Diagnostic Imaging Tips

ACR Appropriateness Criteria® is evidence-based guidelines created to assist physicians in making the most appropriate imaging or treatment decision for a specific clinical condition. By employing these guidelines, providers can enhance the quality of care to their patients and contribute to the most efficacious use of radiology. 

ACR Appropriateness Criteria is directly available to you at this link:  www.acr.org

Members of the following organizations:

• American College of Radiology
• American College of Osteopathic Radiology
• American Osteopathic Association
• American Society of Head and Neck Radiology
• American Roentgen Ray Society
• Radiological Society of North American
• Society of Interventional Radiology
• Society of Nuclear Medicine
• Society of Radiologists in Ultrasound
• Michigan State Medical Society
• Kent County Medical Society
• Michigan Radiological Network

Medicare Guidelines

For your convenience we have provided Medicare’s guidelines for various radiology procedures below as a quick reference to policies on medical necessity and frequency requirements.  Wisconsin Physicians Services (WPS) is the Medicare contractor for Michigan.  The links will allow you to view the policies, known as Local Coverage Determination (LCD). https://www.wpsgha.com/wps/portal/mac/site/policies/guides-and-resources/guides-and-resources/

Documentation Requirements: 

Physician’s Services and diagnostic tests must be submitted with an ICD-10 code to support medical necessity.  The diagnostic code is required to be reported to the payor with the greatest level of accuracy. This means the precise ICD-10 code that fully explains the narrative description of the diagnosis contained in the medical record or test interpretation.  When ordering a diagnostic exam please provide us with clinical informaiton that supports the medical necessity requirements.  Thank you.