Updates to AIM Advanced Imaging of the Abdomen and Pelvis Clinical Appropriateness Guideline*
- Foreign body (Pediatric only), Gastrointestinal bleeding, Henoch-Schonlein purpura, Hematoma or hemorrhage – intracranial or extracranial, Perianal fistula/abscess (fistula in ano), Ascites, Biliary tract dilatation or obstruction , Cholecystitis, Choledocholithiasis, Focal liver lesion, Hepatomegaly, Jaundice, Azotemia, Adrenal mass, indeterminate, Hematuria, Renal mass, Urinary tract calculi, Adrenal hemorrhage, Adrenal mass, Lymphadenopathy, Splenic hematoma, Undescended testicle (cryptorchidism)
- Abdominal and/or pelvic pain
- Combined pelvic pain with abdominal pain criteria in new “abdominal and/or pelvic pain” indication
- Required ultrasound or colonoscopy for select adult patients based on clinical scenario
- Ultrasound-first approach for pediatric abdominal and pelvic pain
- Lower extremity edema
- Added requirement to exclude DVT prior to abdominopelvic imaging
- Splenic mass, benign, Splenic mass, indeterminate, Splenomegaly
- Added new indications for diagnosis, management, and surveillance of splenic incidentalomas following the ACR White Paper (previously reviewed against “tumor, not otherwise specified”)
- Pancreatic mass
- Separated criteria for solid and cystic pancreatic masses
- Defined follow up intervals for cystic pancreatic masses
- Diffuse liver disease
- Added criteria for MR elastography
- Inflammatory bowel disease
- Limited requirement for upper endoscopy to patients with relevant symptoms
- New requirement for fecal calprotectin or CRP to differentiate IBS from IBD
- Enteritis or colitis, not otherwise specified
- Incorporated Intussusception (pediatric only), and Ischemic bowel
- Prostate cancer
- Moved this indication to Oncologic Imaging Guideline
- CPT codes
- Added MR elastography CPT code 76391
As a reminder, ordering and servicing providers may submit prior authorization requests to AIM in one of several ways:
- Access AIM’s ProviderPortalSM directly at providerportal.com. Online access is available 24/7 to process orders in real-time, and is the fastest and most convenient way to request authorization.
- Access AIM via the Availity Web Portal at Availity.com
- Call the AIM Contact Center toll-free number 800-554-0580, Monday – Friday, 8:30 a.m. – 7:00 p.m. ET.
For questions related to guidelines, please contact AIM via email at email@example.com. Additionally, you may access and download a copy of the current and upcoming guidelines here.
* Notice of Material Changes/Amendments to Contract and Changes to Prior Authorization Requirements may apply for new or updated reimbursement policies, medical policies, or prior authorization requirements.
November 2019 Anthem Provider News - Missouri