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JNM (June 2012) Understanding Appropriate Use Criteria in Nuclear Medicine
JNM, June 2012, Volume 40, Number 2

JNM (June 2012) Understanding Appropriate Use Criteria in Nuclear Medicine

Release Date: June 1, 2012
Expiration Date: June 30, 2015

JNM, June 2012, Volume 40, Number 2


California Scope:
 1.0 Non-Imaging (NI)


Author

Mary Beth Farrell, CNMT1 and Manuel D. Cerqueira, MD2

1Intersocietal Accreditation Commission, Ellicott City, Maryland; and 2Department of Nuclear Medicine, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio

Overview

There has been a significant increase in cardiac radionuclide imaging over the past decade, leading to a corresponding increase in scrutiny from Federal and private health plans questioning the necessity of these tests. In response to efforts by third-party payers to limit all types of cardiovascular imaging studies, the American College of Cardiology Foundation, in conjunction with other professional societies, developed appropriate use criteria. The goal of this article is to explain how the criteria were created and define the 3 categories of indications: appropriate, inappropriate, and uncertain. Tips for using appropriate use criteria and tables, including a definition of several key terms technologists should be familiar with, will be provided. In addition, reimbursement, benchmark data, and practical considerations for implementation will be discussed. Finally, several tools to aid in calculating appropriateness are suggested. With a basic understanding, the appropriate use criteria are relatively easy to apply. It is important for facilities to begin to voluntarily incorporate them into their practice and document levels of appropriateness now as payers are developing 2 trends that are not favorable for nuclear cardiology: preauthorization and denial of payment for inappropriate studies.

Key Words: appropriate use criteria; cardiac radionuclide imaging; myocardial perfusion imaging; reimbursement

J Nucl Med Technol 2012; 40:81-86
DOI: 10.2967/jnmt.111.097451

Continuing Education Credit Information

VOICE (Technologists)
The SNMMI, through its Verification of Involvement in Continuing Education (VOICE) program, has approved this journal article for a maximum of 1.0 continuing education hours (CEHs). VOICE-approved credit is recognized by most licensure states and by the NMTCB and ARRT as Category A credit. In order to receive CE credit, you must first complete the activity content. When completed, take the post-test assessment. You must obtain a score of 80% to receive the CE credit. You will have no more than 3 attempts to successfully complete the post-test. Release Date: June 1, 2012. Expiration Date: June 30, 2015. California Scope: 1.0 Non-Imaging (NI).


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