Nevada
Provider Communications
Updates to the AIM Advanced Imaging Clinical Appropriateness Guidelines
Advanced imaging of the spine (updates by section)
- Congenital vertebral defects
- New requirement for additional evaluation with radiographs
- Scoliosis
- Defined criteria for which presurgical planning is indicated
- Requirement for radiographs and new or progressive symptoms for postsurgical imaging
- Spinal dysraphism and tethered cord
- Diagnostic imaging strategy limiting the use of CT to cases where MRI cannot be performed
- New requirement for ultrasonography prior to advanced imaging for tethered cord in infants age five months or less
- Multiple sclerosis
- New criteria for imaging in initial diagnosis of multiple sclerosis
- Spinal infection
- New criteria for diagnosis and management aligned with Infectious Diseases Society of America and University of Michigan guidelines
- Axial spondyloarthropathy
- Defined inflammatory back pain
- Diagnostic testing strategy outlining radiography requirements
- Cervical injury
- Aligned with the American College of Radiology (ACR) position on pediatric cervical trauma
- Thoracic or lumbar injury
- Diagnostic testing strategy emphasizing radiography and limiting the use of MRI for known fracture
- Removed indication for follow-up imaging of progressively worsening pain in the absence of fracture or neurologic deficits
- Syringomyelia
- Removed indication for surveillance imaging
- Non-specific low back pain
- Aligned pediatric guidelines with ACR pediatric low back pain guidelines
Advanced imaging of the extremities (updates by section)
- Osteomyelitis or septic arthritis; myositis
- Removed CT as a follow-up to nondiagnostic MRI due to lower diagnostic accuracy of CT
- Epicondylitis and tenosynovitis — long head of biceps
- Removed due to lack of evidence supporting imaging for this diagnosis
- Plantar fasciitis and fibromatosis
- Removed CT as a follow-up to nondiagnostic MRI due to lower diagnostic accuracy of CT
- Added specific conservative management requirements
- Brachial plexus mass
- Added specific requirement for suspicious findings on clinical exam or prior imaging
- Morton’s neuroma
- Added requirements for focused steroid injection, orthoses, plan for surgery
- Adhesive capsulitis
- Added requirement for planned intervention (manipulation under anesthesia or lysis of adhesions)
- Rotator cuff tear; labral tear shoulder; labral tear hip
- Defined specific exam findings and duration of conservative management
- Recurrent labral tear now requires same criteria as an initial tear (shoulder only)
- Triangular fibrocartilage complex tear
- Added requirement for radiographs and conservative management for chronic tear
- Ligament tear — knee; meniscal tear
- Added requirement for radiographs for specific scenarios
- Increased duration of conservative management for chronic meniscal tears
- Ligament and tendon injuries — foot and ankle
- Defined required duration of conservative management
- Chronic anterior knee pain, including chondromalacia patella and patellofemoral pain syndrome
- Lengthened duration of conservative management and specified requirement for chronic anterior knee pain
- Intra-articular loose body
- Requirement for mechanical symptoms
- Osteochondral lesion (including osteochondritis dissecans, transient dislocation of patella)
- New requirement for radiographs
- Entrapment neuropathy
- Exclude carpal and cubital tunnel
- Persistent lower extremity pain
- Defined duration of conservative management (6 weeks)
- Exclude hip joint (addressed in other indications)
- Upper extremity pain
- Exclude shoulder joint (addressed in other indications)
- Diagnostic testing strategy limiting use of CT to when MRI cannot be performed or is nondiagnostic
- Knee arthroplasty, presurgical planning
- Limited to MAKO and robotic assist arthroplasty cases
- Perioperative imaging, not otherwise specified
- Require radiographs or ultrasound prior to advanced imaging
Vascular imaging (updates by section)
- Alternative nonvascular modality imaging approaches, where applicable
- Hemorrhage, intracranial
- Clinical scenario specification of subarachnoid hemorrhage indication.
- Addition of Pediatric intracerebral hemorrhage indication.
- Horner’s syndrome; pulsatile tinnitus; trigeminal neuralgia
- Removal of management scenario to limit continued vascular evaluation
- Stroke/transient ischemic attack; stenosis or occlusion (intracranial/extracranial)
- Acute and subacute timeframe specifications; removal of carotid/cardiac workup requirement for intracranial vascular evaluation; addition of management specifications
- Sections separated anatomically into anterior/posterior circulation (carotid artery and vertebral or basilar arteries, respectively)
- Pulmonary embolism
- Addition of nondiagnostic chest radiograph requirement for all indications
- Addition of pregnancy-adjusted YEARS algorithm
- Peripheral arterial disease (PAD)
- Addition of new post-revascularization scenario to both upper and lower extremity PAD evaluation
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* Portal at availity.com. From Availity’s home page, select Patient Registration > Authorizations & Referrals. The AIM Specialty Health link is located below Additional Authorizations and Referrals.
- Call the AIM Contact Center toll-free number at 1-800-714-0040 Monday - Friday from 7 a.m. and 7 p.m. Eastern time.
Questions
If you have 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.
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May 2021 Anthem Provider News - Nevada