Academy of Chiropractic

Quickie Podcast 1312
Clinical Information 303 CI

From the Desk of Dr. Mark Studin
Academy of Chiropractic

Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006

MRI is Bad, When Should I do Another



Dr. Studin: Good morning. What's going on?


Guest: I inherited a patient that came in with a MRI on a stand up 0.6 Tesla open. the quality is not nondiagnostic for me.


Dr. Studin: It sucks. My lots of say it sucks. Is that permissible?


Guest: I don't know.


Dr. Studin: Um, so you're saying that it's missing information. So you did not refer this patient in, it was referred by someone else, correct?


Guest: Correct.


Dr. Studin: Okay. And so the question is, should you do it, have it done again or not, right?


Guest: Exactly.


Dr. Studin: Well, here's the arbiter, the arbiter is always, and a 0.6, sometimes you can get enough information off of there and sometimes you can't and sometimes, you know, you're looking at the sash and the slices are off. You don't get enough cuts at the desk. Sometimes you could go to the axial and you could scroll out for the neural canals and you could see if the disc is herniated at that level. There's always, there's always multiple ways to determine if this pathology or not. If after that entire exercise, you feel that it's not, that it's not diagnostic or substandard, which it is it's that the images acquired did not, um, did not cover the area of pathology and an additional MRI is now required to do that. But then you're going to have to call the carrier. Is this a PI case?


Guest: Correct.


Dr. Studin: So, then you're going to have to call a New York it's the no-fault carrier and six other States. And then every other state is the PI carrier in New York. You do not need approval for that. You could just do it, but the imaging center, um, might have to take it on the chin and you need to let them know it was done someplace else and write a very strong letter of necessity. So, they'll keep accepting your referrals because they don't want to work for free. Also, you understand?


Guest: Correct.


Dr. Studin: So, if you feel it's non-diagnostic or it doesn't cover the areas you need, then you should, I would order another MRI. As long as the additional MRI will change your diagnosis or prognosis or treatment plan. If it won't do any of those things, then what's the point. You know, you don't do it to screen to make a lawyer happy. You don't do it just because it didn't catch a disc area, which really didn't look like it was herniated. Anyhow, only if it will change something. And then that's what you're going to have to write up in your letter of necessity. And that's going to be a lengthy one that you're going to have to dictate as to why you're doing it. Did I answer that question that you need more?


Guest: Nope, you did. Thank you.


Dr. Studin: Okay. Later, alligator. Bye.


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