Peer-to-peer queue
Briefings auto-generated from case context. Open the case to drive the call.
05/08 · 20:00 UTC
In 5.5h
Stress Echocardiogram with imaging
UHC · CPT 93351 · AUT-2026-00188
Reviewer
Dr. P. Anand, UHC
vs. Dr. Marcos Garcia, MD
Patient
Mendoza, R. · 54M · MRN MRN-009447
Scheduled May 8, 2026 · 8:00 PM
Failed criterion
Ordered by cardiology OR PCP with documented evaluation
H&P from referring PCP not yet on file — partial documentation.
Suggested talking points
- 1.Cardiology consult signed by Dr. Garcia documents intermediate Diamond-Forrester probability.
- 2.Resting EKG with LBBB makes treadmill alone uninterpretable — echo modality is the appropriate next test.
- 3.Referring PCP H&P will be uploaded prior to scheduled scan; not a clinical gap.
05/09 · 14:00 UTC
In 24h
L4-L5 TLIF (transforaminal lumbar interbody fusion)
Cigna · CPT 22633 · AUT-2026-00190
Reviewer
Dr. M. Lessler, Cigna
vs. Dr. Daniel Kim, DO
Patient
Thompson, J. · 56M · MRN MRN-011009
Scheduled May 9, 2026 · 2:00 PM
Failed criterion
Smoking cessation addressed (if smoker)
Smoking cessation duration 6 months vs. policy 12 months for elective fusion.
Suggested talking points
- 1.Recent NASS evidence (2024 update) supports 6-month cessation as adequate to mitigate non-union risk.
- 2.Patient documented in cessation program; CO-tested negative on three pre-op visits.
- 3.ODI 42 with severe stenosis — additional 6-month delay risks neurologic decline.
05/09 · 21:30 UTC
In 31h
PET/CT skull base to mid-thigh — staging
BCBS IL · CPT 78815 · AUT-2026-00191
Reviewer
Dr. R. Holm, BCBS IL
vs. Dr. Wei Zhang, MD
Patient
Jefferson, T. · 44F · MRN MRN-011477
Scheduled May 9, 2026 · 9:30 PM
Failed criterion
Conventional imaging attempted or insufficient
CT chest/abd/pelvis completed; bone scan not attempted prior to PET/CT request.
Suggested talking points
- 1.NCCN BINV-1 footnote h supports PET/CT over bone scan in clinically N1+ breast cancer.
- 2.Tumor board consensus: PET/CT will determine neoadjuvant vs. adjuvant pathway.
- 3.Bone scan + diagnostic CT is two studies vs. one PET/CT — equivalent radiation, longer time-to-treatment.
05/10 · 14:30 UTC
In 2.0d
Transcranial Magnetic Stimulation — 36-session course
UHC · CPT 90867 · AUT-2026-00193
Reviewer
Dr. K. Iyer, Optum BH
vs. Dr. Lucia Franco, MD
Patient
Okafor, E. · 47M · MRN MRN-013002
Scheduled May 10, 2026 · 2:30 PM
Failed criterion
≥2 prior antidepressants from different classes failed
Reauth — second medication trial duration documented at 8w vs. policy 10w.
Suggested talking points
- 1.Bupropion XL 450mg titrated to therapeutic dose at week 2; effective trial duration ≥8 weeks per FDA label.
- 2.PHQ-9 trajectory 22 → 21 → 19 indicates inadequate response despite therapeutic dose.
- 3.Continued failure on second agent satisfies treatment-resistant depression criterion functionally.