Payers often require pre-authorization of advanced imaging studies, and most of the time the payer wants a specific CPT before they will provide that authorization. Since the choice of study is a clinical decision, Clarity can't fill in the CPT for you. Clarity has licensed the CPT list and created a CPT Selector to help you pick the imaging study that you really want for your patient.
Using this is optional (you can still enter the CPT and study description in the Reason for Referral field), but we encourage you to use it because it will provide a more consistent order for the imaging center, and more consistent documentation for all providers involved in your patients' care.
When you select Imaging Study as your Action Requested, the CPT Selector appears beneath the ICD9 fields. In this example, a pregnant patient is experiencing some pelvic pain, so the provider is ordering an ultrasound. To get the correct CPT, you can just type the CPT number or part of the description in the Select Study field, but you may have more success by first choosing the imaging modality from the dropdown list (Ultrasound in this case), and the body part to be imaged. You have to type at least one character in the Select Study field to start the search – type any relevant text (or a space) to bring up a list of options from which to choose.
Select the third entry (76805) and the screen will change to reflect your selected studies.
You can select up to five studies of the same modality in a single referral. If your patient needs studies with different modalities, finish the first one then Copy the submitted referral to enter the second set of studies you wish to order.
This example shows an order where the referring provider leaves the contrast decision to the radiologist. In general, the best way to order this is to select the study "with and without", then note in the Reason for Referral that contrast is at the radiologist's discretion.
A few other notes on the CPT Selector:
- Use the dropdowns (Modality, Body Part) to restrict your search. There are about 700 imaging CPTs, so anything you can do to narrow the search will make it easier to choose the right study.
- If you are not sure of the body part, search on a more general term. For example for the MR of the hand above, the study description uses "joint of upper extremity".
- If you click on a study in the box in the bottom half, you can hover over it to get the entire description (see above), or you can click the "Remove Selected Study" button if you have the wrong one.
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