Table 4.
Most frequent diagnosis codes provided for the four advanced imaging modalities, deemed supportive and not supportive of guideline indications. For example, “secondary malignant neoplasm of bone or bone marrow” as an indication for a bone scan describes what the study is looking for (bone metastases), but not why the study is being ordered; i.e. what symptom or sign elicits suspicion for that concern and justification for performance of the study.
| Top 5 Supportive Codes. n represents number of imaging claims (not patient numbers). | |||
|---|---|---|---|
| CT Scan (n=12,860) | PET Scan (n=783) | Brain MRI (n=552) | Bone Scan (n=10,100) |
| 789 Abdominal pain, unspecified site (n=587) |
786.5 Chest pain, unspecified (n=33) |
784 Headache (n=71) |
733.9 Disorder of bone and cartilage, unspecified (n=488) |
| 573.8 Other specified disorders of liver (n=350) |
786.09 Other respiratory abnormalities (n<11) |
780.4 Dizziness (n=44) |
724.2 Lumbago (n=132) |
| 785.6 Enlargement of lymph nodes (n=196) |
786.05 Shortness of breath (n<11) |
436 Acute, but ill defined, cerebrovascular disease (n=32) |
786.5 Chest pain, unspecified (n=130) |
| 793.1 Nonspecific (abnormal) findings on radiological and other examination of lung (n=193) |
786.59 Other chest pain (n<11) |
331.9 Cerebral degeneration, unspecified (n=28) |
722.52 Degeneration of lumbar or lumbosacral intervertebral disc (n=114) |
| 786.5 Chest pain, unspecified (n=191) |
793.1 Nonspecific (abnormal) findings on radiological and other examination of lung (n<11) |
780.2 Syncope and collapse (n=16) |
724.5 Backache, unspecified (n=111) |
| Top 5 Non-Supportive Codes. n represents number of imaging claims (not patient numbers). | |||
|---|---|---|---|
| CT Scan (n=12,860) | PET Scan (n=783) | Brain MRI (n=552) | Bone Scan (n=10,100) |
| 518.89 Other diseases of lung, not elsewhere classified (n=663) |
611.72 Lump or mass in breast (n=23) |
437.1 Other generalized ischemic cerebrovascular disease (n=26) |
V72.5 Radiological examination, not elsewhere classified (n=822) |
| V72.5 Radiological examination, not elsewhere classified (n=615) |
794.31 Nonspecific abnormal electrocardiogram (n=22) |
V72.5 Radiological examination, not elsewhere classified (n=25) |
V10.3 Personal history of malignant neoplasm of breast (n=467) |
| V10.3 Personal history of malignant neoplasm of breast (n=590) |
414.01 Coronary atherosclerosis of native coronary artery (n=17) |
V10.3 Personal history of malignant neoplasm of breast (n=20) |
611.72 Lump or mass in breast (n=453) |
| 611.72 Lump or mass in breast (n=585) |
414 Coronary atherosclerosis of unspecified type of vessel, native or graft (n=14) |
435.9 Unspecified transient cerebral ischemia (n=18) |
198.5 Secondary malignant neoplasm of bone and bone marrow (n=350) |
| 786.6 Swelling, mass, or lump on chest (n=400) |
V10.3 Personal history of malignant neoplasm of breast (n=14) |
348.8 Brain conditions, not elsewhere classified (n=17) |
V71.1 Observation for suspected malignant neoplasm (n=230) |