L Spine –

  • Corrected Plexopathy from “Brachial” to Lumboscaral, and updated references. 050710
  • Updated criteria for Erectile Dysfunction 051710
  • 72131 CT Lumbar spine – Updated criteria for Erectile Dysfunction 051710

70540 MRI Orbit, Face, Neck – Updated several references

72195 MR Pelvis

  • Added indications and references for Fibroids 051810
  • Updated other references 051810

6 June

  • 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

7 July

  • 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

8 August

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

9 September

  • 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

10 October

  • 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

CTA Abdomen Updated criteria and references for

  • Abdominal Pain After Meals 10/20/10
  • Ischemic Bowel Suspected 10/20/10
  • Intetinal Angina 10/20/10
  • Carcinoma of Pancreas, added references 10/20/10
  • Claudication added references 10/20/10
  • Suspected Obstruction updated references added clinical requirements to support indication.

MRA Abdomen Updated criteria and references for

  • Abdominal Pain After Meals 10/20/10
  • Ischemic Bowel Suspected 10/20/10
  • Intetinal Angina 10/20/10
  • MUGA scans, added criteria set with references 10/29/10

11 November

CT Chest

  • Added criteria for Brachial Plexus Pathology (Plexopathy) 11/4/10
  • Added criteria and references for trauma to Brachial Plexus Pathology 11/4/10
  • Added reference for Aneurysm previously repaired 11/24/10
  • Added Criteria for Esophageal Rupture (Boerhaave’s Syndrome,) with refrences 11/23/10
  • Added criteria for Asthma with references 11/26/10
  • 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
CT Upper Extremity
  • Added criteria and references for trauma to Brachial Plexus Pathology 11/4/10
  • Added criteria and references for Arthrography of the shoulder 11/30/10
  • 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

12 December

  • 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
  • Added Leukocytosis as an indication 12/16/10
  • Added Metastasis suspected as an indication 12/16/10
  • 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

2011

1 January

  • 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

Oncology Imaging:

  • Anal Carcinoma Revised and updated section, added references 1/1/11
  • Bladder Cancer Revised and updated section, added references 1/1/11
  • Uterine Cancer Added surveillance guidelines 1/12/11

2 February

  • MRI Breast Updated references 2/14/11
  • MRI Lumbar Spine corrected omission of criteria for bilateral radiculopathy, now consistent with unilateral 2/25/11

3 March

CT Abdomen 74150 74160 74170

  • Added criteria for post surgical evaluation 3/8/11
  • Updated criteria for abscess, known and suspected. 3/8/11

CT Abdomen and Pelvis 74176 74177 74178

  • Clarified auto approvals for new combined exam 3/8/11
  • Updated criteria for abscess, known and suspected. 3/8/11

CT Heart 75574

  • Added criteria for asymptomatic abnormal stress test 3/25/11

CT Pelvis 72192 72193 72194

  • Added hydronephrosis on recent imaging to obstructive uropathy indications 3/8/11
  • Updated criteria for abscess, known and suspected. 3/8/11

MRA (Magnetic Resonance Angiogram) Carotid and Vertebral 70547

  • Added criteria for Tumor 3/10/11

MRA (Magnetic Resonance Angiogram) Head 70544

  • Added criteria for Tumor 3/10/11

MRI Breast

  • Clarified criterion for Invasive Lobular Carcinoma to initial staging, not as a routine follow up 3/29/11
  • Updated references 3/29/11
  • 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

4 April

  • 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 Chest

  • Added clinical criteria for Superior Vena Cava syndrome 4/25/2012
  • Added clinical criteria for Thymoma
  • Added criteria for Sarcoidosis 4/7/11
  • 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

MRI of the Breast

  • Added criterion 1.1.6 Two close relatives (mother or sibling) with breast or ovarian cancer 4/6/2012
  • Moved criteria for Search for Primary tumor to Other category 4/6/2012

5 May

  • 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

In General

  • Reformatted most criteria sets to improve ease of use. Completed 5/25/11
  • Standardized criteria for “Osteomyelitis Suspected,” and “osteomyelitis Known” through out all occurrences 5/24/11
  • 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

PET Body

  • Complete update of Thyroid Carcinoma criteria 5/16/11
  • QCT Added brief criteria set 5/26/2012

6 June

  • 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

9 .MRI Brain

  • Added Criterion to Working Diagnosis section on Aneurysm Suspected 6/23/2012
  • Corrected a typographic error regarding Prolactin level 6/22/2012

10 .MRI of the Lower Extremity non joint

  • Added criteria to complaint category 6/22/2012
  • Added criteria to prior imaging section 6/18/11
  • Standardized criteria for tendon tear 6/1/2012
  • 11.MRI of the Lower Extremity Standardized criteria for tendon tear 6/1/2012

12 .MRI of the Upper Extremity non joint

  • Added criteria to complaint category 6/22/2012
  • Added criteria to prior imaging section 6/18/11
  • Standardized criteria for tendon tear 6/1/2012
  • 13.MRI of the Upper Extremity Joint Standardized criteria for tendon tear 6/1/2012

14 .PET Body

  • Modified langiuage to permit PET when there is a strong clinical suspicion of malignancy but no tissue daignosis 6/3/2012
  • Updated references for many tumor types 6/3/2012
  • 15.PET of the Heart Rewrote criteria to include search for “hibernating myocardium.” 6/8/2012

7 July

  • Appendices Removed Section on Mucoceles. 7/5/2012

CT Abdomen

  • clarified that suspiciion of inguinal or femoral hernias are not indications for CT Abd 7/21/2012

CT Abdomen & Pelvis

  • Brought Breast indication into conformity with Oncology Guidelines. 7/27/2012

CT Neck

  • Added note concerning extent of neck CT exams into thorax 7/7/2012
  • Added requirement of laryngoscopy before CT of Neck for hoarseness 7/15/2012

CTA Brain

  • Added Stroke as criterion 7/7/2012
  • Deleted Alternating neurologic deficits as a crtiterion 7/5/2012

Updated criteria for Central Venous Thrombosis 7/5/2012

  • Changed title to Cerebral Venous Thrombosis and added a new reference
  • Deleted Alternating Neurologic Deficits as a criterion

CTA Upper Extremity

  • Added Pulsatile Mass to criteria for Suspected AVM 7/5/2012

MRA Brain

  • Deleted Alternating neurologic deficits as a crtiterion 7/5/2012
Updated criteria for Central Venous Thrombosis 7/5/2012
  • Changed title to Cerebral Venous Thrombosis and added a new reference
  • Deleted Alternating Neurologic Deficits as a criterion
MRI Brain
  • Added requirement that certain tests be performed prior to approval for Dementia 7/5/2012
  • Deleted Alternating neurologic deficits as a crtiterion 7/5/2012
Updated criteria for Central Venous Thrombosis 7/5/2012
  • Changed title to Cerebral Venous Thrombosis and added a new reference
  • Deleted Alternating Neurologic Deficits as a criterion
MRI of the Heart
  • Added Criteria for Congestive Heart Failure 7/7/2012
  • Added note to “Aortic DIssection Suspected” that CTA or MRA were preferred, and a reference. 7/7/2012
  • Changed Title of criterion from “Myocardial viability Assessment ” to “Myocardial Viability Assessment for Planned Revascularization” and added sub criterion and references 7/7/2012
  • Removed redundant Aortic Dissection Criterion. 7/7/2012
Oncology Guidelines
  • Acute Myelogenous Leukemia Revised and updated 7/8/2012
  • Anal Carcinoma Revised and updated 7/8/2012
  • Bladder Carcinoma Revised and updated 7/8/2012
  • Bone Cancer added Criteria set 7/18/2012
  • Breast Cancer revised and updated criteria 7/22/2012
  • Central Nervous System Cancers Updated and added criteria and references 7/18/2012
  • Colon Cancer reviewed and updated 7/22/2012
  • Esophageal Cancer reviewed and updated 7/22/2012
  • Rectal Cancer reviewed and updated 7/22/2012
  • Stomach Cancer updated 7/22/2012
  • Upper GU Tract Carcinoma added Criteria set 7/8/2012
  • Urothelial Carcinoma of the Prostate added Criteria set 7/8/2012
PET Body
  • Brought Breast indication into conformity with Oncology Guidelines. 7/22/2012

8 August

CT Abdomen

  • Added criteria for liver nodule found on other imaging 8/2/2012

Oncology Guidelines

  • Cholagiocarcinoma criteria added 8/2/2012
  • CML reviewed and updated 8/8/2012
  • Gall Bladder Cancer criteria added 8/2/2012
  • Head and Neck Cancers revised and updated 8/2/2012
  • Hepatocellular Cancer revised and updated 8/2/2012
  • Hodgkin / Lymphoma reference updated 8/8/2012
  • Kidney Cancer revised and updated 8/8/2012
  • Melanoma revised and updated 8/4/2012
  • Multiple Myeloma and Plasmacytomas updated 8/8/2012
  • Non-small Cell Lung Cancer NSCLC revised and updated 8/8/2012
  • Occult Primary Revised and updated 8/8/2012
  • Ovarian Cancer updated 8/8/2012
  • Pancreatic Adenocarcinoma updated 8/8/2012
  • Prostate Cancer updated 8/8/2012
  • Small Cell Lung Cancer SCLC added new criteria updated references 8/8/2012
  • Soft Tissue Sarcoma reformatted criteria added reference 8/8/2012
  • Testicular Cancer reviewed and updated 8/8/2012
  • Thymic Cancer reviewed and updated 8/8/2012

9 September

MRI Brain

  • Added criteria for Tremor and Parkinson’s Disease 9/21/2012
  • Numerous typographic and formatting errors and inconsistencies were repaired no clinical criteria were materially changed.

10 October

  • 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

11 November

CT Chest

  • Added “with no prior cancer diagnosis” to clarify criteria for examination and follow up of nodules 11/22/2012
  • Added criteria for pneumonia to working diagnosis and prior medical sections 11/21/2012
  • Added Sputum cytology positive to section on abnormal lab results 11/21/2012
  • 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
MRI Brain
  • Added “Thunderclap” headache to criteria 11/18/2012
  • Updated criteria for Optic neuritis, and added it to Working Diagnosis section 11/25/2012
MRI Orbit
  • Updated criteria for Optic neuritis, 11/25/2012
Oncology Guideline Bladder Cancer:
  • Clarified meaning of bladder wall invasion to include stages T2 and above 11/15/2012
  • Updated Initial work up to include CT abdomen of bladder wall is invaded 11/23/2012

12 December

  • 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

2012

1 January

Oncology Guidelines

  • added Carcinoid tumors 1/3/2012
  • added surveillance criteria for Hodkins 1/16/2012

2 February

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

MRI Upper Extremity Joint

  • added requirements to indication “Arthritis” in the Prior History section 2/13/2012
  • Added requirement for negative X-rays under post trauma 2/16/2012
  • Changed requirement to a single prior nondiagnostc x-ray under pain 2/16/2012

MRA and CTA of Brain or Head

  • Added “Family history of polycystic kidney disease” to indications for screening 2/21/2012
  • Altered intervals allowable for screening exams to one year or more without physician review. 2/21/2012

CT Abdomen

Rewrote Hematuria guidelines as follows 2/22/2012

Hematuria confirmed microscopically (dip stick alone not sufficient)
  • Confirmed microscopically (required only when hematuria is detected by dip stick test alone)
  • Urine is grossly (visibly) bloody
  • Ramesh Mazhari and Paul L Kimmel Hematuria: an algorithmic approach to finding the cause. Cleveland Clinic Journal of Medicine 2002; 69(11):870;
  • American College of Radiology ACR Apprpriateness Criteria Hematuria 2005 page 4 accessed 2/11/09
CT Abdomen and Pelvis

####### Rewrote Hematuria guidelines as follows 2/22/2012 ######## Hematuria confirmed microscopically (dip stick alone not sufficient)

  • Confirmed microscopically (required only when hematuria is detected by dip stick test alone)
  • Urine is grossly (visibly) bloody
  • Ramesh Mazhari and Paul L Kimmel Hematuria: an algorithmic approach to finding the cause. Cleveland Clinic Journal of Medicine 2002; 69(11):870;
  • American College of Radiology ACR Apprpriateness Criteria Hematuria 2005 page 4 accessed 2/11/09

######### MRI Abdomen ########## Rewrote Hematuria guidelines as follows 2/22/2012 ########### Hematuria confirmed microscopically (dip stick alone not sufficient) Note: CT is preferred. MRI may be approved for children, pregnant women, those unable to tolerate iodinated contrast material, and those who have already been examined for this reason with MRI.

  • Confirmed microscopically (required only when hematuria is detected by dip stick test alone)
  • Urine is grossly (visibly) bloody
  • Ramesh Mazhari and Paul L Kimmel Hematuria: an algorithmic approach to finding the cause. Cleveland Clinic Journal of Medicine 2002; 69(11):870;
  • American College of Radiology ACR Apprpriateness Criteria Hematuria 2005 page 4 accessed 2/11/09

3 March

CTA Head

  • Reviewed and updated Tinnitus criteria 3/29/2012

CT Head

  • Applied dementia criteria to rule out Alzheimers 3/8/2012
  • Reviewed and updated Tinnitus criteria 3/29/2012

MRA Head

  • Reviewed and updated Tinnitus criteria 3/29/2012

MRI Head

  • Reviewed and updated Tinnitus criteria 3/29/2012

4 April

CT Orbit, Sella, Posterior Fossa, Ear

  • Added criteria under Abnormal Prior Imaging category. 4/3/2012

MRI Upper Extremity (other than joint)

  • Added Red Flags warnings as “Important Note”

5 May

CT Abdomen

  • Added criteria to Pain, Suspected Perforated Bowel. Added Tenderness, Rebound, Fever, and Air Seen on imaging. 5/2/2012
  • Deleted Pregnancy as an indication under epigastric pain 5/3/2012
  • Deleted Liver abscess under RUQ pain as redundant 5/3/2012
  • Deleted Pneumomia as an indication 5/3/2012
  • Deleted Lactase Deficiency as an indication under Pain 5/18/2012
  • Deleted Appendicitis as an indication for CT of the Abdomen unless there is a specific reason for not also ordering CT of the Pelvis 5/18/2012

Added following to criteria for known metastatic disease 5/18/2012

  • Interval Follow Up, no new symptoms, no recent similar exam in past year.
  • Worsening condition
  • Revised criteria for new and known evaluation of aortic dilatation 5/18/2012
  • Deleted “Prior screening exam for AAA … as inconsistent with Widening of the abdominal aorta criteria 5/18/2012

CT Chest

  • Made all references to Pulmonary Embolism Suspected uniform, no new criteria added 5/21/2012

6 June

MRA and CTA of the Chest

  • Clarified and made uniform several sets of criteria without substantial changes in requirements 6/4/2012
  • Added requirement for pain or a one year follow up for Known Aneurysm 6/4/2012

MRI Abdomen

  • Removed requirement for barium studies before MR for suspected Crohn’s Disease 6/15/212

7 July

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

9 September

  • 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

10 October

Added criteria entries for

  • 78466 Infarct avid Imaging 10/22/202
  • 78453 78454 Planar Myocardial Perfusion imaging 10/22/202
  • 75565 Cardiac Velocity Flow Mapping 10/22/202

11 November

CT Chest

  • Minor wording changes for clarification purposes
  • Added post neoadjuvant therapy for surgical planning purposes to indications 11/13/2012
  • 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

References

  • Ramesh Mazhari and Paul L Kimmel Hematuria: an algorithmic approach to finding the cause. Cleveland Clinic Journal of Medicine 2002; 69(11):870;
  • Ramesh Mazhari and Paul L Kimmel Hematuria: an algorithmic approach to finding the cause. Cleveland Clinic Journal of Medicine 2002; 69(11):870;
  • Ramesh Mazhari and Paul L Kimmel Hematuria: an algorithmic approach to finding the cause. Cleveland Clinic Journal of Medicine 2002; 69(11):870;