CT Upper Extremity - CAM 725HB

GENERAL INFORMATION

  • It is an expectation that all patients receive care/services from a licensed clinician. All appropriate supporting documentation, including recent pertinent office visit notes, laboratory data, and results of any special testing must be provided. If applicable: All prior relevant imaging results and the reason that alternative imaging cannot be performed must be included in the documentation submitted. 
  • Where a specific clinical indication is not directly addressed in this guideline, medical necessity determination will be made based on widely accepted standard of care criteria. These criteria are supported by evidence-based or peer-reviewed sources such as medical literature, societal guidelines and state/national recommendations.

Policy
INDICATIONS FOR UPPER EXTREMITY CT (HAND, WRIST, ARM, ELBOW, OR SHOULDER) (Plain radiographs must precede CT evaluation)

Some indications are for MRI, CT, or MR or CT arthrogram. More than one should not be approved at the same time.

If a CT arthrogram fits approvable criteria below, approve as CT.

Joint or muscle pain without positive findings on an orthopedic exam as listed above, after X-ray completed1,2 (does not apply to young children). If MRI contraindicated or cannot be performed or requested as a CT arthrogram.

  • Persistent joint or musculotendinous pain unresponsive to conservative treatment*, within the last 6 months which includes active medical therapy (physical therapy, chiropractic treatments, and/or physician-supervised exercise**), of at least four (4) weeks, OR
  • With progression or worsening of symptoms during the course of conservative treatment

Joint-specific provocative orthopedic examination and MRI is contraindicated or cannot be performed or requested as a CT arthrogram.

Note: With a positive orthopedic sign, an initial X-ray is always preferred. However, it is not required to approve advanced imaging. Any test that suggests joint instability requires further imaging (list is not all inconclusive).

Shoulder3,4,5,6

  • Rotator cuff weakness on exam
  • Subscapularis tendon tear
    • Belly press off test
    • Napoleon test
    • Bear Hug test
    • Internal rotation lag
    • Lift-off test
  • Supraspinatus tendon tear
    • Drop arm
    • Full can test
    • Empty can (aka Jobe or Supraspinatus test)
    • Hawkins or Neer test7 (only when ordered by an orthopedic surgeon if there is clear documentation in the records that an actual rotator cuff tear is suspected, and NOT just for the evaluation of impingement)
  • Infraspinatus/Teres Minor/Biceps tendon tear
    • External rotation lag sign at 0 and 90 degrees
    • Pain or weakness with resisted external rotation testing
    • Hornblower test
    • Popeye sign (if acute finding or for evaluation of surgical correction)
  • Labral tear/instability
    • Grind test
    • Clunk test
    • Crank test, compression-rotation test
    • O’Brien’s test
    • Anterior load and shift
    • Apprehension test
    • Posterior load and shift test
    • Jerk test
    • Sulcus sign

Elbow8,9

  • Biceps tendon
    • Bicipital aponeurosis (BA) flex test
    • Biceps squeeze test
    • Hook test
    • Passive forearm pronation test
    • Reverse Popeye sign (if acute finding or for evaluation of surgical correction)
  • Instability
  • Posterolateral rotatory drawer test
  • Tabletop relocation test
    • Valgus stress
    • Varus stress
    • Milking maneuver
    • Push-up test

Wrist10,11

  • Lunotriquetral ligament
    • Derby Relocation test
    • Reagan test (lunotriquetral ballottement test)
  • TFCC tear
    • Press test
    • Ulnar foveal sign/test
    • Ulnocarpal stress test
  • Scaphoid ligament 
    • Watson test (scaphoid shift test)
    • Scapholunate ballottement test

Tendon or Muscle Rupture After X-ray12,13,14 (not listed above) If MRI contraindicated or cannot be performed.

  • High clinical suspicion of a specific tendon rupture based on mechanism of injury and physical findings (i.e., triceps or pectorals tendon rupture)

Shoulder Dislocations15,16 If MRI contraindicated or cannot be performed unless requested as CT arthrogram or to evaluate glenoid bone stock or size of Hill-Sachs lesion.

  • Recurrent
  • First time in any of the situations below that increase the risk or repeated dislocation
    • Glenoid or humeral bone loss on X-ray
    • Bankart lesion on radiographs
    • 14- to 40-year-old
    • > 40 with exam findings concerning for rotator cuff tear (i.e., weakness on exam)

Bone Fracture (If MRI contraindicated or cannot be performed)

  • Suspected occult scaphoid fracture with snuffbox pain after initial X-ray
  • Non scaphoid suspected occult, stress or insufficiency fracture with a negative initial X-ray17,18,19
    • Repeat X-rays in 10-14 days if negative or non-diagnostic
  • Pathologic fracture on X-ray or CT20
  • Suspected ligamentous/tendon injury with known fractures on x-ray/CT that may require surgery 

Fracture Nonunion

  • Nonunion or delayed union as demonstrated by no healing between two sets of X-rays. If a fracture has not healed by 4 – 6 months, there is delayed union. Incomplete healing by 6 – 8 months is nonunion.21

Osteochondral Lesions (defects, fractures, osteochondritis dissecans) and X-ray completed22,23,24,25

  • Clinical suspicion based on mechanism of injury and physical findings

Loose bodies or synovial chondromatosis and after X-ray or ultrasound completed

  • In the setting of joint pain or mechanical symptoms 26

Osteonecrosis (e.g., Avascular necrosis [AVN]27,28,29 when MRI is contraindicated or cannot be preformed)

  • To further characterize a prior abnormal X-ray
  • Normal X-rays but symptomatic and high-risk (e.g., glucocorticosteroid use, renal transplant recipient, glycogen storage disease, alcohol abuse,27 sickle cell anemia28)
  • Known osteonecrosis to evaluate a contralateral joint after initial X-rays

Joint prosthesis/replacement

  • Suspected joint prosthesis loosening or dysfunction, (i.e., pseudotumor formation) after initial X-rays30,31

Extremity Mass32

  • Mass or lesion after non-diagnostic X-ray or ultrasound33 MRI preferred. CT is better than MRI to evaluate mass calcification or bone involvement and may complement or replace MRI:34
    • If superficial mass, then ultrasound is the initial study.
    • If deep mass, then X-ray is the initial study.
  • Vascular malformations
    • After initial evaluation with ultrasound and results will change management or for preoperative planning:35
      • CTA is also approvable for initial evaluation.
      • Follow up after treatment/embolization.

Known Primary Cancer of the Extremity36,37,38,39,40

  • Initial staging primary extremity tumor
  • Follow-up of known primary cancer of patient undergoing active treatment within the past year or as per surveillance imaging guidance for that cancer
  • Signs or symptoms or imaging findings suspicious for recurrence
  • Suspected metastatic disease with signs/symptoms and after initial imaging with radiographs

Further evaluation of indeterminate or questionable findings on prior imaging and MRI cannot be performed or CT is preferred (i.e., tumor matrix)

  • For initial evaluation of an inconclusive finding on a prior imaging report (i.e., X-ray, ultrasound or MRI) that requires further clarification.
  • One follow-up exam of a prior indeterminate MR/CT finding to ensure no suspicious interval change has occurred. (No further surveillance unless specified as highly suspicious or change was found on last follow-up exam).

Infection of Bone, Joint or Soft tissue Abscess41,42
MRI and nuclear medicine studies are recommended for acute infection as they are more sensitive in detecting early changes of osteomyelitis.43 CT is better at demonstrating findings of chronic osteomyelitis (sequestra, involucrum, cloaca, sinus tracts) as well as detecting soft tissue gas and foreign bodies.44

  • Abnormal X-ray or ultrasound
  • Negative X-ray but with a clinical suspicion of infection
    • Signs and symptoms of joint or bone infection include:
      • Pain and swelling
      • Decrease range of motion
      • Fever
    • Laboratory findings of infection include any of the following:
      • Elevated ESR or CRP
      • Elevated white blood cell count
      • Positive joint aspiration
  • Ulcer (diabetic, pressure, ischemic, traumatic) with signs of infection (redness, warm, swelling, pain, discharge which may range from white to serosanguineous) that is not improving despite treatment and bone, or deep infection is suspected
    • Increased suspicion if size or temperature increases, bone is exposed/positive probe-to-bone test, new areas of breakdown, new smell45

Pre-operative/procedural evaluation:

  • Pre-operative evaluation for a planned surgery or procedure

Post-operative/procedural evaluation: 

  • When imaging, physical, or laboratory findings indicate joint infection, delayed or non-healing, or other surgical/procedural complications

Inflammatory Arthropathy (e.g., rheumatoid arthritis) and MRI is contraindicated or cannot be performed46,47

  • Further evaluation of an abnormality or non-diagnostic findings on prior imaging 
  • Initial imaging of a single joint for diagnosis or response to therapy after plain films and appropriate lab tests (e.g., RF, ANA, CRP, ESR) 
  • To determine change in treatment or when diagnosis is uncertain prior to start of treatment 
  • Follow-up to determine treatment efficacy in the following:
    • Early rheumatoid arthritis
    • Advanced rheumatoid arthritis if X-ray and ultrasound are equivocal or noncontributory

Known or suspected inflammatory myopathies (If MRI contraindicated or cannot be performed): (Includes polymyositis, dermatomyositis, immune-mediated necrotizing  myopathy, inclusion body myositis)48,49

  • For diagnosis
  • For biopsy planning

Crystalline Arthropathy

  • Dual-energy CT can be used to characterize crystal deposition disease (i.e., gout) after
    • Appropriate rheumatological work up and initial X-rays AND 
    • After inconclusive joint aspiration or when joint aspiration cannot be performed OR50
    • In the setting of extra-articular crystal deposits (i.e., tendons or bursa) 

Foreign Body51

  • Indeterminate X-ray and ultrasound

Peripheral Nerve Entrapment (e.g., carpal tunnel) and MRI is contraindicated or cannot be performed, including any of the following:52,53,54,55,56

  • Abnormal electromyogram or nerve conduction study
  • Abnormal X-ray or ultrasound
  • Clinical suspicion and failed 4 weeks conservative treatment including at least two of the following (active treatment with physical therapy is not required):
    • Activity modification
    • Rest, ice, or heat
    • Splinting or orthotics
    • Medication

Brachial Plexopathy and MRI is contraindicated or cannot be performed57,58

  • If mechanism of injury or EMG/NCV studies are suggestive 
  • Chest CT is preferred study, but neck and/or shoulder (upper extremity) CT can be approved depending on the suspected location of injury

Pediatrics

  • Osteoid Osteoma after an x-ray is done59

Rationale 
Computed tomography (CT) may be used for the diagnosis, evaluation, and management of conditions of the hand, wrist, elbow, and shoulder. CT is not usually the initial imaging test, but it is performed after standard radiographs. CT is used for preoperative evaluation or to evaluate specific abnormalities of the bones, joints, and soft tissues of the upper extremities. 

OVERVIEW
*Conservative Therapy — (Musculoskeletal) should include a multimodality approach consisting of a combination of active and inactive components. Inactive components, such as rest, ice, heat, modified activities, medical devices (including crutches, immobilizer, metal braces, orthotics, rigid stabilizer, or splints, etc. and not to include neoprene sleeves), medications, injections (bursal, and/or joint, not including trigger point), and diathermy, can be utilized. Active modalities may consist of physical therapy, a physician-supervised home exercise program**, and/or chiropractic care. 

**Home Exercise Program (HEP) — The following two elements are required to meet guidelines for completion of conservative therapy:

  • Information provided on exercise prescription/plan AND
  • Follow-up with member with information provided regarding completion of HEP (after suitable 4-week period), or inability to complete HEP due to physical reason- i.e., increased pain, inability to physically perform exercises. (Patient inconvenience or noncompliance without explanation does not constitute “inability to complete” HEP).

Shoulder Dislocation — Glenoid bone loss occurs in anterior shoulder dislocation. Severe degrees of glenoid bone loss are shown on axial radiography, but it can be quantified more definitively using CT. This information is important as it helps to predict the likelihood of further dislocation and the need for bone augmentation surgery. The number of dislocations cannot reliably predict the degree of glenoid bone loss; it is important to quantify glenoid bone loss, initially by arthroscopy and later by CT. 

American Academy of Pediatrics “Choosing Wisely” Guidelines advise against ordering advanced imaging studies (MRI or CT) for most musculoskeletal conditions in a child until all appropriate clinical, laboratory and plain radiographic examinations have been completed. “History, physical examination, and appropriate radiographs remain the primary diagnostic modalities in pediatric orthopedics, as they are both diagnostic and prognostic for the great majority of pediatric musculoskeletal conditions. Examples of such conditions would include, but not be limited to, the work up of injury or pain (spine, knees, and ankles), possible infection, and deformity. MRI examinations and other advanced imaging studies frequently require sedation in the young child (5 years old or less) and may not result in appropriate interpretation if clinical correlations cannot be made. Many conditions require specific MRI sequences or protocols best ordered by the specialist who will be treating the patient … if you believe findings warrant additional advanced imaging, discuss with the consulting orthopedic surgeon to make sure the optimal studies are ordered.”60

References  

  1. Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med. May 2 2013;368(18):1675-84. doi:10.1056/NEJMoa1301408
  2. Mordecai SC, Al-Hadithy N, Ware HE, Gupte CM. Treatment of meniscal tears: An evidence based approach. World J Orthop. Jul 18 2014;5(3):233-41. doi:10.5312/wjo.v5.i3.233
  3. Bencardino JT, Gyftopoulos S, Palmer WE. Imaging in anterior glenohumeral instability. Radiology. Nov 2013;269(2):323-37. doi:10.1148/radiology.13121926
  4. Jain NB, Luz J, Higgins LD, et al. The Diagnostic Accuracy of Special Tests for Rotator Cuff Tear: The ROW Cohort Study. Am J Phys Med Rehabil. Mar 2017;96(3):176-183. doi:10.1097/phm.0000000000000566
  5. Loh B, Lim JB, Tan AH. Is clinical evaluation alone sufficient for the diagnosis of a Bankart lesion without the use of magnetic resonance imaging? Ann Transl Med. Nov 2016;4(21):419. doi:10.21037/atm.2016.11.22
  6. Somerville LE, Willits K, Johnson AM, et al. Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions. Surg J (N Y). Oct 2017;3(4):e154-e162. doi:10.1055/s-0037-1606829
  7. Balevi Batur E, Bekin Sarıkaya PZ, Kaygısız ME, Albayrak Gezer I, Levendoglu F. Diagnostic Dilemma: Which Clinical Tests Are Most Accurate for Diagnosing Supraspinatus Muscle Tears and Tendinosis When Compared to Magnetic Resonance Imaging? Cureus. Jun 2022;14(6):e25903. doi:10.7759/cureus.25903
  8. Kane SF, Lynch JH, Taylor JC. Evaluation of elbow pain in adults. Am Fam Physician. Apr 15 2014;89(8):649-57. 
  9. Karbach LE, Elfar J. Elbow Instability: Anatomy, Biomechanics, Diagnostic Maneuvers, and Testing. J Hand Surg Am. Feb 2017;42(2):118-126.doi:10.1016/j.jhsa.2016.11.025
  10. Pandey T, Slaughter AJ, Reynolds KA, Jambhekar K, David RM, Hasan SA. Clinical orthopedic examination findings in the upper extremity: correlation with imaging studies and diagnostic efficacy. Radiographics. Mar-Apr 2014;34(2):e24-40. doi:10.1148/rg.342125061
  11. Ruston J, Konan S, Rubinraut E, Sorene E. Diagnostic accuracy of clinical examination and magnetic resonance imaging for common articular wrist pathology. Acta Orthop Belg. Aug 2013;79(4):375-80. 
  12. Garras DN, Raikin SM, Bhat SB, Taweel N, Karanjia H. MRI is unnecessary for diagnosing acute Achilles tendon ruptures: clinical diagnostic criteria. Clin Orthop Relat Res. Aug 2012;470(8):2268-73. doi:10.1007/s11999-012-2355-y
  13. Peck J, Gustafson K, Bahner D. Diagnosis of Achilles tendon rupture with ultrasound in the emergency department setting. Images in Academic Medicine: Republication. International Journal of Academic Medicine. May 1, 2017 2017;3(3):205-207. doi:10.4103/ijam.Ijam_16_17
  14. Wilkins R, Bisson LJ. Operative versus nonoperative management of acute Achilles tendon ruptures: a quantitative systematic review of randomized controlled trials. Am J Sports Med. Sep 2012;40(9):2154-60. doi:10.1177/0363546512453293
  15. Galvin JW, Ernat JJ, Waterman BR, Stadecker MJ, Parada SA. The Epidemiology and Natural History of Anterior Shoulder Instability. Curr Rev Musculoskelet Med. Dec 2017;10(4):411-424. doi:10.1007/s12178-017-9432-5
  16. Waterman BR, Kilcoyne KG, Parada SA, Eichinger JK. Prevention and management of post-instability glenohumeral arthropathy. World J Orthop. Mar 18 2017;8(3):229-241. doi:10.5312/wjo.v8.i3.229
  17. Bencardino JT, Stone TJ, Roberts CC, et al. ACR Appropriateness Criteria(®) Stress (Fatigue/Insufficiency) Fracture, Including Sacrum, Excluding Other Vertebrae. J Am Coll Radiol. May 2017;14(5s):S293-s306. doi:10.1016/j.jacr.2017.02.035
  18. Sadineni RT, Pasumarthy A, Bellapa NC, Velicheti S. Imaging Patterns in MRI in Recent Bone Injuries Following Negative or Inconclusive Plain Radiographs. J Clin Diagn Res. Oct 2015;9(10):Tc10-3. doi:10.7860/jcdr/2015/15451.6685
  19. Yin ZG, Zhang JB, Kan SL, Wang XG. Diagnosing suspected scaphoid fractures: a systematic review and meta-analysis. Clin Orthop Relat Res. Mar 2010;468(3):723-34. doi:10.1007/s11999-009-1081-6
  20. Fayad LM, Kawamoto S, Kamel IR, et al. Distinction of long bone stress fractures from pathologic fractures on cross-sectional imaging: how successful are we? AJR Am J Roentgenol. Oct 2005;185(4):915-24. doi:10.2214/ajr.04.0950
  21. Morshed S. Current Options for Determining Fracture Union. Adv Med. 2014;2014:708574. doi:10.1155/2014/708574
  22. Smith TO, Drew BT, Toms AP, Donell ST, Hing CB. Accuracy of magnetic resonance imaging, magnetic resonance arthrography and computed tomography for the detection of chondral lesions of the knee. Knee Surg Sports Traumatol Arthrosc. Dec 2012;20(12):2367-79. doi:10.1007/s00167-012-1905-x
  23. American College of Radiology. ACR Appropriateness Criteria® Acute Trauma to the Knee. American College of Radiology (ACR). Updated 2019. Accessed November 20, 2022. https://acsearch.acr.org/docs/69419/Narrative/
  24. van Dijk CN, Reilingh ML, Zengerink M, van Bergen CJ. Osteochondral defects in the ankle: why painful? Knee Surg Sports Traumatol Arthrosc. May 2010;18(5):570-80. doi:10.1007/s00167-010-1064-x
  25. van Bergen CJ, van den Ende KI, Ten Brinke B, Eygendaal D. Osteochondritis dissecans of the capitellum in adolescents. World J Orthop. Feb 18 2016;7(2):102-8. doi:10.5312/wjo.v7.i2.102
  26. Rajani R, Quinn RH, Fischer SJ. Synovial Chondromatosis. American Academy of Orthopaedic Surgeons (AAOS). Updated January 2022. Accessed November 20, 2022. https://orthoinfo.aaos.org/en/diseases--conditions/synovial-chondromatosis
  27. Felten R, Perrin P, Caillard S, Moulin B, Javier RM. Avascular osteonecrosis in kidney transplant recipients: Risk factors in a recent cohort study and evaluation of the role of secondary hyperparathyroidism. PLoS One. 2019;14(2):e0212931. doi:10.1371/journal.pone.0212931
  28. Murphey MD, Foreman KL, Klassen-Fischer MK, Fox MG, Chung EM, Kransdorf MJ. From the radiologic pathology archives imaging of osteonecrosis: radiologic-pathologic correlation. Radiographics. Jul-Aug 2014;34(4):1003-28. doi:10.1148/rg.344140019
  29. American College of Radiology. ACR Appropriateness Criteria® Osteonecrosis. American College of Radiology. Updated 2022. Accessed November 15, 2022. https://acsearch.acr.org/docs/69420/Narrative/
  30. Fritz J, Lurie B, Potter HG. MR Imaging of Knee Arthroplasty Implants. Radiographics. Sep-Oct 2015;35(5):1483-501. doi:10.1148/rg.2015140216
  31. Fritz J, Lurie B, Miller TT, Potter HG. MR imaging of hip arthroplasty implants. Radiographics. Jul-Aug 2014;34(4):E106-32. doi:10.1148/rg.344140010
  32. Church DJ, Krumme J, Kotwal S. Evaluating Soft-Tissue Lumps and Bumps. Mo Med. Jul-Aug 2017;114(4):289-294. 
  33. Kransdorf MJ, Murphey MD, Wessell DE, et al. ACR Appropriateness Criteria(®) Soft-Tissue Masses. J Am Coll Radiol. May 2018;15(5s):S189-s197. doi:10.1016/j.jacr.2018.03.012
  34. Subhawong TK, Fishman EK, Swart JE, Carrino JA, Attar S, Fayad LM. Soft-tissue masses and masslike conditions: what does CT add to diagnosis and management? AJR Am J Roentgenol. Jun 2010;194(6):1559-67. doi:10.2214/ajr.09.3736
  35. American College of Radiology. ACR Appropriateness Criteria® Clinically Suspected Vascular Malformation of the Extremities. American College of Radiology. Updated 2019. Accessed March 30, 2023. https://acsearch.acr.org/docs/3102393/Narrative/
  36. American College of Radiology. ACR Appropriateness Criteria® Primary Bone Tumors. American College of Radiology. Updated 2019. Accessed November 20, 2022. https://acsearch.acr.org/docs/69421/Narrative/
  37. American College of Radiology. ACR Appropriateness Criteria® Malignant or Aggressive Primary Musculoskeletal Tumor-Staging And Surveillance. American College of Radiology. Updated 2022. Accessed November 20, 2022. https://acsearch.acr.org/docs/69428/Narrative/
  38. Holzapfel K, Regler J, Baum T, et al. Local Staging of Soft-Tissue Sarcoma: Emphasis on Assessment of Neurovascular Encasement-Value of MR Imaging in 174 Confirmed Cases. Radiology. May 2015;275(2):501-9. doi:10.1148/radiol.14140510
  39. Kircher MF, Willmann JK. Molecular body imaging: MR imaging, CT, and US. Part II. Applications. Radiology. Aug 2012;264(2):349-68. doi:10.1148/radiol.12111703
  40. NCCN Imaging Appropriate Use Criteria™. National Comprehensive Cancer Network (NCCN). Updated 2022. Accessed November 15, 2022. https://www.nccn.org/professionals/imaging/default.aspx
  41. Dodwell ER. Osteomyelitis and septic arthritis in children: current concepts. Curr Opin Pediatr. Feb 2013;25(1):58-63. doi:10.1097/MOP.0b013e32835c2b42
  42. Glaudemans A, Jutte PC, Cataldo MA, et al. Consensus document for the diagnosis of peripheral bone infection in adults: a joint paper by the EANM, EBJIS, and ESR (with ESCMID endorsement). Eur J Nucl Med Mol Imaging. Apr 2019;46(4):957-970. doi:10.1007/s00259-019-4262-x
  43. Mandell JC, Khurana B, Smith JT, Czuczman GJ, Ghazikhanian V, Smith SE. Osteomyelitis of the lower extremity: pathophysiology, imaging, and classification, with an emphasis on diabetic foot infection. Emerg Radiol. Apr 2018;25(2):175-188. doi:10.1007/s10140-017-1564-9
  44. Fayad LM, Carrino JA, Fishman EK. Musculoskeletal infection: role of CT in the emergency department. Radiographics. Nov-Dec 2007;27(6):1723-36. doi:10.1148/rg.276075033
  45. Bowers S, Franco E. Chronic Wounds: Evaluation and Management. Am Fam Physician. Feb 1 2020;101(3):159-166. 
  46. Colebatch AN, Edwards CJ, Østergaard M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. Jun 2013;72(6):804-14. doi:10.1136/annrheumdis-2012-203158
  47. Sudoł-Szopińska I, Cwikła JB. Current imaging techniques in rheumatology: MRI, scintigraphy and PET. Pol J Radiol. Jul 2013;78(3):48-56. doi:10.12659/pjr.889138
  48. Jia Y, Tian H, Deng J, Yu K. Multimodal imaging for the clinical assessment of dermatomyositis and polymyositis: A systematic review. Radiology of Infectious Diseases.2017/06/01/ 2017;4(2):81-87. doi:https://doi.org/10.1016/j.jrid.2017.01.003
  49. Joyce NC, Oskarsson B, Jin LW. Muscle biopsy evaluation in neuromuscular disorders. Phys Med Rehabil Clin N Am. Aug 2012;23(3):609-31. doi:10.1016/j.pmr.2012.06.006
  50. Chou H, Chin TY, Peh WC. Dual-energy CT in gout - A review of current concepts and applications. J Med Radiat Sci. Mar 2017;64(1):41-51. doi:10.1002/jmrs.223
  51. Laya BF, Restrepo R, Lee EY. Practical Imaging Evaluation of Foreign Bodies in Children: An Update. Radiol Clin North Am. Jul 2017;55(4):845-867.  doi:10.1016/j.rcl.2017.02.012
  52. Domkundwar S, Autkar G, Khadilkar SV, Virarkar M. Ultrasound and EMG-NCV study (electromyography and nerve conduction velocity) correlation in diagnosis of nerve pathologies. J Ultrasound. Jun 2017;20(2):111-122. doi:10.1007/s40477-016-0232-3
  53. Dong Q, Jacobson JA, Jamadar DA, et al. Entrapment neuropathies in the upper and lower limbs: anatomy and MRI features. Radiol Res Pract. 2012;2012:230679. doi:10.1155/2012/230679
  54. Donovan A, Rosenberg ZS, Cavalcanti CF. MR imaging of entrapment neuropathies of the lower extremity. Part 2. The knee, leg, ankle, and foot. Radiographics. Jul-Aug 2010;30(4):1001-19. doi:10.1148/rg.304095188
  55. Meyer P, Lintingre PF, Pesquer L, Poussange N, Silvestre A, Dallaudière B. The Median Nerve at the Carpal Tunnel … and Elsewhere. J Belg Soc Radiol. Jan 31 2018;102(1):17. doi:10.5334/jbsr.1354
  56. Tos P, Crosio A, Pugliese P, Adani R, Toia F, Artiaco S. Painful scar neuropathy: principles of diagnosis and treatment. Plastic and Aesthetic Research. 2015;2:156-164. doi:10.4103/2347-9264.160878
  57. Mansukhani KA. Electrodiagnosis in traumatic brachial plexus injury. Ann Indian Acad Neurol. Jan 2013;16(1):19-25. doi:10.4103/0972-2327.107682
  58. Vijayasarathi A, Chokshi FH. MRI of the brachial plexus: A practical review. Appl Radiol. 2016;45(4):9-18. 
  59. Iyer RS, Chapman T, Chew FS. Pediatric bone imaging: diagnostic imaging of osteoid osteoma. AJR Am J Roentgenol. May 2012;198(5):1039-52. doi:10.2214/ajr.10.7313
  60. American Academy of Pediatrics. Five things physicians and patients should question: Do not order advanced imaging studies (MRI or CT) for most musculoskeletal conditions in a child until all appropriate clinical, laboratory and plain radiographic examinations have been completed. Choosing Wisely Initiative ABIM Foundation. Updated February 12, 2018. Accessed November 20, 2022. https://www.choosingwisely.org/clinician-lists/aap-posna-mri-or-ct-for-musculoskeletal-conditions-in-children/

Coding Section 

Code Number Description
CPT 73200 Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections
  73201 Computed tomography, upper extremity; with contrast material(s)
  73202 Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections

Procedure and diagnosis codes on Medical Policy documents are included only as a general reference tool for each policy. They may not be all-inclusive.

This medical policy was developed through consideration of peer-reviewed medical literature generally recognized by the relevant medical community, U.S. FDA approval status, nationally accepted standards of medical practice and accepted standards of medical practice in this community, Blue Cross Blue Shield Association technology assessment program (TEC) and other nonaffiliated technology evaluation centers, reference to federal regulations, other plan medical policies, and accredited national guidelines.

"Current Procedural Terminology © American Medical Association. All Rights Reserved" 

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01012024  NEW POLICY

 

 

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