Amusing Radiographic Discriptions...

[drusso]

I just read one today that said, "the lumbosacral canal is roomy." That's nice. Maybe put couch over in the lateral recess and a nice hanging lamp behind the lamina. You know, spruce the place up a little....

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[PMR 4 MSK]

I just read one today that said, "the lumbosacral canal is roomy." That's nice. Maybe put couch over in the lateral recess and a nice hanging lamp behind the lamina. You know, spruce the place up a little....

 

[facets]

I just got a report on a patient who had radiculitis and went to an interventional radiologist. The report said he did a transforaminal at L4 with a facet injection on the way in, (?? any reason besides 2 fees, why do a facet at the same level as the transforaminal) at L4 he injected 10 cc of contrast, yes 10 cc, 60 mg of kenalog, marcaine undisclosed amount, all under MRI or CT. The patient was dismissed and collapsed in the parking lot, duh, marcaine. She has had severe pain since and foot drop. I'm more angry than amused, does he have any clue what he is doing to the patients and our speciality? The patient wnated to know why I work under fluro instead of a scanner, what could I say, because he owned the unit but the whole thing was unneccessary. I have thought of reported him to medicare but he is another physician. What would you guys do?

 

[SSdoc33]

The report said he did a transforaminal at L4 with a facet injection on the way in

nice. i like that. like a surgeon saying "i was going to do a cholecycstectomy, but i took out the appendix on the way in. i mean, hey, i was already there, right?"

 

[mdvol]

Probably went into the joint while trying to get into the foramen, did't know until he started some of that 10cc's and then decided to bill for that too.

 

[TX PAIN DOC]

I just got a report on a patient who had radiculitis and went to an interventional radiologist. The report said he did a transforaminal at L4 with a facet injection on the way in, (?? any reason besides 2 fees, why do a facet at the same level as the transforaminal) at L4 he injected 10 cc of contrast, yes 10 cc, 60 mg of kenalog, marcaine undisclosed amount, all under MRI or CT.

He needed that much contrast while working with a CT/MRI scanner??
Good thing he did not use a c-arm or he might have needed 20 cc.

I don't know about reporting him to medicare without more facts, but I would call him to try to understand what he did and why (other than the obvious). Especially, if I was taking over the care of the patient.

 

[lobelsteve]

Big deal. Just reviewed a case where the injectate for the L4-5 series of 3 was 7cc Depomedrol and 2cc lidocaine. Yup, 280mg per week. At least he went easy when doing her bursa at 120mg.

 

[PMR 4 MSK]

Big deal. Just reviewed a case where the injectate for the L4-5 series of 3 was 7cc Depomedrol and 2cc lidocaine. Yup, 280mg per week. At least he went easy when doing her bursa at 120mg.

As I've posted before, one of the "leaders" for pain in my town, who has served on the boards of several national pain orgs, routinely gives everyone 5 cc of 80 mg/cc depomedrol for ESI, FJI, even MBB. One pt received 1600 mg over a few months.