I recently moved out East and have been ordering post-op spine MRIs without and with contrast (as I always have). I am getting pushback from insurance companies and radiologists about this - they want a plain MRI or a different Dx code. First of all, am I missing something regarding ordering post-op spine MRIs with contrast? I though we wanted to discern scar tissue from HNP. Did something change and I don't know about it? Secondly, if it is still recommended to order with contrast, what codes would work? Thx.
Spine MRI without/with contrast denials
- Thread starter knoxdoc
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May just need a line in your note saying it's medically necessary to discern reherniation v scar tissue
i stopped getting the post op MRIs with contrast about 5 years ago. i guess if you are looking for the scar tissue for potential SCS, but it doesnt seem to add that much, IMHO. most of the surgeons dont order them with contrast. plus you have to worry about the kidneys.
that being said, i havent noticed a difference in coverage with MRIs if you order contrast or not
that being said, i havent noticed a difference in coverage with MRIs if you order contrast or not
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Agree with this approach.
I have definitely found contrast MRIs harder to authorize.
I now order 99% of my spine MRI without contrast. I only order MRIs with contrast if I have specific concern for malignancy or infection.
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Yes, I order ct myelograms on everyone and make sure they book the myelo on my schedule so I can get those units.
J/k. 😂
J/k. 😂
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Contrast really not that helpful. How will it change your plans?
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Changes everything Steve. Surgery for recurrent disc vs stim for intractable epidural fibrosis.
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Recurrent disc doesn’t mean surgery.
And:
Routine use of contrast-enhanced examinations in patients who have had prior lumbar surgery probably adds little diagnostic value and may be confusing.
Magnetic Resonance Evaluation of Recurrent Disc Herniation: ... : Spine
enters now routinely use gadolinium-enhanced examinations in the evaluation of recurrent disc herniation. Others, noting the additional expense of contrast injection, advocate a more limited role for contrast injection and emphasize the importance of T2-weighted axial sequences. Methods. The...
journals.lww.com
The radiology guidelines suggest doing it in the first 6 months but after that probably not as useful in that 2 year+ range.Recurrent disc doesn’t mean surgery.
And:
Routine use of contrast-enhanced examinations in patients who have had prior lumbar surgery probably adds little diagnostic value and may be confusing.
Magnetic Resonance Evaluation of Recurrent Disc Herniation: ... : Spine
enters now routinely use gadolinium-enhanced examinations in the evaluation of recurrent disc herniation. Others, noting the additional expense of contrast injection, advocate a more limited role for contrast injection and emphasize the importance of T2-weighted axial sequences. Methods. The...
Differentiating epidural fibrosis from disc herniation on contrast-enhanced and unenhanced MRI in the postoperative lumbar spine - PubMed
Gad-MR images compared with unenhanced MRI improved diagnostic confidence and agreement in differentiating epidural fibrosis from disc herniation for both observers in the first 6 months and for one observer in the first 18 months after lumbar spine surgery. After 18 months, Gad-MR images...
pubmed.ncbi.nlm.nih.gov
