Pediatric Abdomen Imaging Guidelines

This policy covers pediatric abdominal imaging across modalities (US, CT, MRI, nuclear medicine/PET and related studies) for evaluation of common pediatric abdominal signs and conditions such as generalized abdominal pain, right lower quadrant pain/appendicitis evaluation, flank pain/renal stones, UTI, hematuria, inflammatory bowel disease, liver/adrenal lesions, postoperative pain, and suspected intra‑abdominal abscess. Major limitations/requirements: atypical presentations require physician review and consultation; advanced imaging (CT/MR/NM) generally requires prior clinical evaluation/basic imaging and must be expected to change management (conservative therapy should be continued if the child is improving); certain procedures (e.g., MRI abdomen with contrast, many PET codes) are rarely used or restricted in pediatrics and some unlisted codes are limited to planning/surgical software purposes.

"Peritoneal-Venous Shunt Patency"