Updates to AIM Advanced Imaging of the Abdomen and Pelvis Clinical Appropriateness Guideline*

Effective for dates of service on and after February 9, 2020, the following updates by section will apply to the AIM Advanced Imaging of the Abdomen and Pelvis Clinical Appropriateness Guidelines.

 

• 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 ProviderPortal_SM 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 aim.guidelines@aimspecialtyhealth.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.