Effective for dates of service on and after September 12, 2021, the following updates will apply to the AIM Advanced Imaging Clinical Appropriateness Guidelines. Part of the AIM guideline annual review process, these updates are focused on advancing efforts to drive clinically appropriate, safe, and affordable health care services.
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 US prior to advanced imaging for tethered cord in infants age 5 months or less
Multiple sclerosis
New criteria for imaging in initial diagnosis of MS
Spinal infection
New criteria for diagnosis and management aligned with IDSA and University of Michigan guidelines
Axial spondyloarthropathy
Defined inflammatory back pain
Diagnostic testing strategy outlining radiography requirements
Cervical injury
Aligned with ACR position on pediatric cervical trauma
Thoracic or lumbar injury
Diagnostic testing strategy emphasizing radiography and limiting the use of MRI for known fracture
Remove 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 non-diagnostic 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 non-diagnostic 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 non-vascular 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/TIA; Stenosis or Occlusion (Intracranial/Extracranial)
Acute and subacute time frame 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 non-diagnostic chest radiograph requirement for all indications
Addition of pregnancy-adjusted YEARS algorithm
Peripheral Arterial Disease
Addition of new post-revascularization scenario to both upper and lower extremity PAD evaluation
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.