FLUOROSCOPY PROTOCOLS - Not scheduled on saturdays

Upper GI (UGI) Therapeutic/Steroid Injections

Esophogram (Barium Swallow) IVP (Not performing at this time at any Simonmed locations)

SBFT (Small Bowel Follow Through) Barium Enema (BE)

Sniff Test                                                                      Hysterosalpingogram (HSG) (Not performing at this time in AZ)

ORDERS ARE GOOD FOR 1 YEAR. IF EXPIRED, WE NEED TO CALL THE REFERRING DOCTOR TO GET AN UPDATED ONE.

(Refer to the Training Refresher Materials section under the Tools drop down)

Auth requirements:

Health Choice/Health Choice Generations: OB US is 5-7 days TAT, DUPLEX/DOPPLER is 5-7 day minimum TAT

Tricare: All US, MG, BD, MRI & CT require auth- 14 days minimum TAT

Alignment: US- 7 days minimum TAT

Optum: MRI, NM, PET, CTA, MRA is 14 days minimum TAT (In Nevada ONLY: Out of network for all PET, NM & US except ABI, Arterial, Venous mapping and Prostate and out of network for ALL CT except CT lung, CTA for PE, CTA runoff and patients over 400 lbs.  

Mercy Care/Mercy Care Advantage: US (Elastrography) cpt 76981 is a 14 day minimum TAT

Scan Health: ALL Breast Imaging - 7 day minimum TAT

Humana: All CT/A, MRI/A, NM Modalities are 5-7 days.

Humana FL (Only) All modalities - Schedule 9 days out.  Add-Ons ONLY allowed if patient has referral/authorization number on hand.

STAT GUIDELINES

STATS we do try to accommodate same day next day, if it requires auth we schedule out 4 hours or next AM so auth has time to attempt to obtain.

We check the location most convenient to the pt but if we see no openings we offer surrounding sites that may have openings, if surrounding do not have openings as well we are ok to double book following the below guidelines.

*Agents do not have rights to double book so if this occurs they are reaching out to their leads to do the double booking at which time the leads can check thru to make sure it’s an ok spot to add.

If they double book  they should be notifying the patient they are being worked in and may have a wait and notate this was communicated.

A call must be placed to the site only if the following circumstances apply:

·         Clinic/modality is closing within the hour. Example you get call at 3:15pm and that modality closes at 4pm.

·         We are already double-booked and you are needing to add another exam. Example we have two 4pm and you need to add a 3rd (Triple Booking).

·         Only overbook non contrast spots.  Please ensure contrast coverage is available if you are booking a contrast exam.

·         If you are scheduling a specialty exam, there may be limits on certain exams such as: Arthrograms, Fluoro, Diagnostic Mammo’s, Nuc Med, Etc. You must call the site for approval.

·         If you are scheduling an exam that requires authorization please make sure you inform the patient that if authorization is not received by the time of the exam, their appointment   may be postponed. Allow 4 business hours’ time for auth to be obtained.

·         Same day Saturday appointments that require auth must already have auth on file or the patient will not be able to be seen. If exam requires authorization and it has not already been obtained please schedule for Monday to allow time to obtain STAT auth.  

When scheduling the below STAT exam, these cannot be done after 5pm or on weekends.

CTA CHEST WITH CONTRAST W/3D RECON AND THE DIAGNOSIS IS FOR PE (PULMONARY EMBOLISM)

US DUPLEX SCAN LOWER EXTREM VEINS BILATERAL

US DUPLEX SCAN LOWER EXREM VEINS UNILATERAL (LEFT)

US DUPLEX SCAN LOWER EXREM VEINS UNILATERAL (RIGHT)

US DUPLEX SCAN UPPER EXTREM VEINS BILATERAL

US DUPLEX SCAN UPPER EXTREM VEINS UNILATERL (LEFT)

US DUPLEX SCAN UPPER EXTREM VEINS UNILATERL (RIGHT)

OB ULTRASOUNDS FOR VIABILITY

If you are “postponing scheduling” until the next business day please send recap form to the Dr office to make them aware. Please document in scheduling notes that it was completed.  If you need help please reach out to leadership.

If you are “postponing scheduling” on a Friday until Monday please send recap form to the Dr office as well as call to make them aware. Please document in scheduling notes that it was completed.  If you need help please reach out to leadership.

Please Follow Fluoro Blocks 

IT IS RECOMMENDED THAT PATIENT'S WHO ARE BREAST FEEDING PUMP AND DUMP FOR 24 HOURS AFTER ANY EXAM WITH CONTRAST. 

Only schedule in designated blocks. Cannot schedule in X-ray only slots. 

DO NOT SCHEDULE ON SATURDAYS

Upper GI (UGI)

Drop Down: CR UGI WITH AND WITHOUT AIR W/KUB  (554)

Duration: 30 MINUTES

Prep: Nothing to eat or drink after midnight.  Pt must be able to stand unassisted for 15+ minutes.  If patient is unable to get out of a wheelchair they cannot be seen. 

Esophogram (Barium Swallow) 

Drop Down: ESOPHOGRAM (BARIUM SWALLOW) (552)

Duration: 30 MINUTES

Prep: Nothing to eat or drink after midnight.  Pt must be able to stand unassisted for 15+ minutes.  If patient is unable to get out of a wheelchair they cannot be seen. 

MBS or Modified Barium Swallow 

Specialized barium swallow that is performed in the presence of a Speech Pathologist. 

These are not performed at any SimonMed location.

SBFT (Small Bowel Follow Thru) 

Drop Down: SMALL BOWEL MULTI SERIES W/KUB (556)

Duration: 45 MINUTES

Prep: Nothing to eat or drink after midnight.  Pt must be able to stand unassisted for 15+ minutes.  If patient is unable to get out of a wheelchair they cannot be seen. 

Barium Enema (BE) – Barium Enema w/or w/o KUB

Drop Down: BARIUM ENEMA WITH AIR W/ OR W/O KUB (560)

Duration: 45 MINUTES

Prep: Patient must pick up a prep kit at least 3 days prior to exam. This exam comes with an instruction sheet.  Pt must be able to stand unassisted for 15+ minutes.  If patient is unable to get out of a wheelchair they cannot be seen. 

Sniff Test 

Drop Down: SNIFF TEST (1316) 

Duration: 15 MINUTES

Prep: No prep  

THERAPEUTIC/STEROID INJECTIONS

DROPDOWN: INJECTION MAJOR JNT – FLUORO GUIDANCE (1137)

DURATION: 30 MINUTES

NOTES:

• SCHEDULED IN ARTHROGRAM OR THERAPEUTIC INJECTION SLOT

• NOTATE DOSAGE OF MEDICATION IN CLINICAL INFORMATION

• NOTATE JOINT TO BE INJECTED IN CLINICAL INFORMATION

• ASK THE PATIENT IF THEY CURRENTLY TAKE COUMADIN(WARFARIN). IF YES, INFORM THE PATIENT THEY WILL NEED TO COMPLETE INR LAB WORK WITHIN 24 HOURS OF THEIR SCHEDULED EXAM AND BRING THE RESULTS WITH THEM. THE PATIENT DOES NOT NEED TO BE SCREENED FOR ANY OTHER MEDICATIONS OR BLOOD THINNERS. WE SHOULD NOT INFORM THE PATIENT TO DISCONTINUE ANY MEDICATIONS INCLUDING COUMADIN(WARFARIN).

IVP - USES IODINE CONTRAST   ( WE ARE CURRENTLY NOT PERFORMING AT THIS TIME AT ANY SIMONMED LOCATIONS)

Drop Down: IVP (561)

Duration: 60 MINUTES

Prep: Nothing to eat or drink 4 hours prior. Patient must pick up a prep kit 3 days prior.

We do not perform with TOMO.

Hysterosalpingogram - HSG THIS EXAM CURRENTLY CANNOT BE PERFORMED IN AZ

Drop Down: HYSTEROSALPINGOGRAM (590)

Duration: 30 MINUTES

Prep: No prep

Notes: HYSTEROSALPINGOGRAM: HSG – NOT COVERED BY INSURANCE FOR INFERTILITY (enter as self-pay and run Simplicity for amount due at TOS)

Insurance will cover for 90 day ESSURE follow up.

• Exams are scheduled between the 7th – 10th day of the patient’s menstrual cycle. Day one is on the day patient starts her menstrual cycle as long as there is no bleeding…light spotting Ok. If there is no cycle a STAT blood pregnancy test must be taken the morning of the procedure with STAT results being faxed directly to the site, or the patient will have to hand carry the results to prove that she is not pregnant. Having this exam done while pregnant can terminate the fetus, following menstrual and pregnancy test guidelines are very important. Notate cycle date in Exa.

• Advise patient to call back and reschedule if she is still bleeding on day of exam

• Post ESSURE we must wait 90 days before we can do exam

• IVP dye is used for this exam. We must ensure the patient is not allergic to iodine. If yes, we cannot complete exam.