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Abbreviations and Definitions
The following table includes the important abbreviations and definitions in relation to AUC.
| Abbreviation | Definition |
| Advanced Imaging Services | The PAMA requirement for performing AUC validation applies specifically to procedures that CMS explicitly states qualify as "Advanced Imaging Services". CMS maintains on its website the definitive list of applicable advanced imaging procedures, each identified by specific CPT codes. The LogicNets AUC service can be used to determine if a particular imaging procedure is considered to be an advanced imaging service and therefore subject to AUC validation. |
| AUC | Appropriate Use Criteria. These criteria are authored by PLEs so ordering and furnishing professionals can make the most patient-appropriate ordering decision for the specific clinical condition. To the extent possible, criteria must be evidence-based. |
| CDSM | Clinical Decision Support Mechanism. CDSM is an interactive, electronic tool for clinicians that gives the user AUC information. You can use this information to make the most patient-appropriate treatment decision for the specific clinical condition. Tools are modules within or available through certified electronic health record (EHR) technology (as defined in Section 1848(o)(4) of the Act), private-sector mechanisms independent from certified EHR technology, or those established by CMS. |
| CMS | Centers for Medicare & Medicaid Services |
| CPT Code | Current Procedural Terminology (CPT) Code. This is set is a medical code set maintained by the American Medical Association through the CPT Editorial Panel. The CPT code set (copyright protected by the AMA) describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. |
| Furnishing Professional | A furnishing professional is a physician (as defined in Section 1861(r) of the Act) or a practitioner (as described in Section 1842(b)(18)(C) of the Act) who furnishes an applicable imaging service. In this case, the radiologists. |
| G-Code | These are codes within the PCPCS. |
| Guideline | This is a LogicNets CDSM module that implements the AUC for a certain PCA. |
| HCPCS Code | The Healthcare Common Procedural Coding System is a standardized code system necessary for medical providers to submit healthcare claims to Medicare and other health insurances. |
| Indication | Synonym for PCA. |
| Order | This is a Medicare Part B advanced diagnostic imaging service. |
| Ordering Professional | An ordering professional is a physician (as defined in Section 1861(r) of the Act) or a practitioner (as described in Section 1842(b)(18)(C) of the Act) who orders an applicable imaging service. |
| PAMA | Protecting Access to Medicare Act |
| PCA | Priority Clinical Areas. These are clinical conditions, diseases, symptom complexes, and associated imaging services CMS identifies through annual rulemaking and in consultation with stakeholders. In establishing priority clinical areas, CMS considers how common and widespread a condition, disease, or symptom complex is, the variation of image ordering, and the strength of evidence supporting particular imaging services. CMS also considers the relevance to the Medicare population. CMS identified the following eight priority areas that should be used in the determination of outlier ordering professionals in the future: - Coronary artery disease (suspected or diagnosed) - Suspected pulmonary embolism - Headache (traumatic and nontraumatic) - Hip pain - Low back pain - Shoulder pain (to include suspected rotator cuff injury) - Cancer of the lung (primary or metastatic, suspected or diagnosed) - Cervical or neck pain |
| PLE | Provider-Led Entity. A PLE is a national professional medical specialty society or other organization that is comprised primarily of providers or practitioners who, either within the organization or outside of the organization, predominantly provide direct patient care. |
| qPLE | Qualified Provider-Led Entity. Once a PLE is qualified, the appropriate use criteria (AUC) developed, modified, or endorsed by the entity are considered specified applicable AUC. |
| UCI | Unique Consultation ID. This was previously referred to as Decision Support Number, or DSN. |
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