order MRI without formal consultation?

[ctts]

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Just wanted to see what you all think of this situation...

I go to a CrossFit gym, and while I haven't advertised anything, some people know that I'm a pain doc... So a girl I know at the gym described to me what sounds like a classic L5 radic pattern of pain. Intermittent and at times severe. She is still able to workout, but there are times when she is unable to lift heavy weights. My main quesetion is, in this situation, is it ok for me to just order an MRI for her? Or do I need her to come in to my office for a formal consultation so that I can do proper documentation, before ordering the MRI?

The same situation occured with another guy I know at the gym...and I just ordered an MRI without having him come in (he had a large L4-5 disc extrusion). You see, the gym is pretty small, and so we see each other all the time, and we all get to know each other. So I feel bad to make them come in if they don't really have to... I think the proper thing would be to have them come in for formal consultation, but in these particular cases, I think it wouldn't change the fact that I would probably get an MRI. It seems like this might not be the last time this situation comes up, so I want to try to be more clear on how I should handle this in the future.

It's interesting too, that in the case of the first guy, insurance did not balk at all without any documentation. Yet sometimes, I request an MRI with documentation, and MRI gets denied. What's the deal? I guess it just depends on the insurance?

 

[SSdoc33]

Just wanted to see what you all think of this situation...

I go to a CrossFit gym, and while I haven't advertised anything, some people know that I'm a pain doc... So a girl I know at the gym described to me what sounds like a classic L5 radic pattern of pain. Intermittent and at times severe. She is still able to workout, but there are times when she is unable to lift heavy weights. My main quesetion is, in this situation, is it ok for me to just order an MRI for her? Or do I need her to come in to my office for a formal consultation so that I can do proper documentation, before ordering the MRI?

The same situation occured with another guy I know at the gym...and I just ordered an MRI without having him come in (he had a large L4-5 disc extrusion). You see, the gym is pretty small, and so we see each other all the time, and we all get to know each other. So I feel bad to make them come in if they don't really have to... I think the proper thing would be to have them come in for formal consultation, but in these particular cases, I think it wouldn't change the fact that I would probably get an MRI. It seems like this might not be the last time this situation comes up, so I want to try to be more clear on how I should handle this in the future.

It's interesting too, that in the case of the first guy, insurance did not balk at all without any documentation. Yet sometimes, I request an MRI with documentation, and MRI gets denied. What's the deal? I guess it just depends on the insurance?

#1 have the pt get the MRI thru their PCP. you dont have a professional relationship with them yet. if that cant happen, then they need to come see you.

#2 find a new gym. seems everyone there has a disc herniation.

 

[emd123]

The biggest thing is generating a chart. You have no med mal coverage if there is no chart (ie, patient gets MRI, tumor seen, moves away, never follows up, greedy half brother decides to sue you, whatever).

If you want to be nice, make the visit quick, generate a quick chart, and no charge them.

You are such good friends, but they can't swing by the office to have their reflexes checked for 5 minutes?

What is an MRI good for without follow up anyways?

 

[Ducttape]

not only are you legally liable for the results...

some PCPs are now already in managed care plans and may get very upset if the patient sees you without going through them, or has an MRI scan essentially without their permission.

 

[mid|ine]

#2 find a new gym. seems everyone there has a disc herniation.

Sounds like the perfect gym to be at. Set up an eval clinic there once a month to drum up business!

 

[ctts]

Thanks everyone so far for your replies.

I knew I would get some interesting remarks, especially about CrossFit!

She definitely doesn't have a problem coming to see me. I was trying to be nice...she didn't even ask for any special favors. But I can see how this could potential create trouble (duh...I guess I just needed to hear it from others). I will have her come in then. My office managers probably won't let me no charge her, but if she should have insurance so should be fine.

CrossFit is interesting....before I started, I heard lots of negative things about it, especially in regards to risk of injury. Sure enough, I feel like I now have a mild left S1 radic. Nothing so bad that I've felt a need to get treatment or imaging, but I know something is there. I have been doing CF for a year, but I still always struggle with the idea of it... Sure it can cause disc herniations, especially with poor technique, but so can bending over and tying your shoe laces or sneezing. The first guy I mentioned with the L4-5 disc extrusion...he keeps on going at it, and he's a beast in the gym. Someyhow he just manages his symptoms on his own. Hasn't even needed an ESI yet. As we know, having a disc herniation does not always result in major pain or loss of function... At the same time, while we may be ok when we are young or relatively young (I'm 34), I wonder if minimally symptomatic disc herniations (esecially large ones) that are sustained when younger necessarily means more problems when we are older... Despite all this, and how tough the workouts are, I enjoy it and feel good doing it, so I plan to keep going for now. I also feel like my personal physical struggles with CF helps me to be a better physician in being able to relate to my patients.

 

[Ligament]

Another example of lawyers crippling us and turning us into *******. Yes you can order the MRI. And yes you would be responsible for fu

 

[lobelsteve]

I have downloadable forms. She could fill one out and at the gym on her phone and I'd order the MRI on the spot. Results are coming to me anyways as ordering so not following up is not a possibility.

 

[bedrock]

Another example of lawyers crippling us and turning us into *******. Yes you can order the MRI. And yes you would be responsible for fu

Agree with the lawyer sentiment.

However, I also feel that people don't value our time as they should. If someone wants medical care, even a gym-friend, they should make an appt and pay their co-pay.

I was raised that it was quite rude just walk up to your doctor/dentist in the street and try to get free medical advice, so I don't tolerate this sort of thing at all.
It took a lot of hard work and 13 years of sacrifice to obtain my education, so I don't feel its a burden for these folks to take an hour out of their day, and come to my office for a proper appt, for which I am reimbursed!

 

[pmrmd]

I would have ordered the MRI-L just because I am not scared of an attorney or some hypothesis of a crazy half brother suing me. If you see the person routinely and they are a quasi-friend then why not? You will not be perceived as in it for the buck and people respect that.

 

[Jcm800]

I would have ordered the MRI-L just because I am not scared of an attorney or some hypothesis of a crazy half brother suing me. If you see the person routinely and they are a quasi-friend then why not? You will not be perceived as in it for the buck and people respect that.

I have also done it in these situations.

 

[knoxdoc]

You can order it, but will it need pre-auth? How are you going to get around that mess? Have them come in and make it official.

I think I'd back off the cocktail party medicine. I have a partner who does that and he gets cell phone calls all the time because he is so "accessible". Patients think they can't get their injection or med refills at the drop of a hat, whenever its convenient for them. Its like treating a bunch of physician spouses. No thanks.

 

[Ducttape]

I'm sorry, but doesn't CMS require a medical record including intent to treat and details to justify the treatment? Will ordering an MRI without such a medical record (for care/caid) be viewed as fraud?

 

[DOctorJay]

What are you going to do with the information obtained? You already know what it's going to show.

 

[specepic]

I find that almost everytime I do a pt a 'favor' it bites me in the ass. This usually takes the form of "do I really need an OV or can I come in for the injection". Then they show up to day surgery with a bunch of questions, need a rx RF, and now there R leg hurts instead of their L leg typical pain, and btw I fell last week can you look at my neck.

Now, do I go above and beyond for my pts, I def do, but I'd rather do all that stuff at a OV than in the middle of a tight OR schedule.

I just tell the curbsiders I the grocery store that they need to make an appt

 

[Axehandler]

Just wait until the insurance company or the radiology facility call trying to prior authorize the MRI, no chart you are not going to get it approved.
I think you set yourself up for awkward situations when you don't set the professional tone right from the beginning. When patients know they are getting "special" treatment they tend to push the limits.

 

[PinchandBurn]

OP-

just tell the person, 'nowadays with all the strict regulations, insurance companies wont let me order these things unless you are a patient of record. I feel bad, but these are the rules". That way you dont look like the meanie. If they choose to follow up and be a patient of yours, then you can No Charge them if you like.

 

[dc2md]

Just wanted to see what you all think of this situation...

I go to a CrossFit gym, and while I haven't advertised anything, some people know that I'm a pain doc... So a girl I know at the gym described to me what sounds like a classic L5 radic pattern of pain. Intermittent and at times severe. She is still able to workout, but there are times when she is unable to lift heavy weights. My main quesetion is, in this situation, is it ok for me to just order an MRI for her? Or do I need her to come in to my office for a formal consultation so that I can do proper documentation, before ordering the MRI?

Depends how attractive she is.

But seriously, I'd just say "I'd love to do that, but legally I have to see you in the clinic and do a full consultation"