4 17 1 18 34 4 38 18 2 20 gastroenterology 167 12 179 2328 ... · presenting with a sudden change...

9/01/2015 -09/30/2015

Sum of auth_count Column LabelsRow Labels Approval Disapproval Grand TotalAdvanced Practice Registered Nurse 58 18 76Allergy & Immunology 4 4Anesthesiology 87 23 110Cardiac Surgery 17 1 18Cardiology 549 39 588Chiropractic Medicine 34 4 38Colon & Rectal Surgery 9 2 11Doctors and Rehabilitation 51 18 69Emergency Medicine 22 12 34Endocrinology 18 2 20Gastroenterology 167 12 179General/Family Practice 2328 433 2761Gynecologic Oncology 10 10Hematologist/Oncologist 842 62 904Hospital 1 1Infectious Diseases 7 2 9Internal Medicine 458 75 533Interventional Radiologists 4 4Nephrology 11 11Neurological Surgery 358 41 399Neurology 415 35 450OB/Gynecology 72 2 74Oncology 8 1 9Ophthalmology 26 26Orthopedics 1059 86 1145Osteopath 1 1Other 17 8 25Otolaryngology 259 9 268Pediatrics 72 8 80Plastic Surgery 3 2 5Podiatry 46 8 54Pulmonary Medicine 111 5 116Radiation Oncology 28 4 32Radiology 8 8Rehabilitations 9 5 14Rheumatology 68 17 85Sports Medicine 3 3Surgery 154 7 161Surgical Oncology 19 1 20Thoracic Surgery 14 14Unknown 167 41 208Urology 254 9 263Vascular Surgery 13 13

Geriatrics 1 1Occupational Medicine 2 2Psychiatry 1 1 2Ambulatory/Walk-in Clinic 1 1Free Standing Surgery Center 2 2Obstetrics & Gynecology 2 2Oral/Maxillofacial 1 1Physical Medicine 2 2Grand Total 7871 995 8866

spec_name min_outcome diag_proc reason_for_denial indication_offered auth_count

Advanced Practice Registered Nurse Approval 70450 CT BRAIN, HEAD

This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness." 1

Advanced Practice Registered Nurse Approval 70480 CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC. "This request is for orbit,sella, int. auditory canal,temporal bone, mastoid, CT.239.8"; "There is suspicion of bone infection, cholesteoma, or inflammatory disease.ostct" 1

Advanced Practice Registered Nurse Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST

This is a request for neck soft tissue CT.; There has not been recent trauma or other injury to the neck.; There is suspicion of or known tumor, metastasis, lymphadenopathy, or mass. 1

Advanced Practice Registered Nurse Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; unknown; It is not known if there has been any treatment or conservative therapy.; unknown; < Enter answer here - or Type In Unknown If No Info Given. > 1

Advanced Practice Registered Nurse Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is presenting with a sudden change in severity, associated with exertion, or a mental status change. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; There recent neurological deficits on exam such as one sided weakness, speech impairments or vision defects. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is associated with headache, blurred or double vision or a change in sensation noted on exam. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing vertigo; The condition is associated with headache, blurred or double vision or a change in sensation noted on exam. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested due to trauma or injury.; There are new, intermittent symptoms or deficits such as one sided weakness, speech impairments, or vision defects. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 4/3/2015; There has been treatment or conservative therapy.; physical therapy , heat therapy , pain medications , anti inflammatory; numbness , weakness , swelling , tingling , tremors , severe headaches , blurry vision , hypo esthesia , in left c6 distribution; to r/o MS 1

Advanced Practice Registered Nurse Approval 71250 CT CHEST, THORAX

A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There IS evidence of a lung, mediastinal or chest mass noted within the last 30 days." 1

Advanced Practice Registered Nurse Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST

This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is a reason why the patient cannot have a Cervical Spine MRI.; This study is being ordered due to chronic neck pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of Lower extremity weakness. 1

Advanced Practice Registered Nurse Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks.; No, this patient did not have a recent course of supervised physical Therapy.; The patient has failed a course of anti-inflammatory medication or steroids. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; yes, there is a documented evidence of extremity weakness on physical examination. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 4/3/2015; There has been treatment or conservative therapy.; physical therapy , heat therapy , pain medications , anti inflammatory; numbness , weakness , swelling , tingling , tremors , severe headaches , blurry vision , hypo esthesia , in left c6 distribution; to r/o MS 1


This study is being ordered for trauma or injury.; Patient states that she fell on 12/9/14 and hit right hip.; There has been treatment or conservative therapy.; Patient has been seeing a chiropractor with no improvement. Has also tried Aleve/Ibuprofen.; ; Lumbar Spine/Lower back: INSPECTION: tender right SI joint, also palpable mass/spasm?? left SI area, mobile, tender. STRAIGHT LEG RAISING TEST: equivocal. REFLEXES: left 2+, right diminshed, difficult to ellicit. Cervi 1

Advanced Practice Registered Nurse Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does have new signs or symptoms of bladder or bowel dysfunction. 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; It is not known if the patient has completed 6 weeks of physical therapy?; The patient has been treated with medication.; other medications as listed.; inceds, muscle relaxers, aspirin, steroids; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has not directed a home exercise program for at least 6 weeks.; history of gastric ulcers 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has 6 weeks of completed conservative care in the past 3 months or had a spine injection 6

Advanced Practice Registered Nurse Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 1


This study is being ordered for trauma or injury.; Patient states that she fell on 12/9/14 and hit right hip.; There has been treatment or conservative therapy.; Patient has been seeing a chiropractor with no improvement. Has also tried Aleve/Ibuprofen.; ; Lumbar Spine/Lower back: INSPECTION: tender right SI joint, also palpable mass/spasm?? left SI area, mobile, tender. STRAIGHT LEG RAISING TEST: equivocal. REFLEXES: left 2+, right diminshed, difficult to ellicit. Cervi 1

Advanced Practice Registered Nurse Approval 72192 CT PELVIS WITHOUT CONTRAST

This is a request for a Pelvis CT.; This study is being ordered because of a suspicious mass/ tumor.; There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor.; "The patient has had a pelvic ultrasound, barium, CT, or MR study."; unknown 1

Advanced Practice Registered Nurse Approval 73200 CT ARM OR UPPER EXTREMITY

This is a request for an upper extremity, shoulder, scapula, elbow, hand, or wrist joint CT.; There is not a history of upper extremity joint or long bone trauma or injury.; This is not a preoperative or recent postoperative evaluation.; There is not suspicion of upper extremity neoplasm or tumor or metastasis.; There is not suspicion of upper extremity bone or joint infection.; The ordering physician is not an orthopedist or rheumatologist. 2

Advanced Practice Registered Nurse Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT

This study is being ordered for trauma or injury.; 9-13-2015; There has not been any treatment or conservative therapy.; Pain, swelling and impaired circulation to hand.; Pt fell. 1

Advanced Practice Registered Nurse Approval 73221 MRI JOINT OF UPPER EXTREMITY

The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has completed and failed a course of conservative treatment of at least 4 weeks.; The ordering physician is not an orthopedist.; There is documented findings of severe pain on motion. 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from a recent injury.; There is not a suspicion of tendon, ligament, rotator cuff injury or labral tear.; There is not a suspicion of fracture not adequately determined by x-ray.; Surgery or arthrscopy is scheduled in the next 4 weeks. 1


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There has has been a history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has not experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1


This study is being ordered for trauma or injury.; 9-13-2015; There has not been any treatment or conservative therapy.; Pain, swelling and impaired circulation to hand.; Pt fell. 1

Advanced Practice Registered Nurse Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Swelling greater than 3 days 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Yes, there is a known trauma involving the knee.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were normal. 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Yes, there is a known trauma involving the knee.; Swelling greater than 3 days 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; It is not known if there is a suspected meniscus, tendon, or ligament injury.; There is not a suspicion of fracture not adequately determined by x-ray.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from an old injury.; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 1


This is a request for a lower extremity MRI.; This is not a pulsatile mass.; "There is no evidence of tumor or mass from a previous exam, plain film, ultrasound, or previous CT or MRI."; There is not a suspicion of an infection.; The patient is not taking antibiotics.; This is not a study for a fracture which does not show healing (non-union fracture).; This is not a pre-operative study for planned surgery. 1

Advanced Practice Registered Nurse Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT

This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the hip other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has been treated with and failed a course of supervised physical therapy. 1

Advanced Practice Registered Nurse Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT

This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the hip other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has been treated with and failed a course of supervised physical therapy. 1

Advanced Practice Registered Nurse Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered for a suspicious mass or tumor.; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are no new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; There is not a suspicion of an adrenal mass.; This is not a request to confirm a suspicious renal mass suggested by physical exam, lab studies, IVP or ultrasound.; sever acute abdominal pain in left upper quadrat 1

Advanced Practice Registered Nurse Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; < Enter answer here - or Type In Unknown If No Info Given. > 1

Advanced Practice Registered Nurse Approval 74176 CT ABD & PELVIS W/O CONTRAST 1

Advanced Practice Registered Nurse Approval 74176 CT ABD & PELVIS W/O CONTRAST

This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis. 2

Advanced Practice Registered Nurse Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; There is a known or a strong suspicion of kidney or ureteral stones. 3


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; <Enter Additional Clinical Information> 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; 2 weeks mild achiness/pinching off and on at one point on abdomen, associated with increased gas, increased BM's from 2 to 3-4 daily. Pt wondering if his hernias are causing problems or affecting his GI tract. 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Left lower quadrant inflammatory process is raised, pain 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; r/o diverticulitis 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; tenderness in left lower quad. Very painful. hurts when he has a bowel movement also, possible hernia palpated. noticed pain about 2 years ago but would come and go, has been constant over past couple of weeks and worse when baring down to have a BM. 1


This is a request for an abdomen-pelvis CT combination.; Pre-op or post op evaluation; The requested study is for post-operative evaluation.; The requested study is a first follow up study for a post operatove complication. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is male.; A rectal exam was not performed.; Carlos Smith is a 32 y.o. Male who is well known to the trauma clinic from a GSW to the abdomen on 7/21 that required exploratory laparotomy and right hemicolectomy with primary anastomosis with ileocolonic reconstruction and repair of serosal tear x 1. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient had an lipase lab test.; The results of the lab test were unknown.; A urinalysis has not been completed.; Auscultation - hypoactive bowel sounds. Anterior palpation - tenderness, epigastric, right mid & lower quadrant. ABDOMINAL PAIN,CONSTIPATION,NAUSEA,RIGHT MID TO LOWER ABD PAIN,FOLLOW UP CROHNS DISEASE 1

Advanced Practice Registered Nurse Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; < Enter answer here - or Type In Unknown If No Info Given. > 1

Advanced Practice Registered Nurse Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1993 , recent worsening systems; There has been treatment or conservative therapy.; muscle relaxer tramadall; pain headaches neck /shoulder pain, worse at night; none 1

Advanced Practice Registered Nurse Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; unknown; It is not known if there has been any treatment or conservative therapy.; unknown; < Enter answer here - or Type In Unknown If No Info Given. > 1

Advanced Practice Registered Nurse Disapproval 70540 MRI ORBIT/FACE/NECK W/O DYE Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; It is not known if there has been any treatment or conservative therapy.; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1

Advanced Practice Registered Nurse Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; The symptoms began ~10 years ago. The symptoms are reported as being moderate. The symptoms occur daily. The location is feet, legs. Aggravating factors include unknown. Relieving factors include lyrica 150 mg two times a day, but it is not helping a lot.; There has been treatment or conservative therapy.; lovastatin 20 mg tablet take 1 tablet by oral route every day with the evening meal 02/23/2014 Prozac 20 mg capsule take 1 capsule by oral route every day in the morning 03/25/2014 Lyrica 75 mg capsule take 2 capsules (150MG) route 2 ti; ; HIs L spine MRI did not indicate a spinal stenosis or HNP and he says the pain is deep and occurred when he fell off the bed on his tail bone, I have to wonder if he has a piriformis syndrome or tailbone injury. We will contact ortho for an idea. He d 1

Advanced Practice Registered Nurse Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary


Advanced Practice Registered Nurse Disapproval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1993 , recent worsening systems; There has been treatment or conservative therapy.; muscle relaxer tramadall; pain headaches neck /shoulder pain, worse at night; none 1

Advanced Practice Registered Nurse Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; The symptoms began ~10 years ago. The symptoms are reported as being moderate. The symptoms occur daily. The location is feet, legs. Aggravating factors include unknown. Relieving factors include lyrica 150 mg two times a day, but it is not helping a lot.; There has been treatment or conservative therapy.; lovastatin 20 mg tablet take 1 tablet by oral route every day with the evening meal 02/23/2014 Prozac 20 mg capsule take 1 capsule by oral route every day in the morning 03/25/2014 Lyrica 75 mg capsule take 2 capsules (150MG) route 2 ti; ; HIs L spine MRI did not indicate a spinal stenosis or HNP and he says the pain is deep and occurred when he fell off the bed on his tail bone, I have to wonder if he has a piriformis syndrome or tailbone injury. We will contact ortho for an idea. He d 1

Advanced Practice Registered Nurse Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; Sept 2014; There has been treatment or conservative therapy.; physical therapy, medications and flexeril, Mobic; pain; < Enter answer here - or Type In Unknown If No Info Given. > 1

Advanced Practice Registered Nurse Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; UNKNOWN; There has been treatment or conservative therapy.; MEDICATIONS, PHYSICAL THERAPY; Patient has shooting pain down bilateral legs and sometimes just in left thigh area but also has pain that radiates into left calf and knee.; Patient had x-ray that showed mild scoliosis however has not any further diagnostic testing done to rule out nerve damage. 1

Advanced Practice Registered Nurse Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; Sept 2014; There has been treatment or conservative therapy.; physical therapy, medications and flexeril, Mobic; pain; < Enter answer here - or Type In Unknown If No Info Given. > 1

Advanced Practice Registered Nurse Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; < Enter answer here - or Type In Unknown If No Info Given. > 1

Advanced Practice Registered Nurse Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Pt has leg numbness on the left side 1

Advanced Practice Registered Nurse Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; UNKNOWN; There has been treatment or conservative therapy.; MEDICATIONS, PHYSICAL THERAPY; Patient has shooting pain down bilateral legs and sometimes just in left thigh area but also has pain that radiates into left calf and knee.; Patient had x-ray that showed mild scoliosis however has not any further diagnostic testing done to rule out nerve damage. 1

Advanced Practice Registered Nurse Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is not from a recent injury, old injury, chronic pain or a mass.; 1

Advanced Practice Registered Nurse Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an abdomen-pelvis CT combination.; Organ Enlargement; There is no evidence of organ enlargement on ultrasound, plain film, or IVP.; Nausea; splinting of left upper quad 1

Advanced Practice Registered Nurse Disapproval 74181 MRI ABDOMEN Radiology Services Denied Not Medically Necessary


Advanced Practice Registered Nurse Disapproval 93350 ECHO TTHRC R-T 2D -+M-MODE COMPLETE REST&STRS Radiology Services Denied Not Medically Necessary

This is a request for a Stress Echocardiogram.; The member does not have known or suspected coronary artery disease; None of the listed reasons for the study were selected 1

Allergy & Immunology Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST 2

Allergy & Immunology Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST

This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as Chronic Rhinosinusitis (episode is greater than 12 weeks) 1

Allergy & Immunology Approval 71250 CT CHEST, THORAX 1

Ambulatory/Walk-in Clinic Approval 74176 CT ABD & PELVIS W/O CONTRAST

This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is requested for hematuria.; The hematuria is due to Renal Calculi/kidney/ ureteral stone. 1

Anesthesiology Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST 2Anesthesiology Approval 72131 CT LUMBAR SPINE, LOW BACK 2

Anesthesiology Approval 72131 CT LUMBAR SPINE, LOW BACK

This is a request for a lumbar spine CT.; The patient does not have a history of severe low back trauma or lumbar injury.; This is not a preoperative or recent postoperative evaluation.; This study is not part of a myelogram or discogram.; The patient is experiencing symptoms of radiculopathy for six weeks or more. 2

Anesthesiology Approval 72131 CT LUMBAR SPINE, LOW BACK This is a request for a lumbar spine CT.; The patient has a history of severe low back trauma or lumbar injury. 3

Anesthesiology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 2

Anesthesiology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient demonstrate neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks.; It is not known if this patient had a recent course of supervised physical Therapy.; The patient has failed a course of anti-inflammatory medication or steroids. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks.; Yes, this patient had a recent course of supervised physical Therapy. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; There has been a supervised trial of conservative management for at least 6 weeks.; Yes, this patient had a recent course of supervised physical Therapy. 1



Anesthesiology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Neurological deficits; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 1


This study is being ordered for a neurological disorder.; 04/2015; There has been treatment or conservative therapy.; Pt has been taking endomethacin and flexeril and doing exercises; NECK AND LOW BACK pain radiates to the LEFT ARM AND LEG. The pain is described as ACHING, TINGLING, SHOOTING. The pain is better with REST. The pain is worse with PROLONGED SITTING.; 1


This study is being ordered for a neurological disorder.; 2011; There has been treatment or conservative therapy.; massage therapy; numbness and tingling in all four extremities, lbp radiating in both legs, bilateral shoulder pain going into arms, weakness, bowel/bladder dysfunction; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; JANUARY 2015; There has been treatment or conservative therapy.; HAS TRIED NORCO 5, 7.5 AND 10MG, GABAPENTIN, VICOPROFEN, SACROILIAC JOINT INJECTIONS; CHRONIC NECK AND BACK PAIN. SOME NUMBNESS IN FEET.; HAS HAD A SERIES OF SACROILIAC JOINT INJECTIONS WITHOUT MUCH RELIEF. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1990; There has not been any treatment or conservative therapy.; Chronic low back and neck pain; Radiate down right leg to knee occasionally to foot, numbness and tingling in both hands 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2014; There has been treatment or conservative therapy.; X-RAY'S, CHIROPRATIC THERAPY, FLEXERIL, TRAMADOL, OTC PAIN CREAMS, PHYSICAL THERAPY; NECK AND BACK PAIN; 1

Anesthesiology Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST 1

Anesthesiology Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does not have any neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks. 1

Anesthesiology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 15

Anesthesiology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 3


The study requested is a Lumbar Spine MRI.; None of the above; It is not known if the patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has had back pain for over 4 weeks.; MDO bypassed the clinical questions. 1



Anesthesiology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 2


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has completed Treatment with a facet joint or epidural injection in the past 6 weeks 1

Anesthesiology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 4

Anesthesiology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; chronic lower back pain 1


This study is being ordered for a neurological disorder.; 04/2015; There has been treatment or conservative therapy.; Pt has been taking endomethacin and flexeril and doing exercises; NECK AND LOW BACK pain radiates to the LEFT ARM AND LEG. The pain is described as ACHING, TINGLING, SHOOTING. The pain is better with REST. The pain is worse with PROLONGED SITTING.; 1


This study is being ordered for a neurological disorder.; 2011; There has been treatment or conservative therapy.; massage therapy; numbness and tingling in all four extremities, lbp radiating in both legs, bilateral shoulder pain going into arms, weakness, bowel/bladder dysfunction; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; JANUARY 2015; There has been treatment or conservative therapy.; HAS TRIED NORCO 5, 7.5 AND 10MG, GABAPENTIN, VICOPROFEN, SACROILIAC JOINT INJECTIONS; CHRONIC NECK AND BACK PAIN. SOME NUMBNESS IN FEET.; HAS HAD A SERIES OF SACROILIAC JOINT INJECTIONS WITHOUT MUCH RELIEF. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1990; There has not been any treatment or conservative therapy.; Chronic low back and neck pain; Radiate down right leg to knee occasionally to foot, numbness and tingling in both hands 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2014; There has been treatment or conservative therapy.; X-RAY'S, CHIROPRATIC THERAPY, FLEXERIL, TRAMADOL, OTC PAIN CREAMS, PHYSICAL THERAPY; NECK AND BACK PAIN; 1

Anesthesiology Approval 72192 CT PELVIS WITHOUT CONTRAST

This is a request for a Pelvis CT.; This study is being ordered due to known or suspected infection.; "The ordering physician is NOT a surgeon, gynecologist, urologist, gastroenterologist, or infectious disease specialist or PCP ordering on behalf of a specialist who has seen the patient."; "Caller does not know if there are physical findings or abnormal blood work consistent with peritonitis, pelvic inflammatory disease, or appendicitis."; "The caller does not know whether there are active, clinical findings or endoscopic findings of Crohn's disease, ulcerative colitis, or diverticulitis."; "Caller does not know whether there are radiographical or ultrasound findings consistent with abnormal fluid collection, pelvic abscess, pelvic inflammation or ascites."; LOW BACK PAIN, CONSTANT, THROBBING THAT RADIATES INTO FOOT 1

Anesthesiology Approval 72196 MRI PELVIS 1Anesthesiology Approval 73221 MRI JOINT OF UPPER EXTREMITY 2

Anesthesiology Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; unknown; wants to evaluate because he is having post surgical symptoms 1




This is a request for cervical spine MRI; None of the above; It is not known if the patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has had back pain for over 4 weeks.; 1


This is a request for cervical spine MRI; Trauma or recent injury; No, the patient does not have new or changing neurological signs or symptoms.; MVA in 2015, no imaging, pain w/o relief 1

Anesthesiology Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1990; There has been treatment or conservative therapy.; physical therapy/medication therapy; pain down left leg to knee into foot/constant shooting pain/numbness and tingling in both hands/has problem gripping on to objects; unknown 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 20+yrs; There has been treatment or conservative therapy.; chiro care, meds, home exercise; chronic spinal pain and joint pain, numbness and tingling,; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; HAD FOR SEVERAL YEARS started in 1996; There has been treatment or conservative therapy.; physical therapy and injections on pain medications; neck and lower back pain neck pain radiates to both of his arms; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for trauma or injury.; 02/24/13; There has been treatment or conservative therapy.; Patient has had two sessions of phyical therapy, epidural steroid injection for neck and right shoulder, pain medication therapy and every the patient has tried has not helped.; right shoulder pain and cervical pain; Patient has had two sessions of phyical therapy, epidural steroid injection for neck and right shoulder, pain medication therapy and every the patient has tried has not helped. Patient is complainting of cervical pain and right shoulder pain. Symptoms a 1


This study is being ordered for trauma or injury.; 07/23/2014; There has been treatment or conservative therapy.; Evaluation and treatment to date includes muscle relaxants, OTC analgesics, narcotic analgesics, physical therapy and epidural steroid injection.; Neck Pain, Low Back Pain, Numbness in extremities; Numbness and tingling bilateral upper and lower extremtities 1

Anesthesiology Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for a thoracic spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 1

Anesthesiology Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; weakness located in the right leg; Surveillance 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Had spine injection 4/2015, scheduled for another 8/18/2015 1


The study requested is a Lumbar Spine MRI.; Trauma or recent injury; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; ; 1

Anesthesiology Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1990; There has been treatment or conservative therapy.; physical therapy/medication therapy; pain down left leg to knee into foot/constant shooting pain/numbness and tingling in both hands/has problem gripping on to objects; unknown 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; HAD FOR SEVERAL YEARS started in 1996; There has been treatment or conservative therapy.; physical therapy and injections on pain medications; neck and lower back pain neck pain radiates to both of his arms; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for trauma or injury.; 07/23/2014; There has been treatment or conservative therapy.; Evaluation and treatment to date includes muscle relaxants, OTC analgesics, narcotic analgesics, physical therapy and epidural steroid injection.; Neck Pain, Low Back Pain, Numbness in extremities; Numbness and tingling bilateral upper and lower extremtities 1

Anesthesiology Disapproval 72192 CT PELVIS WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for a Pelvis CT.; This study is being ordered due to known or suspected infection.; "The ordering physician is NOT a surgeon, gynecologist, urologist, gastroenterologist, or infectious disease specialist or PCP ordering on behalf of a specialist who has seen the patient."; "There are no physical findings or abnormal blood work consistent with peritonitis, pelvic inflammatory disease, or appendicitis."; "There are NO active, clinical findings or endoscopic findings of Crohn's disease, ulcerative colitis, or diverticulitis."; "There are no radiographical or ultrasound findings consistent with abnormal fluid collection, pelvic abscess, pelvic inflammation or ascites."; CHRONIC PAIN IN SACROILIAC JOINTS 1

Anesthesiology Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; 02/24/13; There has been treatment or conservative therapy.; Patient has had two sessions of phyical therapy, epidural steroid injection for neck and right shoulder, pain medication therapy and every the patient has tried has not helped.; right shoulder pain and cervical pain; Patient has had two sessions of phyical therapy, epidural steroid injection for neck and right shoulder, pain medication therapy and every the patient has tried has not helped. Patient is complainting of cervical pain and right shoulder pain. Symptoms a 1

Anesthesiology Disapproval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT Radiology Services Denied Not Medically Necessary


Cardiac Surgery Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST 1Cardiac Surgery Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the Neck. 1Cardiac Surgery Approval 71250 CT CHEST, THORAX 4

Cardiac Surgery Approval 71250 CT CHEST, THORAX

A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for follow up trauma.; The ordering physician a Surgeon, Pulmonologist, or Cardiologist. 1

Cardiac Surgery Approval 71250 CT CHEST, THORAX

A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Follow up from lung biopsy for mediastinal adenopathy. 1

Cardiac Surgery Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST 4

Cardiac Surgery Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST

Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will not be performed in conjunction with a Chest CT.; This study is being ordered for Known or Suspected Congenital Abnormality.; The abnormality is of a cardiac nature.; There is no known or suspected coarctation of the aorta.; There is another type of arch anomaly.; 43 y/o female with hx of DM and shortness of breath presented to Dr. Sherbet with abnormal stress test, she then had a left heart cath and was found to have severe proximal LAD disease . She occasionally has chest pain at rest. The patient states that she 1

Cardiac Surgery Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Yes, this is a request for a Chest CT Angiography.; This study is requested to evaluate suspected pulmonary embolus. 1

Cardiac Surgery Approval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING 1Cardiac Surgery Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study 1

Cardiac Surgery Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study

This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for a post myocardial infarction evaluation.; The patient is presenting new symptoms of chest pain or increasing shortness of breath.; The patient has not had a nuclear cardiology study since having an MI. 1

Cardiac Surgery Disapproval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary

Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will not be performed in conjunction with a Chest CT.; This study is being ordered for another reason besides Known or Suspected Congenital Abnormality, Known or suspected Vascular Disease.; The Pt has an ascending aortic aneurysm, follow up 1

Cardiology Approval 70450 CT BRAIN, HEAD 1

Cardiology Approval 70450 CT BRAIN, HEAD



This is a request for a brain/head CT.; The study is requested for headache.; There is not headache not improved by pain medications.; "There are recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness." 1


This is a request for a brain/head CT.; The study is requested for recent head trauma or injury.; "There are recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness." 1

Cardiology Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2009; There has been treatment or conservative therapy.; BLOOD PRESSURE MEDS; NON SYMPTEMATIC; < Enter answer here - or Type In Unknown If No Info Given. > 1

Cardiology Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST

This study is being ordered for Vascular Disease.; unknown; There has been treatment or conservative therapy.; unknown; complaining of headache, numbnees, along with dizziness; unknown 1

Cardiology Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the brain. 1Cardiology Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST 3

Cardiology Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2009; There has been treatment or conservative therapy.; BLOOD PRESSURE MEDS; NON SYMPTEMATIC; < Enter answer here - or Type In Unknown If No Info Given. > 1

Cardiology Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST

This study is being ordered for Vascular Disease.; unknown; There has been treatment or conservative therapy.; unknown; complaining of headache, numbnees, along with dizziness; unknown 1

Cardiology Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the Neck. 5Cardiology Approval 70540 MRI ORBIT/FACE/NECK W/O DYE 1Cardiology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 1

Cardiology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST


Cardiology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of stroke or aneurysm; There are recent neurological symptoms such as one sided weakness, speech impairments, or vision defects. 1

Cardiology Approval 71250 CT CHEST, THORAX 4

Cardiology Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; 1

Cardiology Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; ascending aorta aneurysym 1

Cardiology Approval 71250 CT CHEST, THORAX

A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician IS a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient." 1

Cardiology Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for suspected pulmonary Embolus. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for vascular disease other than cardiac.; "The ordering physician is a surgeon, pulmonologist, or cardiologist." 2



Cardiology Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST 6

Cardiology Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; It is not known if there has been any treatment or conservative therapy.; shortness of breath when walking. hx DVT/PE 11/2014, s/p IVC filter, here to discuss whether to leave it in or remove it, not currently on anticoag or ASA dyspnea, worse with exertion,; hx DVT/PE 11/2014, s/p IVC filter, here to discuss whether to leave it in or remove it, not currently on anticoag or ASA dyspnea, worse with exertion, 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 08/18/2015; There has not been any treatment or conservative therapy.; none; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; july 2015; There has been treatment or conservative therapy.; inhaler for copd ; adorvastatin ; morpherin, spereva, albuterol; shortness of breath, angina, cough; abnormal ekg 1


Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will be performed in conjunction with a Chest CT.; pulmonary vein mapping 2


Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will not be performed in conjunction with a Chest CT.; This study is being ordered for another reason besides Known or Suspected Congenital Abnormality, Known or suspected Vascular Disease.; None 1


Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will not be performed in conjunction with a Chest CT.; This study is being ordered for another reason besides Known or Suspected Congenital Abnormality, Known or suspected Vascular Disease.; THORACIC AORTIC ANEURYSM 1


Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will not be performed in conjunction with a Chest CT.; This study is being ordered for Known or Suspected Congenital Abnormality.; The abnormality is of a cardiac nature.; There is no known or suspected coarctation of the aorta.; It is not known if there is another type of arch anomaly.; Patient had echo that etiology of murmur likely secondary to aortic or arch pathology, i.e., subclavain stenosis pending CTA CHEST. 1


Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will not be performed in conjunction with a Chest CT.; This study is being ordered for Known Vascular Disease.; This is a Follow-up to a previous angiogram or MR angiogram.; There are no new signs or symptoms indicative of a dissecting aortic aneurysm.; There are no signs or symptoms indicative of a progressive vascular stenosis.; 1


Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will not be performed in conjunction with a Chest CT.; This study is being ordered for Known Vascular Disease.; This is a Follow-up to a previous angiogram or MR angiogram.; There are no new signs or symptoms indicative of a dissecting aortic aneurysm.; There are no signs or symptoms indicative of a progressive vascular stenosis.; f/u ascending aortic aneuryms. 1


Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will not be performed in conjunction with a Chest CT.; This study is being ordered for Suspected Vascular Disease.; There are no new signs or symptoms indicative of a dissecting aortic aneurysm.; This is not an evaluation for thoracic outlet syndrome.; There are no signs or symptoms indicative of vascular insufficiency to the neck or arms.; There are no signs or symptoms indicative of Superior Vena Cava syndrome.; New patient referred by Dr. Mego for eval of Afib and Consult for afib ablation. He is on Xarelto for stroke prevention. He has had 3 episodes over 8 years Persistent AF now, for the last 1.5 weeks, started Xarelto then Dyspnea, dizziness 1

Cardiology Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Yes, this is a request for a Chest CT Angiography.; This study is requested to evaluate suspected pulmonary embolus. 7

Cardiology Approval 71550 MRI CHEST This is a request for a chest MRI.; This study is being ordered for vascular disease.; "The ordering physician is a surgeon, pulmonologist, or cardiologist." 1

Cardiology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 2

Cardiology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 1

Cardiology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Limited activity, cant move around, or walk 1

Cardiology Approval 72198 MRA , MRI PELVIS ANGIOGRAPHY WITH/WITHOUT CONTRAST 1Cardiology Approval 73706 CT ANGIOGRAPHY LOWER EXTREMITY 1

Cardiology Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks. 1

Cardiology Approval 74150 CT ABDOMEN WITHOUT CONTRAST 1

Cardiology Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered for a known tumor, cancer, mass, or rule out metastases.; Yes, this is a request for follow up to a known tumor or abdominal cancer. 1

Cardiology Approval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST 2Cardiology Approval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST This is a request for CT Angiography of the Abdomen and Pelvis. 1

Cardiology Approval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 08/18/2015; There has not been any treatment or conservative therapy.; none; < Enter answer here - or Type In Unknown If No Info Given. > 1

Cardiology Approval 74175 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the abdomen. 2Cardiology Approval 74185 MRA, MRI ANGIOGRAPHY ABDOMEN WITH/WITHOUT CONTRAST 1Cardiology Approval 75557 Cardiac MRI Morph & structure w/o contrast This is a request for a heart or cardiac MRI 4Cardiology Approval 75572 CT Heart 6Cardiology Approval 75572 CT Heart This is a request for a Heart CT. 3Cardiology Approval 75574 CT Angiography Heart coronary arteries, CCTA 5

Cardiology Approval 75574 CT Angiography Heart coronary arteries, CCTA

The patient does not have three or more of the following conditions: age over 50, diabetes, history of hypertension, history of LDL cholesterol above 130, history of HDL cholesterol below 35, obesity (BMI above 35), and/or active history of smoking.; ; Yes, there is Chronic Chest Pain.; No, patient does not have new onset congestive heart failure.; This study is being ordered for suspected Coronary Artery Disease (CAD) and symptomatic?; No, patient did not have a Nuclear Cardiology study within the past six months.; This request is for a Coronary CT Angiography study. 1


This request is for a Coronary CT Angiography study.; It is not known if patient did not have a Nuclear Cardiology study within the past six months.; positive calcium score with a history of coronary artery disease. 1


This request is for a Coronary CT Angiography study.; It is not known if patient did not have a Nuclear Cardiology study within the past six months.; Shortness of Breath and Chest pain 1


This request is for a Coronary CT Angiography study.; No, patient did not have a Nuclear Cardiology study within the past six months.; This study is being ordered for prior equivocal or uninterruptible cardiac imaging .; Yes, this patient has an equivocal or uninterpretable stress test (exercise, perfusion, or stress echo).; Patient had stress echo today which was inadequate stress, limited by right leg pain, consider DVT and claudication. Needing CTA Chest. 1


This request is for a Coronary CT Angiography study.; No, patient did not have a Nuclear Cardiology study within the past six months.; This study is being ordered for suspected Coronary Artery Disease (CAD) and symptomatic?; No, patient does not have new onset congestive heart failure.; No, there is no Chronic Chest Pain.; There is "Acute Chest Pain" or Angina.; abnormal rest stress echo 1


This request is for a Coronary CT Angiography study.; No, patient did not have a Nuclear Cardiology study within the past six months.; This study is being ordered for suspected Coronary Artery Disease (CAD) and symptomatic?; No, patient does not have new onset congestive heart failure.; No, there is no Chronic Chest Pain.; There is no "Acute Chest Pain" or Angina.; No, this patient does not have equivocal or uninterpretable stress test (exercise, perfusion, or stress echo).; about one year ago she developed swelling in the left foot and it was negative for blood clot. She had admission in August for afib RVR and was in the ICU 6 days for rate control. She was shocked to NSR in December. She had her treatment in conway and see 1

Cardiology Approval 75574 CT Angiography Heart coronary arteries, CCTA This request is for a Coronary CT Angiography study.; Yes, patient had a Nuclear Cardiology study within the past six months.; 1

Cardiology Approval 75574 CT Angiography Heart coronary arteries, CCTA This request is for a Coronary CT Angiography study.; Yes, patient had a Nuclear Cardiology study within the past six months.; <Additional Clinical Information> 1

Cardiology Approval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING 9Cardiology Approval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING Yes, this is a request for CT Angiography of the abdominal arteries. 17Cardiology Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study 105

Cardiology Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study

The patient is presenting new symptoms of chest pain or increasing shortness of breath.; The study is being ordered for known CAD.; This patient had a previous cardiac surgery or angioplasty.; The patient has not had a stress echocardiogram within the past eight weeks.; The patient's age is between 45 and 64.; This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study). 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is at least 65 years old.; It is not known if the patient has diabetes.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is at least 65 years old.; The patient does not have diabetes.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath. 7

Cardiology Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is at least 65 years old.; The patient has diabletes. 3

Cardiology Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is diabetic. 6


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has had a recent exercise treadmill test that was positive. 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; It is not known whether the patient has one or more of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Dyspnea, Chest Pain, Unstable Angina The patient has some symptoms almost concerning for cardiomyopathy. She has not been on her blood pressure medicine secondary to financial constraints. We will plan for echocardiographic study. Give her anginal type s 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; 39 year old obese male presenting with syncope 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; cath report on the 7th of this month double vessel disease , 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Chest pain and palpitations 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Chest pain radiating to left arm and jaw. Strong family history CAD. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; chest pain, hypertension, Raynaud's phenomenon. Chest Pain (Angina) This is a recurrent problem. The current episode started more than 1 week ago. The problem occurs every several days. The problem has been resolved. Associated symptoms include chest pa 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; chest pain, tobacco abuse. Chest Pain (Angina) This is a new problem. The current episode started more than 1 week ago. The problem occurs rarely. The problem has not changed since onset.Associated symptoms include chest pain. Pertinent negatives include 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; chest pain, tobacco use, shortness of breath on exertion, obesity, screening for cardiovascular screening. Chest Pain (Angina) This is a chronic problem. Episode onset: intermittent for about an year. The problem occurs every several days. The problem h 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Don N Savell is here at the request of Dr. Perez for consultation and diagnostic testing, as needed, due to hospitalization followup and syncopal episodes. He is a 37 year old man with a history of childhood onset of leukemia with treatment.He does have 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; EKG demonstrates sinus rhythm, subtle ST-segment abnormalities laterally. The PR interval is normal, QRS is normal. QT interval is borderline prolonged visually and measures 358 or 408. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; hest pain "stabbing pain with shoulder pain and numbness on left arm and hands , also having SOB Morbid obesity (278.01): 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Mr. Marshall comes in for initial evaluation of chest pain. He states he's been having chest pain off and on for the last year. He has been at seen at three times the emergency department. They told him was it was reflux. He states he does not believe it 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Ms. Brandt is referred by Dr. Shotts to evaluate chest pain. Symptoms started about a month ago, coincidentally when she started lipitor, however symptoms have persisted since stopping the statin. Constant, 5/10 severity, but can be intermittent, occurs s 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; New patient referred DR Burleson chest pain for months, left precordial. radiating left arm, associated dyspnea, stable symptoms, not associated syncope..discussed smoking issue, one pack a day....discussed diet carbs low glycemic index and weight loss.. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; None. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; obese SOB on exxuration// edema/ smoker// hyperntsion 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Patient has tingling and weakness in feet and limbs and nausea along with the chest pressure and SOB. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Patient presented with complaints of tachypalpitations that occur several times a week, lasting a few minutes. She has occasional chest tightness off and on, not related to exertion. 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Precordial chest pain details; the discomfort is located primarily in the center of the chest. It radiates to the shoulders and interscapular area. The pain initially began a few months ago. Typically, individual episodes of chest pain last less than f 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; pt cant get on treadmill very obese...having palpitations with abnormal ekg 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Pt has abnormal EKG, is obese, cannot get on treadmill, having SOB. Having PVCs. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; pt has congestive heart failure .Cardiomyopathy. Ef is at 25 %. Hypertension. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Pt has known Coronary Artery Disease (verified by left heart catheterization, stent placed in March 2015) and is experiencing worsening chest pain on exertion and shortness of breath on exertion. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; smoker, cp ,history of cad 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; substernal chest pain exertional & at rest, sob exertional, cardiac dysrythmias 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; substernal cp on exertion, sob/exertion, atrial fibrillation 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; torn ligament in knee 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has one or more of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs. 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; It is not known if the patient has had a stress echocardiogram within the past eight weeks.; CURRENT DIAGNOSES 1. Hypertension-Essential (Benign) 2. Angina (Variant) 3. Tachycardia 4. Shortness of Breath 5. Chest tightness/pressure 6. Chest Pain, Unspecified 7. Angina 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; It is not known if the patient has had a stress echocardiogram within the past eight weeks.; Mrs. Harding came into the ER with severe chest pain and shortness of breath. Her labs were normal at the time. Her lung sounds were clear. Her doctor ordered this test because he suspects coronary artery disease. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; It is not known if the patient has had a stress echocardiogram within the past eight weeks.; none 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; It is not known if the patient has had a stress echocardiogram within the past eight weeks.; Patient with past medical history of significant Hypertension, and positive for family history of coronary Artery Disease, has decrease ejection Faction on echo, has atrial fibrillation. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; It is not known if the patient has had a stress echocardiogram within the past eight weeks.; unknown 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has had a stress echocardiogram within the past eight weeks.; Baseline mild mild to distal inferior wall motion abnormality seen on apical 4 chamber view that did not change with exercise (poor quality view). Would advise followup NST for clarification, but I do NOT think this is a high risk finding in light of hi 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has had a stress echocardiogram within the past eight weeks.; Doctor is trying to make sure patients stents are still in place. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has had a stress echocardiogram within the past eight weeks.; treadmill stress test shows positive signs of ischemia and was discontinued due to shortness of breath, mild regurgitation noted on echocardiogram 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The caller indicated that the study was not ordered for: Known or suspected coronary artery disease, post myocardial infarction evaluation, pre operative or post operative (Cardiac surgery, angioplasty or stent) evaluation.; 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for a post myocardial infarction evaluation.; The patient is not presenting new symptoms of chest pain or increasing shortness of breath.; pt has a symptom's of walking unchanged acute , elevation , 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; The CAD diagnosis was esablished by something other than, a previous cardiac surgery / angioplasty, a previous MI, congestive heart failure or a previous stress echocardiogram, nuclear cardiology study or a stress EKG.; cad, dyspnea, smoker 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; The CAD diagnosis was esablished by something other than, a previous cardiac surgery / angioplasty, a previous MI, congestive heart failure or a previous stress echocardiogram, nuclear cardiology study or a stress EKG.; Referred from hospital. Abnormal EKG. Stint placement. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; The CAD diagnosis was esablished by something other than, a previous cardiac surgery / angioplasty, a previous MI, congestive heart failure or a previous stress echocardiogram, nuclear cardiology study or a stress EKG.; The patient presents for a follow up exam with worsening fatigue and anginal equivalent symptomatology. Her blood pressure is adequately controlled. She is having no chest pain per se, just fatigue and malaise with SOB. We will proceed with a nuclear imag 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient had a previous cardiac surgery or angioplasty.; It is not known if the patient is presenting with new symptoms of chest pain or increasing shortness of breath.; Atherosclerotic Heart Disease of Native Coronary Artery Without Angina Pectoris Hyperlipidemia, Unspecified 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient had a previous cardiac surgery or angioplasty.; It is not known if the patient is presenting with new symptoms of chest pain or increasing shortness of breath.; Patient has Dyslipidemia, Hypertension and Family History of CAD as well. Can't walk on treadmill due to back problems and dizziness. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient had a previous cardiac surgery or angioplasty.; It is not known if the patient is presenting with new symptoms of chest pain or increasing shortness of breath.; The patient present for follow up evaluation. He is having no recurrent anginal symptomatology. His pas percutaneous intervention was approximately six years ago. He recently had his lab drawn. His lipid panel did show a total cholesterol of greater than 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient had a previous cardiac surgery or angioplasty.; The patient is not presenting new symptoms of chest pain or increasing shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has not had a recent stress echocardiogram.; It is not known if the patient had a recent abnormal EKG consistent with CAD.; 51 year old diabetic male with hyperlipidemia, TIA, carotid artery atherosclerosis, pvd, cad. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient had a previous cardiac surgery or angioplasty.; The patient is not presenting new symptoms of chest pain or increasing shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has not had a recent stress echocardiogram.; It is not known if the patient had a recent abnormal EKG consistent with CAD.; Mr Drewry has known CAD, and ischemic heart disease. He has had stents placed. he has a pace maker. He requires this test to know if he can go back to work. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient had a previous cardiac surgery or angioplasty.; The patient is not presenting new symptoms of chest pain or increasing shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has not had a recent stress echocardiogram.; The patient had a recent abnormal EKG consistent with CAD.; The patient is female. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient had a previous cardiac surgery or angioplasty.; The patient is not presenting new symptoms of chest pain or increasing shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has not had a recent stress echocardiogram.; The patient has not had a recent abnormal EKG consistent with CAD.; Known CAD, 11 years out from stenting of the right coronary artery. Two years since last nuclear stress test. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient had a previous cardiac surgery or angioplasty.; The patient is presenting new symptoms of chest pain or increasing shortness of breath. 31


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient had a previous myocardial infarction.; It is not known if the patient is presenting with new symptoms of chest pain or increasing shortness of breath.; Patient also has Mixed Hyperlipidemia, Benighn Hypertension and Obesity. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient had a previous myocardial infarction.; The patient is presenting new symptoms of chest pain or increasing shortness of breath. 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient's diagnosis was established by a previous stress echocardiogram, nuclear cardiology study, or stress EKG.; The patient is presenting new symptoms of chest pain or increasing shortness of breath. 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; It is unknown if the patient has symptomsof atypical chest pain (angina) or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has not had a recent stress echocardiogram.; The patient had a recent abnormal EKG consistent with CAD.; The patient is female. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is not presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient had a recent non-nuclear stress test.; The results of the previous nuclear cardiology study were not normal.; Patient had non nuclear exercise stress test which came back with abnormal results. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient had a recent non-nuclear stress test.; It is not known if there are documented findings of hyperlipidemia.; "Patient is not clinically obese, nor has an emphysematous chest configuration."; There are documented clinical findings of hypertension. 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient had a recent non-nuclear stress test.; There are documented clinical findings of hyperlipidemia. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; It is not known if the patient has a physical limitation to exercise.; It is not known if there are documented findings of hyperlipidemia.; "Patient is not clinically obese, nor has an emphysematous chest configuration."; It is not known if there are documented clinical findings of hypertension.; The patient is not diabetic.; The patient is female. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; It is not known if the patient has a physical limitation to exercise.; It is not known if there are documented findings of hyperlipidemia.; "Patient is not clinically obese, nor has an emphysematous chest configuration."; There are no documented clinical findings of hypertension.; The patient is not diabetic.; The patient is female. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; It is not known if the patient has a physical limitation to exercise.; It is not known if there are documented findings of hyperlipidemia.; This patient is clinically obese or has an emphysematous chest configuration. 3


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; It is not known if the patient has a physical limitation to exercise.; There are documented clinical findings of hyperlipidemia. 7


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; It is not known if the patient has a physical limitation to exercise.; There are no documented clinical findings of hyperlipidemia.; This patient is clinically obese or has an emphysematous chest configuration. 3


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; It is not known if the patient has had a previous cardiac surgery or angioplasty.; 54 year of female with chest pain, hypertension, and hyperlipidemia. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient had previous cardiac surgery or angioplasty.; There are new symptoms or changing EKG findings. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; < Enter answer here - or Type In Unknown If No Info Given. > 3


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; Abnormal echo: With WMA. Benign essential hypertension 03. Other malaise and fatigue Extremity weakness: RLE weakness. Patient having to pick leg up at this time because it won't move. DDD: Histoy of DDD of L-spine. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; Annual follow up. She has had a 3 week history of intermittent L sided parasternal chest pain which has variable duration. No other real symptoms associated with it. It has been quite some time since her last stress evaluation and she is concerned because 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; Burst of non-sustained palpitations. hx Mi, Abn ekg with diffuse, early polarization changes, mild chest discomfort, sob with exertion. Gxt Cardiolite to see if there is an arrhythmia present and evaluate for any ischemic disease. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; Chest Pain (Angina) This is a recurrent problem. The current episode started more than 1 week ago. The problem occurs every several days. The problem has not changed since onset.Associated symptoms include chest pain and shortness of breath. Nothing aggr 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; David M Scudder is a 53 y.o. male who presents for a f/u after being seen in the ER for c/o atypical chest pain. He is a new pt to our clinic. Preferred to be worked up as an out-pt and therefore was set to f/u with us here in the clinic. The day of his E 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; dyspnea, smoker,familt history, 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; Fam hx of heart disease, abnormal EKG. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; Hypertension, hyperlipidemia 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; None 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; patient had Adenosine stress test and now Dr. would like Thallium viability study 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; Patient's blood pressure has been on the low side recently as well as having Chest pain, positional dizziness and some visual problems. There are no distinct aggrevating or relieving factors. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; symptomatic patient lung disease w/ chest pain and SOB 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; This gentleman also has Hypercholesterolemia,Osteoarthritis, Diabetes mellitius type 1, he is a smoker with palpitations, shortness of breath and precordial pain. A long family history of coronary artery disease. He also suffers from dyslipidemia and hyp 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; to rule out Ischemia! 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has a physical limitation to exercise.; It is not known if there are documented findings of hyperlipidemia.; "Patient is not clinically obese, nor has an emphysematous chest configuration."; There are documented clinical findings of hypertension. 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has a physical limitation to exercise.; It is not known if there are documented findings of hyperlipidemia.; It is not known if the patient is clinically obese or if there is an emphysematous chest configuration.; There are documented clinical findings of hypertension. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has a physical limitation to exercise.; It is not known if there are documented findings of hyperlipidemia.; This patient is clinically obese or has an emphysematous chest configuration. 5


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has a physical limitation to exercise.; There are documented clinical findings of hyperlipidemia. 38


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has a physical limitation to exercise.; There are no documented clinical findings of hyperlipidemia.; "Patient is not clinically obese, nor has an emphysematous chest configuration."; There are documented clinical findings of hypertension. 3


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has a physical limitation to exercise.; There are no documented clinical findings of hyperlipidemia.; "Patient is not clinically obese, nor has an emphysematous chest configuration."; There are no documented clinical findings of hypertension.; The patient is not diabetic.; The patient is female. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has a physical limitation to exercise.; There are no documented clinical findings of hyperlipidemia.; This patient is clinically obese or has an emphysematous chest configuration. 9


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; This study is being ordered as a post-operative (Cardiac Surgery, Angioplasty or stent ) evaluation.; The patient is presenting new symptoms of chest pain or significant EKG changes.; It is not known if patient had a nuclear cardiology study since surgery.; The patient has not had a stress echocardiogram since surgery.; Patient has been having chest pressure and occasional palpitations since his PFO closure about 2 months ago by Dr. Mego at Ark. Heart Hospital. He has CVA found on Head CT on 3/18/2015 showing indeterminate lacunar infarcts. Patient has hx of migraines an 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; This study is being ordered as a post-operative (Cardiac Surgery, Angioplasty or stent ) evaluation.; The patient is presenting new symptoms of chest pain or significant EKG changes.; Yes, patient had a nuclear cardiology study since surgery.; The results of the previous nuclear cardiology study were normal.; never felt anything like I felt the day I wa walking across the living room and I felt like a bolt in the chest and pain and pressure and I felt I was going to fallown CORONARY ATHEROSCLEROSIS (414.0): PCI of the LAD, performed 5-30-2012 with improveme 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; This study is being ordered as a pre-operative evaluation.; The patient has not had a recent stress echocardiogram.; This evaluation is prior to major surgery involving general anesthesia.; The patient has suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has a physical limitation to exercise.; There are documented clinical findings of hyperlipidemia. 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; This study is being ordered as a pre-operative evaluation.; The patient has not had a recent stress echocardiogram.; This evaluation is prior to major surgery involving general anesthesia.; The patient has suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has a physical limitation to exercise.; There are no documented clinical findings of hyperlipidemia.; This patient is clinically obese or has an emphysematous chest configuration. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; It is not known if the study is requested for suspected or known coronary artery disease. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 1 or less cardiac risk factors; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; Another test besides a Nuclear Cardiology Study, CCTA or Stress Echocardiogram has been completed to evaluate new or changing symptoms.; 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 2 cardiac risk factors; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 20 to 29; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 2 cardiac risk factors; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 20 to 29; Ms Reusser is a 46 yo WF with a hx of right carotid bruit, bipolar/anxiety and reflux who was referred by Dr Siddiqui for palpitations and dyspnea. Palpitations occur every couple week with rest and activity lasting a couple minutes. DOE daily which resol 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 2 cardiac risk factors; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 30 to 39; Patient recently had a stroke and subsequently had a carotid endarterectomy he on the left. Dr. CD Williams did the surgery at the heart hospital. Overall she seems to be doing well although she does have some. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 2 cardiac risk factors; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 40 or greater 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is 30 to 39; Chest pain with arm numbness, SOB, syncopal episode, fatigue, chronic back pain so unable to walk TM, smoker, strong family hx 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is 30 to 39; Chest Pain, SOB, Hypertension, Obesity 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is 30 to 39; diabetic, smoker,abnekg, obesity, heart murmur, 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is 30 to 39; N/A 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is 40 or greater 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; There is known coronary artery disease, history of heart attack (MI), coronary bypass surgery, coronary angioplasty or stent.; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 20 to 29; 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; There is known coronary artery disease, history of heart attack (MI), coronary bypass surgery, coronary angioplasty or stent.; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 30 to 39; Chest pain with shortness of breathe. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; There is known coronary artery disease, history of heart attack (MI), coronary bypass surgery, coronary angioplasty or stent.; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 30 to 39; Mr. Summit is here for a follow up visit. He has pin sticking chest pain that lasts a second. This happens off and on all day. He has chest tightness, pressure and dyspnea with walking to much. This is relieved with rest. This lasts less than five minutes 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; There is known coronary artery disease, history of heart attack (MI), coronary bypass surgery, coronary angioplasty or stent.; There are not new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient had cardiac testing including Stress Echocardiogram, Nuclear Cardiology (SPECT/MPI), Coronary CT angiography (CCTA) or Cardiac Catheterization in the last 2 years.; 1

Cardiology Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is requested for known or suspected valve disorders. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Not sure; There has been treatment or conservative therapy.; Medication; shortness of breath on exertion.; Pt has hypertension, hyperlipidemia, and diabetes. 1


This study is being ordered for Vascular Disease.; Mrs. Traylor is an established patient here for a hospital follow up appointment. She was evaluated at AHH ER on August 3rd for worsening chest pain. She described left-sided chest discomfort that radiated to her back. Her symptoms started three days prio; There has not been any treatment or conservative therapy.; Mrs. Traylor is an established patient here for a hospital follow up appointment. She was evaluated at AHH ER on August 3rd for worsening chest pain. She described left-sided chest discomfort that radiated to her back. Her symptoms started three days prio; Mrs. Traylor is an established patient here for a hospital follow up appointment. She was evaluated at AHH ER on August 3rd for worsening chest pain. She described left-sided chest discomfort that radiated to her back. Her symptoms started three days prio 1

Cardiology Approval 78472 CARDIAC OR HEART BLOOD POOL IMAGING

This is a request for a MUGA scan.; This study is NOT being ordered for Chemotherapy, Known Cardiomyopathy/ Myocarditis, Suspected Cardiomyopathy/ Myocarditis, or Congestive Heart Failure.; last injection fraction 39% 11/9/2014 , Eval low EF 1

Cardiology Approval 93307 TTHRC R-T IMG 2D +-M-MODE REC COMPL

This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; The reason for ordering this study is unknown. 7


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; This study is being ordered for evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicative of heart disease.; This is for the initial evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicatvie of heart disease.; The abnormal symptom, condition or evaluation is not known or unlisted above. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; This study is being ordered for evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicative of heart disease.; This is for the initial evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicatvie of heart disease.; The patient has an abnormal EKG; This study is being requested for the initial evaluation of frequent or sustained atrial or ventricular cardiac arrhythmias. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; This study is being ordered for evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicative of heart disease.; This is for the initial evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicatvie of heart disease.; The patient has high blood pressure; The patient does not have a history of a recent heart attack or hypertensive heart disease. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; This study is being ordered for evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicative of heart disease.; This is for the initial evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicatvie of heart disease.; The patient has shortness of breath; Known or suspected valve disease.; This is an initial evaluation of suspected valve disease. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; This study is being ordered for evaluation of cardiac arrhythmias; This study is being requested for the initial evaluation of frequent or sustained atrial or ventricular cardiac arrhythmias. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; This study is being ordered for evaluation of cardiac arrhythmias; This study is NOT being requested for the initial evaluation of frequent or sustained atrial or ventricular cardiac arrhythmias. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Cardiac Murmur.; It is unknown if this request is for initial evaluation of a murmur.; It is unknown if this is a request for follow up of a known murmur. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Cardiac Murmur.; This request is for initial evaluation of a murmur.; It is unknown if the murmur is grade III (3) or greater.; There are clinical symptoms supporting a suspicion of structural heart disease. 4


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Cardiac Murmur.; This request is for initial evaluation of a murmur.; The murmur is grade III (3) or greater. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Cardiac Murmur.; This request is NOT for initial evaluation of a murmur.; This is a request for follow up of a known murmur.; There has been a change in clinical status since the last echocardiogram. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Cardiac Valves.; This is an annual re-evaluation of artificial heart valves.; It has been at least 12 months since the last echocardiogram was performed. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Cardiac Valves.; This is an annual review of known valve disease.; It has been 12 - 23 months or more since the last echocardiogram. 2


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Cardiac Valves.; This is an initial evaluation of suspected valve disease. 4


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Heart Failure; This is for the initial evaluation of heart failure. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Heart Failure; This is NOT for the initial evaluation of heart failure.; There has been a change in clinical status since the last echocardiogram. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Heart Failure; This is NOT for the initial evaluation of heart failure.; There has NOT been a change in clinical status since the last echocardiogram. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Left Ventricular Function.; It is unknown if the patient has a history of a recent heart attack or hypertensive heart disease. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Left Ventricular Function.; The patient does not have a history of a recent heart attack or hypertensive heart disease. 9


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Left Ventricular Function.; The patient has a history of a recent myocardial infarction (heart attack). 3


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Left Ventricular Function.; The patient has a history of hypertensive heart disease.; There is a change in the patient’s cardiac symptoms. 5


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Left Ventricular Function.; The patient has a history of hypertensive heart disease.; There is NOT a change in the patient’s cardiac symptoms.; It has been at least 24 months since the last echocardiogram was performed. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Left Ventricular Function.; The patient has a history of hypertensive heart disease.; There is NOT a change in the patient’s cardiac symptoms.; It has NOT been at least 24 months since the last echocardiogram was performed. 1

Cardiology Approval 93307 TTHRC R-T IMG 2D +-M-MODE REC COMPL This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Pulmonary Hypertension. 6


This study is being ordered for Inflammatory/ Infectious Disease.; Patient states he had a Cath about 3 years ago w/Dr. Jordan and is wanting to switch cardiologists. He saw Dr. Freddy Chrisman on 8-19-2015. On that date he complained of chest discomfort in the precordial area that radiates to the left arm and Dyspnea.; It is not known if there has been any treatment or conservative therapy.; CATH results showed mild CAD. He presented with Precordial chest discomfort that radiates to the left arm and Dyspnea. He has Edema and Obesity (410 lbs.); Patient cannot walk on TMST due to obesity and physical limitations. With his progression of shortness of breath, the doctor would like to have an Echo of the heart as well. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; It is not known if there has been any treatment or conservative therapy.; shortness of breath when walking. hx DVT/PE 11/2014, s/p IVC filter, here to discuss whether to leave it in or remove it, not currently on anticoag or ASA dyspnea, worse with exertion,; hx DVT/PE 11/2014, s/p IVC filter, here to discuss whether to leave it in or remove it, not currently on anticoag or ASA dyspnea, worse with exertion, 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/14/15; There has not been any treatment or conservative therapy.; shortness of breath, chest pain, and palpitations; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1-2 months; There has not been any treatment or conservative therapy.; Chest pain with left arm pain, associated with shortness of breath. The patient has multiple risk factors including hypertension, hyperlipidemia, and diabetes mellitus. She is a non cigarette smoker.; echocardiogram to evaluate her left ventricular systolic function and her murmur. Cardiolite stress test will be done to rule out potential underlying coronary artery disease with exercise induced ischemia. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Mr Stand presents today for a new evaluation for minimal DOE and history of heart murmur. He has a history of right knee infection with hospitalization at UAMS in 2013 with ECG revealing poor R wave progression across the precordial leads. His blood cultu; There has not been any treatment or conservative therapy.; 1. Heart murmur 2. Chest pain at rest; Mr Stand presents today for a new evaluation for minimal DOE and history of heart murmur. He has a history of right knee infection with hospitalization at UAMS in 2013 with ECG revealing poor R wave progression across the precordial leads. His blood cultu 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Not sure; There has been treatment or conservative therapy.; Medication; shortness of breath on exertion.; Pt has hypertension, hyperlipidemia, and diabetes. 1


This study is being ordered for Vascular Disease.; Mrs. Traylor is an established patient here for a hospital follow up appointment. She was evaluated at AHH ER on August 3rd for worsening chest pain. She described left-sided chest discomfort that radiated to her back. Her symptoms started three days prio; There has not been any treatment or conservative therapy.; Mrs. Traylor is an established patient here for a hospital follow up appointment. She was evaluated at AHH ER on August 3rd for worsening chest pain. She described left-sided chest discomfort that radiated to her back. Her symptoms started three days prio; Mrs. Traylor is an established patient here for a hospital follow up appointment. She was evaluated at AHH ER on August 3rd for worsening chest pain. She described left-sided chest discomfort that radiated to her back. Her symptoms started three days prio 1

Cardiology Approval 93312 TEE R-T IMG 2D W/PRB IMG ACQUISJ I&R

This a request for an echocardiogram; This is a request for a Transesophageal Echocardiogram.; This study is beibg requested for evalutaion of atrial fibrillation or flutter to determine the presence or absence of left atrial thrombus or evaluate for radiofrequency ablation procedure. 1

Cardiology Approval 93350 ECHO TTHRC R-T 2D -+M-MODE COMPLETE REST&STRS

This is a request for a Stress Echocardiogram.; The member has known or suspected coronary artery disease.; It is unknown if the patient had cardiac testing including Stress Echocardiogram, Nuclear Cardiology (SPECT/MPI), Coronary CT angiography (CCTA) or Cardiac Catheterization in the last 2 years.; The patient is experiencing new or changing cardiac symptoms. 1


This is a request for a Stress Echocardiogram.; The member has known or suspected coronary artery disease.; The patient had cardiac testing including Stress Echocardiogram, Nuclear Cardiology (SPECT/MPI), Coronary CT angiography (CCTA) or Cardiac Catheterization in the last 2 years.; The patient is experiencing new or changing cardiac symptoms. 2


This is a request for a Stress Echocardiogram.; The member has known or suspected coronary artery disease.; The patient has NOT had cardiac testing including Stress Echocardiogram, Nuclear Cardiology (SPECT/MPI), Coronary CT angiography (CCTA) or Cardiac Catheterization in the last 2 years. 14


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/14/15; There has not been any treatment or conservative therapy.; shortness of breath, chest pain, and palpitations; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1-2 months; There has not been any treatment or conservative therapy.; Chest pain with left arm pain, associated with shortness of breath. The patient has multiple risk factors including hypertension, hyperlipidemia, and diabetes mellitus. She is a non cigarette smoker.; echocardiogram to evaluate her left ventricular systolic function and her murmur. Cardiolite stress test will be done to rule out potential underlying coronary artery disease with exercise induced ischemia. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Cardiology consultation for this 38-year-old lady. She comes with chief complaint of chest pain palpitations ankle swelling. She has noticed the chest pain over the last few months. She describes pain behind her left shoulder which radiates into her left ; There has not been any treatment or conservative therapy.; CHEST PAIN PALPIATIONS ARRHYTHMIAS; Cardiology consultation for this 38-year-old lady. She comes with chief complaint of chest pain palpitations ankle swelling. She has noticed the chest pain over the last few months. She describes pain behind her left shoulder which radiates into her left 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Mr Stand presents today for a new evaluation for minimal DOE and history of heart murmur. He has a history of right knee infection with hospitalization at UAMS in 2013 with ECG revealing poor R wave progression across the precordial leads. His blood cultu; There has not been any treatment or conservative therapy.; 1. Heart murmur 2. Chest pain at rest; Mr Stand presents today for a new evaluation for minimal DOE and history of heart murmur. He has a history of right knee infection with hospitalization at UAMS in 2013 with ECG revealing poor R wave progression across the precordial leads. His blood cultu 1

Cardiology Disapproval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for neck soft tissue CT.; There has not been recent trauma or other injury to the neck.; There is no suspicion of or known tumor, metastasis, lymphadenopathy, or mass.; There is not a suspicion of an infection or abscess.; This is not being ordered by an ENT specialist. 2

Cardiology Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary A Chest/Thorax CT is being ordered.; This study is being ordered for vascular disease other than cardiac.; There is no radiologic evidence of mediastinal widening.; Unknown 1

Cardiology Disapproval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for Vascular Disease.; Over the past few weeks she has had cough and wheezing. Cough is daily and nonproductive, improved with updraft. It has not gotten better despite steroids and zpack. She smokes. Mild SOB and no chest pain.; There has been treatment or conservative therapy.; UPDRAFTS; COUGH AND WHEEZING; Over the past few weeks she has had cough and wheezing. Cough is daily and nonproductive, improved with updraft. It has not gotten better despite steroids and zpack. She smokes. Mild SOB and no chest pain. 1

Cardiology Disapproval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for Vascular Disease.; Over the past few weeks she has had cough and wheezing. Cough is daily and nonproductive, improved with updraft. It has not gotten better despite steroids and zpack. She smokes. Mild SOB and no chest pain.; There has been treatment or conservative therapy.; UPDRAFTS; COUGH AND WHEEZING; Over the past few weeks she has had cough and wheezing. Cough is daily and nonproductive, improved with updraft. It has not gotten better despite steroids and zpack. She smokes. Mild SOB and no chest pain. 1

Cardiology Disapproval 75574 CT Angiography Heart coronary arteries, CCTA Radiology Services Denied Not Medically Necessary

This request is for a Coronary CT Angiography study.; No, patient did not have a Nuclear Cardiology study within the past six months.; This study is being ordered for suspected Coronary Artery Disease (CAD) and symptomatic?; No, patient does not have new onset congestive heart failure.; Yes, there is Chronic Chest Pain.; The patient does not have three or more of the following conditions: age over 50, diabetes, history of hypertension, history of LDL cholesterol above 130, history of HDL cholesterol below 35, obesity (BMI above 35), and/or active history of smoking.; chest pain, shortness of breath, pressure-like heaviness in left-side chest radiating to left arm: 2013 cardiac cath did not show specific results: EKG did not show significant changes 1

Cardiology Disapproval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING Radiology Services Denied Not Medically Necessary Yes, this is a request for CT Angiography of the abdominal arteries. 1

Cardiology Disapproval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study Radiology Services Denied Not Medically Necessary

This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; It is not known if the patient has a physical limitation to exercise.; It is not known if there are documented findings of hyperlipidemia.; This patient is clinically obese or has an emphysematous chest configuration. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; Left arm pain, syncope and abdominal pain 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; It is not known if the member has known or suspected coronary artery disease. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member does not have known or suspected coronary artery disease 2


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 1 or less cardiac risk factors; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 20 to 29; chest pain, dyspnea, hypertension 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 1 or less cardiac risk factors; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 20 to 29; This will be an Exercise Nuc Stress Patient has Chronic Back pain. Is a Current smoker. Family Hx DM 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 2 cardiac risk factors; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 20 to 29; chest pain 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 2 cardiac risk factors; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 20 to 29; chest pain, dyspnea on exertion, positive family history 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 2 cardiac risk factors; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 20 to 29; chest pain, syncope, carotid bruit, dyspnea on exertion, leg pain, claudication 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is 20 to 29; ANGINAL EQUIVALENT DOE, SYNCOPE, SMOKER, HTN, MURMUR-PULM STENOSIS, CONGENITAL HEART SX AS CHILD 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is 20 to 29; new on set of hypertension with chest pain and regular heat beats and normal ekg. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is 30 to 39; Enter answer here - or Type I1. chest pain/shortness of breath on exertion: Patient states that she began having these symptoms about one month ago. They have progressively gotten worse. She has a history of smoking as well as early coronary artery dise 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is 30 to 39; Exercise Stress test performed and patient continues to have chest pain and shortness of breath. There is also left arm pain. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is less than 20; Pt had ABN base line EKG. Tread mill stress test is non diagnostic. Pt has severe arthritis. 1






This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member has known or suspected coronary artery disease.; There is known coronary artery disease, history of heart attack (MI), coronary bypass surgery, coronary angioplasty or stent.; There are new or changing cardiac symptoms including atypical chest pain (angina) and/or shortness of breath.; The patient has not had other testing done to evaluate new or changing symptoms.; The BMI is 30 to 39; none 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is requested for congestive heart failure.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is 30 to 39; Pt. have COPD oxygen dependent; can't walk on a treadmill 1

Cardiology Disapproval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study Radiology Services Denied Not Medically Necessary This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is requested for evaluation of the heart prior to non cardiac surgery. 1

Cardiology Disapproval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study Radiology Services Denied Not Medically Necessary This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is requested for known or suspected valve disorders. 2


This study is being ordered for Inflammatory/ Infectious Disease.; Patient states he had a Cath about 3 years ago w/Dr. Jordan and is wanting to switch cardiologists. He saw Dr. Freddy Chrisman on 8-19-2015. On that date he complained of chest discomfort in the precordial area that radiates to the left arm and Dyspnea.; It is not known if there has been any treatment or conservative therapy.; CATH results showed mild CAD. He presented with Precordial chest discomfort that radiates to the left arm and Dyspnea. He has Edema and Obesity (410 lbs.); Patient cannot walk on TMST due to obesity and physical limitations. With his progression of shortness of breath, the doctor would like to have an Echo of the heart as well. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; More than one year ago; There has not been any treatment or conservative therapy.; chest pain, palpitations, diaphoresis, malaise, fatigue, shortness of breath, weakness; n/a 1

Cardiology Disapproval 78459 Myocardial imaging, PET Radiology Services Denied Not Medically Necessary

This is a request for a Cardiac-imaging PET scan.; This study is being ordered to identify a myocardial perfusion defect.; This patient has NOT had a SPECT scan within the past eight (8) weeks.; Yes, the patient has symptoms including chest tightness, angina and/or shortness of breath on exertion.; The patient does NOT have a body Mass List score index equal to or above 40.; pain 8 out of 10, known cad with chest pain. EF about 50. bmi only 30. worsening dyspnea with excertion 1

Cardiology Disapproval 78459 Myocardial imaging, PET Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; july 2015; There has been treatment or conservative therapy.; inhaler for copd ; adorvastatin ; morpherin, spereva, albuterol; shortness of breath, angina, cough; abnormal ekg 1

Cardiology Disapproval 93307 TTHRC R-T IMG 2D +-M-MODE REC COMPL Radiology Services Denied Not Medically Necessary



This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; This study is being ordered for evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicative of heart disease.; This is for the initial evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicatvie of heart disease.; The abnormal symptom, condition or evaluation is not known or unlisted above. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; This study is being ordered for evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicative of heart disease.; This is for the initial evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicatvie of heart disease.; The patient has an abnormal EKG; This study is NOT being requested for the initial evaluation of frequent or sustained atrial or ventricular cardiac arrhythmias. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Cardiac Murmur.; This request is NOT for initial evaluation of a murmur.; This is a request for follow up of a known murmur.; There has been a change in clinical status since the last echocardiogram. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Cardiac Valves.; This is an annual review of known valve disease.; It has been 24 months or more since the last echocardiogram. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; More than one year ago; There has not been any treatment or conservative therapy.; chest pain, palpitations, diaphoresis, malaise, fatigue, shortness of breath, weakness; n/a 1

Chiropractic Medicine Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This request is for a Brain MRI; The study is being requested for evaluation of a headache.; This headache is not described as sudden, severe or chronic recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; It is not known if there are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Please see fax attached. 1

Chiropractic Medicine Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient does not have dizziness, fatigue or malaise, sudden change in mental status, Bell's palsy, Congenital abnormality, loss of smell, hearing loss or vertigo.; 1

Chiropractic Medicine Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST



This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; 4th week of conservative management with no improvement 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; unknown 1



Chiropractic Medicine Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Neurological deficits; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 2


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 7/28/2015; There has been treatment or conservative therapy.; PT, Chiro, insaids nothing is working; Pt experiencing headaches, neck pain and R arm pain.; None 1

Chiropractic Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST


Chiropractic Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST


Chiropractic Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 1

Chiropractic Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 8

Chiropractic Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; bypass 1

Chiropractic Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; unknown 1

Chiropractic Medicine Approval 73221 MRI JOINT OF UPPER EXTREMITY



The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; has decreased range of motion pain and throbbing active and passive rage of motion are very minimal 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient received oral analgesics.; The patient has completed 6 weeks or more of Chiropractic care. 1

Chiropractic Medicine Disapproval 70544 Mr angiography head w/o dye Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 7/28/2015; There has been treatment or conservative therapy.; PT, Chiro, insaids nothing is working; Pt experiencing headaches, neck pain and R arm pain.; None 1

Chiropractic Medicine Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; There has not been a supervised trial of conservative management for at least 6 weeks.; <Enter Additional Clinical Information> 1

Chiropractic Medicine Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has not directed conservative treatment for the past 6 weeks.; None 1

Chiropractic Medicine Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; R/O disc herniation 1

Colon & Rectal Surgery Approval 71250 CT CHEST, THORAX 1

Colon & Rectal Surgery Approval 71250 CT CHEST, THORAX

This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; rectal cancer 1

Colon & Rectal Surgery Approval 72196 MRI PELVIS 2

Colon & Rectal Surgery Approval 72196 MRI PELVIS


Colon & Rectal Surgery Approval 74176 CT ABD & PELVIS W/O CONTRAST 3

Colon & Rectal Surgery Approval 74176 CT ABD & PELVIS W/O CONTRAST


Colon & Rectal Surgery Disapproval 72196 MRI PELVIS Radiology Services Denied Not Medically Necessary

This study is being ordered for Congenital Anomaly.; 06-29-2015; There has not been any treatment or conservative therapy.; pain; < Enter answer here - or Type In Unknown If No Info Given. > 1

Colon & Rectal Surgery Disapproval 74181 MRI ABDOMEN Radiology Services Denied Not Medically Necessary

< Enter answer here - or Type In Unknown If No Info Given. >; pain; There has not been any treatment or conservative therapy.; 06-29-2015; This study is being ordered for Congenital Anomaly. 1

Doctors and Rehabilitation Approval 70544 Mr angiography head w/o dye 1Doctors and Rehabilitation Approval 70547 Mr angiography neck w/o dye 1

Doctors and Rehabilitation Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST


Doctors and Rehabilitation Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 1

Doctors and Rehabilitation Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; Degeneration of the lumbar and cervical dics; < Enter answer here - or Type In Unknown If No Info Given. > 1



Doctors and Rehabilitation Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Neurological deficits; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 2


This study is being ordered for a neurological disorder.; gradually over time; There has been treatment or conservative therapy.; pain medication, NSAIDS, ibuprofen; neck and mid-back pain; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 7/20/15; There has been treatment or conservative therapy.; betamethasone acetate and sodium phos 6 mg/mL suspension for injection Take by injection route. 07/20/15 administered John Yocum, MD bumetanide 1 mg tablet 09/11/15 filled Caremark clonazepam 1 mg tablet 09/11/15 filled Caremark ; Pain, numbness, tingling; tenderness on palpation of the right greater trochanter(s). Soft Tissue Palpation on the Right: tenderness of the lower paraspinals, the quadratus lumborum, and the gluteus medius tenderness of the lower paraspinals and the quadratus lumborum. Active Rang 1

Doctors and Rehabilitation Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is not experiencing or presenting symptoms of abnormal gait, lower extremity weakness, asymmetric reflexes, fracture, radiculopathy or bowel or bladder dysfunction.; The patient is experiencing sensory abnormalities such as numbness or tingling.; There has been a supervised trial of conservative management for at least 6 weeks. 2

Doctors and Rehabilitation Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This study is being ordered for a neurological disorder.; gradually over time; There has been treatment or conservative therapy.; pain medication, NSAIDS, ibuprofen; neck and mid-back pain; 1

Doctors and Rehabilitation Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 3

Doctors and Rehabilitation Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST

The patient has acute or chronic back pain.; The patient has 6 weeks of completed conservative care in the past 3 months or had a spine injection; The study requested is a Lumbar Spine MRI. 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; The patient is in extreme pain due to displacement of lumbar intervertebral disc.; The patient is a 46-year-old female who was originally treated for cervical spine pain, which improved following epidural steroid injections but then began complaining of right paramidline lumbosacral spine pain. The patient underwent a single therapeuti 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; weakness due to numbness and tingling in lower extremities burning in feet; patient continues to have the same issues after completeing 6 weeks of physical therapy with no relief still having numbness and tingling. 1



Doctors and Rehabilitation Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 1

Doctors and Rehabilitation Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 3


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 7/20/15; There has been treatment or conservative therapy.; betamethasone acetate and sodium phos 6 mg/mL suspension for injection Take by injection route. 07/20/15 administered John Yocum, MD bumetanide 1 mg tablet 09/11/15 filled Caremark clonazepam 1 mg tablet 09/11/15 filled Caremark ; Pain, numbness, tingling; tenderness on palpation of the right greater trochanter(s). Soft Tissue Palpation on the Right: tenderness of the lower paraspinals, the quadratus lumborum, and the gluteus medius tenderness of the lower paraspinals and the quadratus lumborum. Active Rang 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Aug 2007; There has been treatment or conservative therapy.; injections to shoulder/back; pain; LRM 1

Doctors and Rehabilitation Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is not an orthopedist.; Pain greater than 3 days; The patient had recent plain films of the knee.; The results of the plain films is not known.; Yes, patient has completed and failed a course of conservative treatment.; Physician directed course of non-steroidal anti-inflammatory medications 1

Doctors and Rehabilitation Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT


Doctors and Rehabilitation Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT 1

Doctors and Rehabilitation Disapproval 72131 CT LUMBAR SPINE, LOW BACK Radiology Services Denied Not Medically Necessary


Doctors and Rehabilitation Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Neurological deficits; No, the patient is not experiencing or presenting new symptoms of upper extremity weakness?; No, the patient is not demonstrating unilateral muscle wasting.; No, the patient is not experiencing or presenting new symptoms of Bowel or bladder dysfunction.; No, the patient is not experiencing new onset of parathesia diagnosed by a neurologist; No, the patient is not experiencing or presenting x-ray evidence of a recent fracture.; 1

Doctors and Rehabilitation Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This is a request for cervical spine MRI; Trauma or recent injury; No, the patient does not have new or changing neurological signs or symptoms.; 1


This study is being ordered for a neurological disorder.; 15+ years ago; There has been treatment or conservative therapy.; back surgery, pain medications, NSAIDs; neck and back pain, radiculopathy; 1


This study is being ordered for a neurological disorder.; gradually over time; There has been treatment or conservative therapy.; pain medication, muscle relaxer, NSAIDs,; neck and mid to lower back pain; 1


This study is being ordered for a neurological disorder.; gradually over time; There has been treatment or conservative therapy.; pain medication, NSAIDs and physical therapy; neck and mid to lower back pain; 1

Doctors and Rehabilitation Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary


Doctors and Rehabilitation Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary


Doctors and Rehabilitation Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; She reports weakness and unsteady gait; 1. Axial lower back pain consistent with internal disc disruption at L5-S1 and L4-L5 confirmed with provocational lumbar discography. 2. Bilateral lower limb pain consistent with somatic referral from #1 versus S1 versus L5 radicular pain. PLAN 1

Doctors and Rehabilitation Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 1


This study is being ordered for a neurological disorder.; 15+ years ago; There has been treatment or conservative therapy.; back surgery, pain medications, NSAIDs; neck and back pain, radiculopathy; 1





Doctors and Rehabilitation Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Aug 2007; There has been treatment or conservative therapy.; injections to shoulder/back; pain; LRM 1

Doctors and Rehabilitation Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; gradually over time; There has been treatment or conservative therapy.; physical therapy, pain medication, muscle relaxer, NSAIDs; bilateral knee pain; 2

Doctors and Rehabilitation Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; over 10 years; There has been treatment or conservative therapy.; pain medication, muscle relaxers; bilateral knee pain; 2

Emergency Medicine Approval 70450 CT BRAIN, HEAD


Emergency Medicine Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This request is for a Brain MRI; It is unknown if the study is being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; It is not known if the condition is associated with headache, blurred or double vision or a change in sensation noted on exam.; It is not known if a metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; < Enter answer here - or Type In Unknown If No Info Given. > 1




This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is presenting with a sudden change in severity, associated with exertion, or a mental status change. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; This study is being ordered for stroke or TIA (transient ischemic attack).; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient has one sided arm or leg weakness. 1

Emergency Medicine Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Yes, this is a request for a Chest CT Angiography.; This study is requested to evaluate suspected pulmonary embolus. 1

Emergency Medicine Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST

This study is being ordered for trauma or injury.; 9-13-15; There has been treatment or conservative therapy.; He is a pt in pain management. He is treated with Meloxicam, Tylenol-Codeine #4; Back pain with numbness and weakness in his left leg. Pt has hx of neck surgery and has chronic neck pain but has new and worsening symptoms.; unknown 1

Emergency Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 1

Emergency Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 1

Emergency Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; PT IS SUFFERING NEUROLOGICAL DEFICITS. 1

Emergency Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST

This study is being ordered for trauma or injury.; 9-13-15; There has been treatment or conservative therapy.; He is a pt in pain management. He is treated with Meloxicam, Tylenol-Codeine #4; Back pain with numbness and weakness in his left leg. Pt has hx of neck surgery and has chronic neck pain but has new and worsening symptoms.; unknown 1

Emergency Medicine Approval 73221 MRI JOINT OF UPPER EXTREMITY


Emergency Medicine Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This is a request for a foot MRI.; The study is being ordered forfoot pain.; The study is NOT being ordered for chronic pain, acute pain, rule our tarsal coalition, known or suspected septic arthritis or oseteomylitis, tendonitis, neuroma or plantar fasciitis.; non healing ulcer drainage and pain 1

Emergency Medicine Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; It is not known if the member experience a painful popping, snapping, or giving away of the knee.; Swelling greater than 3 days 1

Emergency Medicine Approval 74176 CT ABD & PELVIS W/O CONTRAST 1

Emergency Medicine Approval 74176 CT ABD & PELVIS W/O CONTRAST


Emergency Medicine Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; There is a known or a strong suspicion of kidney or ureteral stones. 1

Emergency Medicine Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study 3

Emergency Medicine Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary

This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; headaches for 7 days, no visual changes/ no improvement with meds/ 1

Emergency Medicine Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This request is for a Brain MRI; It is unknown if the study is being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; It is not known if the condition is associated with headache, blurred or double vision or a change in sensation noted on exam.; It is not known if a metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; ip/no clinical 1

Emergency Medicine Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Patient states she has had a headache since July 2 and she also has Right upper quad pain she also reports fatigue and weakness; It is not known if there has been any treatment or conservative therapy.; Chills,fatigue,weakness,fever,sweats,headache,light headedness,weakness,Dizzines,abd pain and nausea; unknown 1

Emergency Medicine Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; Weakness due to radiating pain from neck to wrist; < Enter answer here - or Type In Unknown If No Info Given. > 1

Emergency Medicine Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; n/a; It is not known if there has been any treatment or conservative therapy.; neck, back and lower back pain; < Enter answer here - or Type In Unknown If No Info Given. > 1

Emergency Medicine Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary


Emergency Medicine Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary


Emergency Medicine Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary


Emergency Medicine Disapproval 74150 CT ABDOMEN WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an Abdomen CT.; This study is being ordered for an infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease.; It is not known if the patient has been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; It is unknown if there are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; < Enter answer here - or Type In Unknown If No Info Given. > 1

Emergency Medicine Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; There is a known or a strong suspicion of kidney or ureteral stones. 1

Emergency Medicine Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Patient states she has had a headache since July 2 and she also has Right upper quad pain she also reports fatigue and weakness; It is not known if there has been any treatment or conservative therapy.; Chills,fatigue,weakness,fever,sweats,headache,light headedness,weakness,Dizzines,abd pain and nausea; unknown 1

Emergency Medicine Disapproval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study Radiology Services Denied Not Medically Necessary


Endocrinology Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST

This is a request for neck soft tissue CT.; There has not been recent trauma or other injury to the neck.; It is unknown if there is suspicion of or known tumor, metastasis, lymphadenopathy, or mass.; There is not a suspicion of an infection or abscess.; This is not being ordered by an ENT specialist. 1

Endocrinology Approval 70540 MRI ORBIT/FACE/NECK W/O DYE

This is a request for an Orbit MRI.; There is not a history of orbit or face trauma or injury.; There is not a suspicion of an infection or abscess.; This examination is being requested to evaluate lymphadenopathy or mass. 1

Endocrinology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 4

Endocrinology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This is a request for an Internal Auditory Canal MRI.; There is not a suspected Acoustic Neuroma or tumor of the inner or middle ear.; There is not a suspected cholesteatoma of the ear.; The patient has not had a recent brain CT or MRI within the last 90 days.; There are no neurologic symptoms or deficits such as one-sided weakness, speech impairments, vision defects or sudden onset of severe dizziness.; This is not a pre-operative evaluation for a known tumor of the middle or inner ear. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing fatigue or malaise.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of tumor; A biopsy has not been completed to determine tumor tissue type.; There are not recent neurological symptoms such as one-sided weakness, speech impairments, or vision defects.; There is not a new and sudden onset of headache (less than 1 week) not improved by pain medications.; The tumor is a pituitary tumor or pituitary adenoma.; There are physical findings or laboratory values indicating abnormal pituitary hormone levels. 1

Endocrinology Approval 71250 CT CHEST, THORAX 1

Endocrinology Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for known tumor. 1

Endocrinology Approval 71250 CT CHEST, THORAX


Endocrinology Approval 72192 CT PELVIS WITHOUT CONTRAST 1Endocrinology Approval 74150 CT ABDOMEN WITHOUT CONTRAST 2

Endocrinology Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Lt flank pain moderate to severe no radiation; low grade fever 1

Endocrinology Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Other; There are clinical findings or indications of Hematuria. 1

Endocrinology Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY 1

Endocrinology Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; Timothy W Montgomery is a 28 y.o. male. Referred for infertility and hypogonadism. At age 18 patient was seen at LRDC, and placed on testosterone injections from age 18-20. No injections for 3-4 years due to insurance (age 20-24). About age 25-28 he start 1

Endocrinology Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are new lab results or other imaging studies including ultrasound, Doppler or plain films findings. 1

Free Standing Surgery Center Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST


Gastroenterology Approval 70450 CT BRAIN, HEAD


Gastroenterology Approval 71250 CT CHEST, THORAX 1

Gastroenterology Approval 71250 CT CHEST, THORAX



This study is being ordered for Inflammatory/ Infectious Disease.; a week ago; There has been treatment or conservative therapy.; pt was d/c from hospital on full liquid diet with prescriptions and is instructed to follow up with internal disease dr and GI dr as directed.; abdominal pain, nausesa and vomiting; on noncontrasted CT while in hospital pt was found to have liver lesions and abnormal lymph nodes. Radiologist recommended contrasted CT to further evaluate area and Dr is wanting to rule out lymphadenopathy and assess chest area for spreading 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 9/3/15; There has been treatment or conservative therapy.; antibiotics; rectal bleeding, weight greater than 50 pounds, abdominal pain, blood in stool; Diverticulitis and weight loss 1

Gastroenterology Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST 1Gastroenterology Approval 72196 MRI PELVIS 1Gastroenterology Approval 74150 CT ABDOMEN WITHOUT CONTRAST 4

Gastroenterology Approval 74150 CT ABDOMEN WITHOUT CONTRAST



This is a request for an Abdomen CT.; This study is being ordered for a suspicious mass or tumor.; There is a suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy. 2


This is a request for an Abdomen CT.; This study is being ordered for an infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis. 1


This is a request for an Abdomen CT.; This study is being ordered for an infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease.; Yes, the patient has been seen by a specialist or are the studies being requested on behalf of a specialist for an infection. 1


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; 1




This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Patient had EGD for epigastric abdominal pain and weight loss. Pathology came back and patient has gastric inflammation. 1


This is a request for an Abdomen CT.; This study is being ordered for organ enlargement.; Which organ is enlarged? Other; Ultrasound of the liver showed enlarged pancreas or nodule on pancreas. 1

Gastroenterology Approval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST 1Gastroenterology Approval 74176 CT ABD & PELVIS W/O CONTRAST 53

Gastroenterology Approval 74176 CT ABD & PELVIS W/O CONTRAST

This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; It is unknown if there are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; Yes, the patient has been seen by a specialist or are the studies being requested on behalf of a specialist for an infection. 26


This is a request for an abdomen-pelvis CT combination.; Known Tumor, Cancer, Mass, or R/O metastases; This is not a request for follow up of a known tumor or cancer involving both the abdomen and pelvis or if this patient is undergoing active treatment.; This is a request for initial staging of a known tumor other than prostate. 2


This is a request for an abdomen-pelvis CT combination.; Known Tumor, Cancer, Mass, or R/O metastases; This is not a request for follow up of a known tumor or cancer involving both the abdomen and pelvis or if this patient is undergoing active treatment.; This is not a request for initial staging of a known tumor other than prostate.; There is no known prostate cancer with a PSA greater than 10.; yes, there is a palpable or observed abdominal mass.; There has not been a recent abdominal and or pelvis CT scan. 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; ab pain and nausea, known Crohn's 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; abdominal pain 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; evaluation for ulcers in the esophagus 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Patient is having diffuse abdominal and pelvic pain as well abdominal bloating. 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; recurrent abdominal pain, abnormal liver function tests, high elevation in transaminases, poor appetite, recurrent right flank pain 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; unknown 1


This is a request for an abdomen-pelvis CT combination.; Pre-op or post op evaluation; The requested study is for pre-operative evaluation.; The study is requested by a surgeon, specialist or PCP on behalf of a specialist who has seen the patient. 1


This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is a suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy. 1


This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are new symptoms including hematuria. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; It is not known if the pain is acute or chronic.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is male.; A rectal exam was performed.; The results of the exam were normal.; The patient did not have an Ultrasound.; unexplained varices 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; There has been a physical exam.; The patient is male.; A rectal exam was not performed.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; There has not been a physical exam.; The patient did not have a amylase or lipase lab test.; A urinalysis has not been completed.; 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was performed.; The results of the exam are unknown.; IMPRESSION: 1. 6.3 cm deep subcutaneous abdominal fluid collection at and to the left of midline at about the level of the open wound seen on the exam of 9/29/2014, presumed abdominal wall abscess. No intraperitoneal fluid collection otherwise to suggest 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was performed.; The results of the exam were abnormal.; Abnormal labs 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was performed.; The results of the exam were normal.; The patient had an Ultrasound.; The Ultrasound was normal.; A contrast/barium x-ray has been completed.; The results of the contrast/barium x-ray were normal.; The patient had an endoscopy.; The endoscopy was normal. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; It is unknown if the patient had an Amylase or Lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were normal.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; It is unknown if the patient had an Amylase or Lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were normal.; PREVIOUS CT PREFORMED BY AN ER PHYSICIAN SHOWED PANCREATIC DUCTAL PROMINENCE. ALSO SHOWED, CALCIFICATIONS ON THE OVARIES. THE PATIENT COMPLAINES BOTH UPPER AND LOWER GI PAIN AND HAS BLOOD IN STOOL. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has not been completed.; 56 yr old female patient w/ LLQ pain. 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is none of the listed reasons.; unknown 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is suspicious mass or suspected tumor or metastasis.; The patient had an abnormal abdominal Ultrasound, CT or MR study.; The patient has NOT completed a course of chemotherapy or radiation therapy within the past 90 days.; The patient is presenting new symptoms. 2


This is a request for an abdomen-pelvis CT combination.; Vascular disease; The requested studies are being ordered for known or suspected blood clot, thrombosis, or stenosis and are being ordered by a surgeon or by the attending physician on behalf of a surgeon. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 9/3/15; There has been treatment or conservative therapy.; antibiotics; rectal bleeding, weight greater than 50 pounds, abdominal pain, blood in stool; Diverticulitis and weight loss 1

Gastroenterology Approval 74181 MRI ABDOMEN 6

Gastroenterology Approval 74181 MRI ABDOMEN

Pt is being evaluated for liver transplant. Imaging is being done to evel for HCC.; "The ordering physician is an oncologist, urologist, gastroenterologist, or surgeon."; This study is being ordered for pre-operative evaluation.; This request is for an Abdomen MRI. 1


This request is for an Abdomen MRI.; This study is being ordered for known or suspected infection.; "The ordering physician is a gastroenterologist, urologist, or infectious disease specialist."; 1


This request is for an Abdomen MRI.; This study is being ordered for known or suspected infection.; "The ordering physician is a gastroenterologist, urologist, or infectious disease specialist."; 24 year old female with crohns diseas of small intestine with intestinal obtstruction mri to eval 1


This request is for an Abdomen MRI.; This study is being ordered for known or suspected infection.; "The ordering physician is a gastroenterologist, urologist, or infectious disease specialist."; 44 y/o F with intermittent N/V and abdominal pain referred for evaluation. No pertinent medical history to explain this, no UGI surgeries, no herbal meds use. Zofran and Promethazine do not help much. 1. Will obtain MRCP to evaluate the pancreaticob 1


This request is for an Abdomen MRI.; This study is being ordered for known or suspected infection.; "The ordering physician is a gastroenterologist, urologist, or infectious disease specialist."; 57AAF presenting to clinic as a follow-up visit. She has a PMHx of Crohn's Disease (fistulizing and stricturing in nature) originally diagnosed in 2007. Pt was started on Remicade in Jan 2015 and is currently on every 8 week infusion regimen with goo 1


This request is for an Abdomen MRI.; This study is being ordered for known or suspected infection.; "The ordering physician is a gastroenterologist, urologist, or infectious disease specialist."; Aug 2015 MRI/MRCP IMPRESSION: 1. Findings consistent with acute edematous pancreatitis. Mild extrinsic compression of the CBD related to the pancreatic head inflammatory process. No evidence for biliary duct dilatation or choledocholithiasis. 2. Un 1


This request is for an Abdomen MRI.; This study is being ordered for known or suspected infection.; "The ordering physician is a gastroenterologist, urologist, or infectious disease specialist."; Patient has Chirosis 1


This request is for an Abdomen MRI.; This study is being ordered for Known Tumor.; "The ordering physician is an oncologist, urologist, gastroenterologist, or surgeon."; This study is being ordered for staging.; Patient is currently being evaluated for a liver transplant. Imaging is to view the progression of tumor. 1


This request is for an Abdomen MRI.; This study is being ordered for Known Tumor.; This study is being ordered for follow-up.; The patient did NOT have chemotherapy, radiation therapy or surgery in the last 3 months.; They did NOT have an Abdomen MRI in the last 10 months. 1


This request is for an Abdomen MRI.; This study is being ordered for pre-operative evaluation.; "The ordering physician is an oncologist, urologist, gastroenterologist, or surgeon."; Imaging is to evaluate severity of portal vein thrombosis before being evaluated for a possible liver transplant. 1


This request is for an Abdomen MRI.; This study is being ordered for pre-operative evaluation.; "The ordering physician is an oncologist, urologist, gastroenterologist, or surgeon."; Patient is currently listed for a liver transplant. Imaging is for continued listing and evaluate for portal hypertension. 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; I personally reviewed and interview Ms. Elaine P Fabbio today during his clinic visit. I agree with findings, assessment and plan of care as stated on Dr. Ramavaram note. In summary she comes today with outside imaging showing 2 small cystic lesions in th 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; Patient had CT scan on 8/19/15 that showed 5 hypervascular masses in the liver. Hemangiomas vs nodular hyperpasia. Recommended MRI. She is complaining of fatigue, severe abd pain/cramping and diarrhea. 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are no documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; Patient is scheduled for a pancreatic biopsy and the radiologist is requested patient to have an MRCP prior to see if biopsy is needed. 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; The patient has NOT had previous abnormal imaging including a CT, MRI or Ultrasound.; This study is NOT being ordered to evaluate an undescended testicle in a male.; had CT liver biopsy and normal - HEP C though 1


This request is for an Abdomen MRI.; This study is not being ordered for known tumor, suspicious mass or suspected tumor/metastasis, organ enlargement, known or suspected vascular disease, hematuria, follow-up trauma, or a pre-operative evaluation.; 1


This request is for an Abdomen MRI.; This study is not being ordered for known tumor, suspicious mass or suspected tumor/metastasis, organ enlargement, known or suspected vascular disease, hematuria, follow-up trauma, or a pre-operative evaluation.; evaluating pancreases// abdominal pain 1


This request is for an Abdomen MRI.; This study is not being ordered for known tumor, suspicious mass or suspected tumor/metastasis, organ enlargement, known or suspected vascular disease, hematuria, follow-up trauma, or a pre-operative evaluation.; MD found 3 lensions in liver during CT. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; pt seen in the office for abd pain, pt recent CT scan shows nodular liver and dilated common bile duct need further eval with MRI Abd and MRCP to r/o Mass in the pancreas and question of cirrhosis of the liver 1

Gastroenterology Approval 74261 CT Colonography, diagnostic without contrast

The member had colon screening studies completed prior to this request.; This patient has a medical problem that makes him/her unsuitable for conventional colonoscopy.; Did virtual last yr had colon blockage did a CT virtual last yr this is a F/U 1

Gastroenterology Approval 75571 Corornary Artery Calcium Score, EBCT 1

Gastroenterology Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study

This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; < Enter answer here - or Type In Unknown If No Info Given. > 1

Gastroenterology Approval 78813 PET IMAGING WHOLE BODY 1Gastroenterology Approval S8037 mrcp 7

Gastroenterology Approval S8037 mrcp

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; pt seen in the office for abd pain, pt recent CT scan shows nodular liver and dilated common bile duct need further eval with MRI Abd and MRCP to r/o Mass in the pancreas and question of cirrhosis of the liver 1

Gastroenterology Approval S8037 mrcp

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; ; There has been treatment or conservative therapy.; ; ; 1

Gastroenterology Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; < Enter answer here - or Type In Unknown If No Info Given. > 1

Gastroenterology Disapproval 74150 CT ABDOMEN WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an Abdomen CT.; This study is being ordered as a pre-op or post op evaluation.; The requested study is for post-operative evaluation.; The requested study is a first follow up study for a post operatove complication. 1

Gastroenterology Disapproval 74150 CT ABDOMEN WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; < Enter answer here - or Type In Unknown If No Info Given. > 1

Gastroenterology Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary





This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; Abd pain 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; unknown 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was performed.; The results of the exam were abnormal.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient had an amylase lab test.; The results of the lab test were normal.; A urinalysis has not been completed.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for Inflammatory/ Infectious Disease.; a week ago; There has been treatment or conservative therapy.; pt was d/c from hospital on full liquid diet with prescriptions and is instructed to follow up with internal disease dr and GI dr as directed.; abdominal pain, nausesa and vomiting; on noncontrasted CT while in hospital pt was found to have liver lesions and abnormal lymph nodes. Radiologist recommended contrasted CT to further evaluate area and Dr is wanting to rule out lymphadenopathy and assess chest area for spreading 1

Gastroenterology Disapproval 74181 MRI ABDOMEN Radiology Services Denied Not Medically Necessary


Gastroenterology Disapproval 74263 CT Colonography, screening Radiology Services Denied Not Medically Necessary This is a request for CT Colonoscopy for screening purposes only. 1General/Family Practice Approval 70450 CT BRAIN, HEAD 45

General/Family Practice Approval 70450 CT BRAIN, HEAD

This is a request for a brain/head CT.; "There are recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; The study is requested for recent head trauma or injury. 1

General/Family Practice Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; 2

General/Family Practice Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; < Enter answer here - or Type In Unknown If No Info Given. > 1

General/Family Practice Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; Memory loss of unknown cause 1

General/Family Practice Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; Patient had a syncopal episode and lost consciousness for a brief time 1

General/Family Practice Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; Patient has experienced a TIA 1

General/Family Practice Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; unknown 1

General/Family Practice Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; 2

General/Family Practice Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for evaluation of known tumor. 1


This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for something other than trauma or injury, evaluation of known tumor, stroke or aneurysm, infection or inflammation, multiple sclerosis or seizures.; The patient has a sudden change in mental status.; Patient has confusion and dizziness with a worsening headache. 1


This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for stroke or aneurysm.; This study is being ordered for a previous stroke or aneurysm.; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient has dizziness.; BLURRED VISION, WEAKENESS 1


This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for stroke or aneurysm.; This study is being ordered for neurological deficits.; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient has one sided arm or leg weakness. 1


This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for trauma or injury.; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient has dizziness.; pt fell and hit her head, pt has headaches, did loose consciousness, has muscle weakness, ringing in the ears nausea, blurred vision 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; < Enter answer here - or Type In Unknown If No Info Given. > 2


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; headache and numbness of the lips 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; headaches that are getting worse, medication is not helping 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; Patient experiencing 5 day durational headache, with a pain index of 10 out of 10. Patient taking Hydrocodone. 1




This is a request for a brain/head CT.; The study is requested for headache.; There is not headache not improved by pain medications.; "There are recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness." 5

General/Family Practice Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for history of stroke, (CVA) known or follow-up. 1

General/Family Practice Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for known or suspected brain tumor, mass or cancer.; There is a suspected or known brain tumor. 3


This is a request for a brain/head CT.; The study is requested for new onset of seizures or newly identified change in seizure activity or pattern.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a brain/head CT.; The study is requested for new onset of seizures or newly identified change in seizure activity or pattern.; Patient has had 2 known seizures in the past 3 months. Patients first episode was 1 year ago in august 1


This is a request for a brain/head CT.; The study is requested for recent head trauma or injury.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a brain/head CT.; The study is requested for recent head trauma or injury.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; Large laceration to forehead 1


This is a request for a brain/head CT.; The study is requested for recent head trauma or injury.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; Pt had head injury having headaches, nausea and dizziness. 1


This is a request for a brain/head CT.; The study is requested for recent head trauma or injury.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; unknown 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; ; It is not known if there has been any treatment or conservative therapy.; pt presented to the clinic today with THE WORST HEADACHE SHE HAS EVER HAD! holding her head in her hands, started through the night and has gotten worse as the day goes on; pt co the worst headache ever, and dr howard is wanting to make sure this is not a anurysum or a bleed of some kind. 1

General/Family Practice Approval 70480 CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC.

"This request is for orbit,sella, int. auditory canal,temporal bone, mastoid, CT.239.8"; "There is not suspicion of bone infection, cholesteoma, or inflammatory disease.ostct"; "There is a history of serious head or skull, trauma or injury.ostct" 1

General/Family Practice Approval 70480 CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC. "This request is for orbit,sella, int. auditory canal,temporal bone, mastoid, CT.239.8"; "There is suspicion of bone infection, cholesteoma, or inflammatory disease.ostct" 1

General/Family Practice Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST 6

General/Family Practice Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST "This request is for face, jaw, mandible CT.239.8"; "There is a history of serious facial bone or skull, trauma or injury.fct" 1

General/Family Practice Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST

"This request is for face, jaw, mandible CT.239.8"; "There is not a history of serious facial bone or skull, trauma or injury.fct"; "There is suspicion of neoplasm, tumor or metastasis.fct" 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; It is unknown if the patient is immune-compromised.; The patient's current rhinosinusitis symptoms are described as (sudden onset of 2 or more symptoms of nasal discharge, blockage or congestion, facial pain, pressure and reduction or loss of sense of smell, which are less than 12 wks in duration); It has been 14 or more days since onset AND the patient failed a course of antibiotic treatment; 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; It is unknown if the patient is immune-compromised.; The patient's current rhinosinusitis symptoms are described as Recurrent Acute Rhinosinusitis (4 or more acute episodes per year) 1

General/Family Practice Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is immune-compromised. 4


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as (sudden onset of 2 or more symptoms of nasal discharge, blockage or congestion, facial pain, pressure and reduction or loss of sense of smell, which are less than 12 wks in duration); It has been 14 or more days since onset AND the patient failed a course of antibiotic treatment; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as (sudden onset of 2 or more symptoms of nasal discharge, blockage or congestion, facial pain, pressure and reduction or loss of sense of smell, which are less than 12 wks in duration); It has been less than 14 days since onset AND the patient improved, then worsened; Patient is having painful sinus pressure with nausea, headache, and congestion. 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as (sudden onset of 2 or more symptoms of nasal discharge, blockage or congestion, facial pain, pressure and reduction or loss of sense of smell, which are less than 12 wks in duration); It has been less than 14 days since onset; BIL ear pain that radiates to back of head and behind eyes 1




This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as Recurrent Acute Rhinosinusitis (4 or more acute episodes per year) 4


This is a request for a Sinus CT.; This study is not being ordered for trauma, tumor, sinusitis, osteomyelitis, pre operative or a post operative evaluation.; Left side of the nasal mucosa is swollen possible foreign body. pt has had nasal surgery in the past. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; IMPRESSION: Right greater than left maxillary sinus disease with opacification and likely mucosal thickening. 1

General/Family Practice Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST 2

General/Family Practice Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST

This is a request for neck soft tissue CT.; The patient has a neck lump or mass.; There is a palpable neck mass or lump.; The neck mass is larger than 1 cm.; A fine needle aspirate was NOT done.; HISTORY OF SMOKING 1


This is a request for neck soft tissue CT.; The patient has a neck lump or mass.; There is a palpable neck mass or lump.; The neck mass is larger than 1 cm.; A fine needle aspirate was NOT done.; tender mass rt anterior 1 x 2cm also has hypothyroidism and leukocytosis. needs ct for further evaluation 1


This is a request for neck soft tissue CT.; The patient has a neck lump or mass.; There is a palpable neck mass or lump.; The size of the neck mass is unknown.; The neck mass has NOT been examined twice at least 30 days apart.; Enter answer here - or Type In UnknoCC: Ms. Cain is a 23 year old White female. She presents with lymph enlargement. HPI: Patient complains of lymphadenopathy. A possible swollen lymph node that was first noticed 3 weeks ago. This is located 1


This is a request for neck soft tissue CT.; The study is being ordered for something other than Trauma or other injury, Neck lump/mass, Known tumor or metastasis in the neck, suspicious infection/abcess or a pre-operative evaluation.; < Enter answer here - or Type In Unknown If No Info Given. > 1

General/Family Practice Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST This is a request for neck soft tissue CT.; There has been recent trauma or other injury to the neck. 1


This is a request for neck soft tissue CT.; There has not been recent trauma or other injury to the neck.; There is no suspicion of or known tumor, metastasis, lymphadenopathy, or mass.; There is a suspicion of an infection or abscess. 1




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; repeat to make sure cancer has not spread 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 08/02/2015; There has been treatment or conservative therapy.; Antibiotics; Non mobile lymph node behind the ear mass is in the mastoid process. Patient states she feels tired all the time.; MRI's have been requested for surgical consult and to determine treatment. 1

General/Family Practice Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST

This study is being ordered for a neurological disorder.; 09/16/2015; There has not been any treatment or conservative therapy.; stroke like symptoms, neurological deficits; patient had a mri patient had several mini trans ischemic attacks 1

General/Family Practice Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Headache (784.0). I have reviewed her records. It has been previously rec that she get a CTA. I think this is a good idea given the severity of her FH.; There has not been any treatment or conservative therapy.; She feels pretty good except for headaches. She has a strong FH of aneurysms. She has never had any imaging.; She feels pretty good except for headaches. She has a strong FH of aneurysms. She has never had any imaging. 1

General/Family Practice Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the brain. 1General/Family Practice Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST 2

General/Family Practice Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST

This study is being ordered for a neurological disorder.; 09/16/2015; There has not been any treatment or conservative therapy.; stroke like symptoms, neurological deficits; patient had a mri patient had several mini trans ischemic attacks 1

General/Family Practice Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Headache (784.0). I have reviewed her records. It has been previously rec that she get a CTA. I think this is a good idea given the severity of her FH.; There has not been any treatment or conservative therapy.; She feels pretty good except for headaches. She has a strong FH of aneurysms. She has never had any imaging.; She feels pretty good except for headaches. She has a strong FH of aneurysms. She has never had any imaging. 1

General/Family Practice Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the Neck. 2General/Family Practice Approval 70540 MRI ORBIT/FACE/NECK W/O DYE 2

General/Family Practice Approval 70540 MRI ORBIT/FACE/NECK W/O DYE "This is a request for orbit,face, or neck soft tissue MRI.239.8"; The study is ordered for suspicion of infection or abscess 1

General/Family Practice Approval 70540 MRI ORBIT/FACE/NECK W/O DYE "This is a request for orbit,face, or neck soft tissue MRI.239.8"; The study is ordered for the evaluation of lymphadenopathy or mass 2

General/Family Practice Approval 70540 MRI ORBIT/FACE/NECK W/O DYE

This study is being ordered for trauma or injury.; Several years; It is not known if there has been any treatment or conservative therapy.; < Describe primary symptoms here - or Type In Unknown If No Info Given >; Patient has a cyst and tumors on his back 1

General/Family Practice Approval 70544 Mr angiography head w/o dye 3

General/Family Practice Approval 70544 Mr angiography head w/o dye

This is a request for a Brain and Neck MRA combination.; There is NOT a family history of a brain aneurysm in the parent, brother, sister or child of the patient.; There has been a recent (less than 2 week) neck or carotid artery ultrasound.; The results of the ultrasound are unknown.; The patient had an onset of neurologic symptoms within the last two weeks.; The patient has dizziness.; 1

General/Family Practice Approval 70544 Mr angiography head w/o dye This is a request for a Brain MRA.; There is an immediate family history of aneurysm. 4


This is a request for a Brain MRA.; There is not an immediate family history of aneurysm.; The patient does not have a known aneurysm.; The patient has had a recent MRI or CT for these symptoms.; There has not been a stroke or TIA within the past two weeks. 1


This is a request for a Brain MRA.; There is not an immediate family history of aneurysm.; The patient does not have a known aneurysm.; The patient has not had a recent MRI or CT for these symptoms.; There has not been a stroke or TIA within the past two weeks. 1


This study is being ordered for a neurological disorder.; 08/19/2015; There has been treatment or conservative therapy.; meds prescribed, instructions given; dizziness, gait instability, weakness; pt is having racing thoughts, difficulty concentrating. loss of balance and an abnormal CT scan 1

General/Family Practice Approval 70547 Mr angiography neck w/o dye 1

General/Family Practice Approval 70547 Mr angiography neck w/o dye

This is a request for a Brain and Neck MRA combination.; There is NOT a family history of a brain aneurysm in the parent, brother, sister or child of the patient.; There has been a recent (less than 2 week) neck or carotid artery ultrasound.; The results of the ultrasound are unknown.; The patient had an onset of neurologic symptoms within the last two weeks.; The patient has dizziness.; 1

General/Family Practice Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 62

General/Family Practice Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This is a request for an Internal Auditory Canal MRI.; There is a suspected Acoustic Neuroma or tumor of the inner or middle ear. 1

General/Family Practice Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST



This request is for a Brain MRI; It is unknown if the study is being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; It is not known if the condition is associated with headache, blurred or double vision or a change in sensation noted on exam.; It is not known if a metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; unknown 1


This request is for a Brain MRI; It is unknown if the study is being requested for evaluation of a headache.; Requested due to trauma or injury.; There are new, intermittent symptoms or deficits such as one sided weakness, speech impairments, or vision defects. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; It is not known if there are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; HA x 5 weeks multiple meds. Hx of migraines 3 years ago. N/V Past hx of sinus disease 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; It is not known if there are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; unknown 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Increased frequency of headaches with history of meningioma. Prior surgery for meningioma. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects. 2


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; It is not known if there are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; headaches for couple weeks. right side of head has knots, keeping her awake. sun makes headaches worse. right eye and side of head. throbbing/pounding. (had to understand caller with accent, sorry.) 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; MRI of brain w/o contrast shows 6mm measurement of pineal gland may be represent of small cyst or pinealoma, suggest post contrasted MRI for evaluation of the pituitary 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; this patient is a non-complainer. she presented with complaints of a persistent severe headaches associated with vertigo. we have sent her to an ENT for evaluation and no cause was found. this has been persistent for at least 6 months and she has tried nu 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; family hx of TIA, 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; HA and dizziness 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Patient has history of hydrocephalus which he had to have brain surgery for. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Pt went to ER and had a CT and on results showed an empty sella syndrome and requested for further review. Been seeing neurologists on symptoms 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects. 7




This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; It is unknown if there recent neurological deficits on exam such as one sided weakness, speech impairments or vision defects.; There is a new and sudden onset of a headache less than 1 week not improved by medications.; It is not known if the headache is described as a “thunderclap” or the worst headache of the patient’s life.; Acute memory impairment - 780.93 New onset of headaches after age 50- 784.0 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; There are NO recent neurological deficits on exam such as one sided weakness, speech impairments or vision defects.; There is a new and sudden onset of a headache less than 1 week not improved by medications.; The headache is described as a “thunderclap” or the worst headache of the patient’s life. 5




This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient does not have a sudden severe, chronic or recurring or a thunderclap headache.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient does not have a sudden severe, chronic or recurring or a thunderclap headache.; Headache - Detailed Reported by patient. Location: unilateral; frontal (R side/over R eye); temporal Quality: not the worst headache ever; similar to previous headaches; sharp/stabbing Severity: mild to moderate usually Duration: started: (abou 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient had a thunderclap headache or worst headache of the patient's life (within the last 3 months). 6

General/Family Practice Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; ongoing since Dec 2014 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; PATIENT HAS BEEN HAVING TOO MUCH PRESSURE AROUND THE EYES AS WELL AS SEVERE HEADACHES. EYE DOCTOR IS SUGGESTING TO DO AN MRI FOR EVALUATION 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; patient is having visual disburance, persisting headache overtime. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; visual disturbances, patient experiences vision loss in one eye at times. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; Worsening headaches with associated dizziness, photophobia, phonophobia, and facial numbness. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a sudden and severe headache.; The patient had a recent onset (within the last 3 months) of neurologic symptoms.; The patient has dizziness.; 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a sudden and severe headache.; The patient had a recent onset (within the last 3 months) of neurologic symptoms.; The patient has dizziness.; none 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a sudden and severe headache.; The patient had a recent onset (within the last 3 months) of neurologic symptoms.; The patient has one sided arm or leg weakness. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a sudden and severe headache.; The patient had a recent onset (within the last 3 months) of neurologic symptoms.; The patient has vision changes.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a sudden and severe headache.; The patient had a recent onset (within the last 3 months) of neurologic symptoms.; The patient has vision changes.; Pt has nausea and light sensitivity. With new symptoms of vision changes. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a sudden and severe headache.; The patient has NOT had a recent onset (within the last 3 months) of neurologic symptoms.; member had a stroke in 2004, fainted four times on September 5, 2015 headache, dizziness, blurred vision 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a sudden and severe headache.; The patient has NOT had a recent onset (within the last 3 months) of neurologic symptoms.; Mr. WILLIAMS presents with a diagnosis of passenger injury in MVA. This was diagnosed 10 days ago. The course has been progressively worsening. It is of severe intensity. They were traveling at 60 MPH and another vehicle pulled in from of them trying 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; This headache is not described as sudden, severe or chronic recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; This headache is not described as sudden, severe or chronic recurring.; The headache is presenting with a sudden change in severity, associated with exertion, or a mental status change. 2


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient does not have dizziness, fatigue or malaise, sudden change in mental status, Bell's palsy, Congenital abnormality, loss of smell, hearing loss or vertigo.; memory loss and dementia 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient does not have dizziness, fatigue or malaise, sudden change in mental status, Bell's palsy, Congenital abnormality, loss of smell, hearing loss or vertigo.; Patient has sudden severe uncontrollable movements with headache. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient does not have dizziness, fatigue or malaise, sudden change in mental status, Bell's palsy, Congenital abnormality, loss of smell, hearing loss or vertigo.; vision loss 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient has Bell's Palsy.; MEMORY LOSS 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient has fatigue or malaise; < Enter answer here - or Type In Unknown If No Info Given. > 1




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; The lab results were abnormal 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; Syncope 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing dizziness.; The condition is associated with headache, blurred or double vision or a change in sensation noted on exam. 7


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing fatigue or malaise.; The condition is associated with headache, blurred or double vision or a change in sensation noted on exam. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing hearing loss.; The patient had a normal audiogram.; facial numbness 1




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing vertigo; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; The results of the lab tests are unknown.; altered mental status 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing vertigo; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing vertigo; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; pt. has tremors , dizziness , mri to evaluate 1




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested due to trauma or injury.; There are not new, intermittent symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; The trauma or injury to the head occured more than 1 week ago.; pt has right eye lateral upper hemianopsia visual field defect after MVA on 06-18-15 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of infection or inflammation; The patient has a fever, stiff neck AND positive laboratory findings (like elevated WBC or abnormal Lumbar puncture fluid examination that indicate inflammatory disease or an infection. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of Multiple Sclerosis; The patient has not undergone treatment for multiple sclerosis.; There are not intermittent or new neurological symptoms or deficits such as one-sided weakness, speech impairments, or vision defects.; R/O MS 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of Multiple Sclerosis; The patient has undergone treatment for multiple sclerosis. 2


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of seizures; It is not known if there has been a previous Brain MRI completed.; Patient has a pituitary adenoma, she also suffers from seizures and has migraines. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of seizures; There has not been a previous Brain MRI completed. 4




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of tumor; A biopsy has not been completed to determine tumor tissue type.; There are not recent neurological symptoms such as one-sided weakness, speech impairments, or vision defects.; There is not a new and sudden onset of headache (less than 1 week) not improved by pain medications.; The tumor is not a pituitary tumor or pituitary adenoma.; Recent syncopal episode possible seizure and arachnoid cyst. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of tumor; A biopsy has not been completed to determine tumor tissue type.; There are recent neurological symptoms such as one-sided weakness, speech impairments, or vision defects. 2

General/Family Practice Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; This study is being ordered for a tumor. 2


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; This study is being ordered for Multiple Sclerosis.; The patient has new symptoms.; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient has one sided arm or leg weakness. 1




This study is being ordered for a neurological disorder.; 08/19/2015; There has been treatment or conservative therapy.; meds prescribed, instructions given; dizziness, gait instability, weakness; pt is having racing thoughts, difficulty concentrating. loss of balance and an abnormal CT scan 1


This study is being ordered for a neurological disorder.; 3 weeks ago; There has not been any treatment or conservative therapy.; numbness to 3/4/5th digits of right hand with radiation upward in his right arm. Blurred vision. Family history of MS; 1


This study is being ordered for a neurological disorder.; headache. occasionally gets more intense noticed right eye drooping for last week weakness on right side of face as well still having some numbness and tingling in right arm and pain in lower cervical area.; There has been treatment or conservative therapy.; Pt been to chiropractor a few times and has had multiple treatments but has gotten worse pain. Pt has taken otc NSAIDs & muscle relaxers with no relief. Also has been seen by Physical Therapy for several weeks.; Facial weakness on R side. Headache. Neck Pain. Paresthesia of upper limb. Ptosis.; Headache, occasionally gets more intense. right eye drooping for the last week weakness on right side of face as well still having some numbness and tingling in right arm and pain in lower cervical area. No relief with conservative therapy. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; ................; It is not known if there has been any treatment or conservative therapy.; dddddddddddd7; ddddddddddd 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/28/2015; There has not been any treatment or conservative therapy.; Facial numbness, headache, numbness and tingling down left arm; Saw Chiropractic on 9/28/15 difficulty swallowing 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 4/15/2015; There has been treatment or conservative therapy.; Patient has been treated with MDP and Flonase. Patient has seen cardiologist to rule out heart disease causing vertigo and weakness. The patient also has seen an ENT who has performed an ENG exam, posturography and audiometric testing.; Patient complains of chronic vertigo and weakness.; After consulting with specialist, it's in agreement the patient would benefit from and MRI of the brain. 1


This study is being ordered for trauma or injury.; 8 days ago; There has been treatment or conservative therapy.; < Describe treatment / conservative therapy here - or Type In Unknown If No Info Given >; Head trauma and blurred vision; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for trauma or injury.; April 2015; There has not been any treatment or conservative therapy.; Pt is having numbness, no feeling, dizziness, back pain and has had seizures since the fall.; MDO wants to determine if there is any injury to the back and any contribution to the brain that is causing the seizures. 1

General/Family Practice Approval 71250 CT CHEST, THORAX 49

General/Family Practice Approval 71250 CT CHEST, THORAX

"There IS evidence of a lung, mediastinal or chest mass noted within the last 30 days."; A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass. 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for a pre-operative evaluation.; "The ordering physician is NOT an oncologist, surgeon, pulmonologist, cardiologist or PCP ordering on behalf of a specialist who has seen the patient."; There is not a known tumor.; There is not a known inflammatory disease.; There is no known vascular disease.; 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for follow up trauma.; The ordering physician a is NOT a Surgeon, Pulmonologist, or Cardiologist.; There is no radiologic evidence of mediastinal widening.; There is physical or radiologic evidence of a chest wall abnormality. 1

General/Family Practice Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; < Enter answer here - or Type In Unknown If No Info Given. > 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; 1 year follow up for abnormal radiographic exam. 1

General/Family Practice Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; ABN chest x-ray, ABN weight loss 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; abnormal finding on xray pericard effusion 1

General/Family Practice Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; copd , bronchitis, wheezing, 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Exam Accession Number Exam Date/Time Ordering Dr. CT Spine Lumbar Without Contrast CT150598957 08/04/2015 11:59 AM Nathan Turney, MD Reason For Exam None Specified Report Final EXAM: CT SPINE LUMBAR WO CONTRAST CLINICAL: Scia 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; multiple nodules of lung. Abnormal CT abdomen 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Patient had CT abdomen 09/04/15 and it showed a pulmonary nodule in LLL and Radiologist recommends CT chest to asses the nondeterminate LLL lung nodule. 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Patient had Lung nodule noted incidentally in prior study done by Cardio. She is a current smoker. 1

General/Family Practice Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; pulmonary nodules 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; SHORTNESS OF BREATH PULONARY ABDILMA 1

General/Family Practice Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; unknown 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The caller doesn't know if the ordering physician is a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "There is radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; The patient is NOT presenting new signs or symptoms.; The last chest CT was performed more than 6 months ago. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The caller doesn't know if the ordering physician is a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is radiologic evidence of non-resolving pneumonia after at least 4 weeks of treatment. 1




A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; It is not known if there is radiologic evidence of non-resolving pneumonia.; "There is radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; The patient is presenting new signs or symptoms. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "The caller doesn't know if there is radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; It is not known if there is radiologic evidence of a lung abscess or empyema.; There is no radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; There is no radiologic evidence of asbestosis.; < Enter answer here - or Type In Unknown If No Info Given. > 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "There is no radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; There is no radiologic evidence of a lung abscess or empyema.; There is no radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; There is no radiologic evidence of asbestosis.; 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "There is no radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; There is no radiologic evidence of a lung abscess or empyema.; There is no radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; There is no radiologic evidence of asbestosis.; Dependent atelectasis within each lower lobe. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "There is no radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; There is no radiologic evidence of a lung abscess or empyema.; There is no radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; There is no radiologic evidence of asbestosis.; patient had lung cancer a part of lung was removed 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "There is no radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; There is no radiologic evidence of a lung abscess or empyema.; There is no radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; There is no radiologic evidence of asbestosis.; patient has known COPD and chronic bronchitis 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "There is no radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; There is no radiologic evidence of a lung abscess or empyema.; There is no radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; There is no radiologic evidence of asbestosis.; Pt has been complaining of cough. X-ray was done and is showing diffues nodulare intersitital lung diease plust left hilar and right holar prominence. CT is recommended. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "There is no radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; There is no radiologic evidence of a lung abscess or empyema.; There is radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; The patient is presenting new signs or symptoms. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "There is radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; The patient is presenting new signs or symptoms. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is radiologic evidence of non-resolving pneumonia after at least 4 weeks of treatment. 3

General/Family Practice Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for known tumor. 9


A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient has NOT had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; The patient is 54 years old or younger.; 1


A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient has NOT had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; The patient is 54 years old or younger.; unexplained weight loss in current smoker - 16.6lbs in 7-9 months; SOB with chest pressure, abdominal pain with steady weight loss 1


A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient has NOT had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient did NOT quit smoking in the past 15 years.; The patient does NOT have signs or symptoms suggestive of lung cancer such as an unexplained cough, coughing up blood, unexplained weight loss or other condition. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient has NOT had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient did NOT quit smoking in the past 15 years.; The patient has signs or symptoms suggestive of lung cancer such as an unexplained cough, coughing up blood, unexplained weight loss or other condition.; Patient Is having shortness of breath with inability to get air out. 1

General/Family Practice Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for suspected pulmonary Embolus. 8


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "Caller is NOT SURE if there is evidence of a lung, mediastinal or chest mass noted within the last 30 days."; 1




A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There IS evidence of a lung, mediastinal or chest mass noted within the last 30 days."; They did not have a previous Chest x-ray. 2


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There IS evidence of a lung, mediastinal or chest mass noted within the last 30 days."; They had a previous Chest x-ray.; FINDINGS: Frontal and lateral views reveals there is a faint radiodensity overlying the left mid lung at the six-seven rib interspace measuring 12 mm. There is a chronic elevation of the right diaphragm. The cardiomediastinal silhouette is normal. There 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There IS evidence of a lung, mediastinal or chest mass noted within the last 30 days."; They had a previous Chest x-ray.; weight loss since last visit and night sweats. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There IS evidence of a lung, mediastinal or chest mass noted within the last 30 days."; They had a previous Chest x-ray.; x ray shows a mass in the right lung and recommends the ct scan 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; < Enter answer here - or Type In Unknown If No Info Given. > 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; Follow up for lung nodule. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; pt. is smoker for 11years , has lower left lung nodule found on ct scan order scan for treatment 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; X-ray done on 3/2/15 showed a pulmonary nodule. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; follow up of metastatic colon cancer 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; known metastatic cancer, approx 5-6cm mass on left flank 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; ordering physician is a urology and we are doing a follow up for survanlence for cancer of the kidney. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; Pt has a history of carcinoid tumor of the colon. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; repeat to make sure cancer has not spread 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; CT CHEST-RIGHT UPPER LOBE LUNG NODULES WIT SMALL MASS ON CXR DONE 8/31/15. QUIT SMOKING 2010 AFTER 20 YRS. CT BRAIN-HYPONATREMIA, ALSO HAS FREQUENT SEVERE HEADACHES. HYPERTENTION; It is not known if there has been any treatment or conservative therapy.; ; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Six months; There has been treatment or conservative therapy.; LAB done- antibiotics; N & V , ABD Pain severe; HX of cancer in family-pain severe, chills 1


This study is being ordered for trauma or injury.; 9/6/2015; There has been treatment or conservative therapy.; Pt was in hospital after she fell off motor cycle going 55 miles per hours.; Chest pain, abd pain post trauma; None 1

General/Family Practice Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST 6

General/Family Practice Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Yes, this is a request for a Chest CT Angiography.; This study is requested to evaluate suspected pulmonary embolus. 15

General/Family Practice Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST 5

General/Family Practice Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST

This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is a reason why the patient cannot have a Cervical Spine MRI.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of Asymmetric reflexes.; This study is being ordered due to trauma or acute injury within 72 hours. 1


This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is no reason why the patient cannot have a Cervical Spine MRI.; Patient has metastatic lung cancer, started having neck pain. very weak and can't travel very far to do MRI. 1


This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is no reason why the patient cannot have a Cervical Spine MRI.; pt had falling from ladder and hurt himself part of impact was neck. 7-24-15 1

General/Family Practice Approval 72128 CT THORACIC SPINE, UPPER BACK NO CONTRAST 4

General/Family Practice Approval 72128 CT THORACIC SPINE, UPPER BACK NO CONTRAST

This is a request for a thoracic spine MRI.; There is a reason why the patient cannot undergo a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does not have any neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks. 1

General/Family Practice Approval 72128 CT THORACIC SPINE, UPPER BACK NO CONTRAST

This is a request for a thoracic spine MRI.; There is a reason why the patient cannot undergo a thoracic spine MRI.; The study is being ordered due to Neurological deficits.; The patient is experiencing or presenting recent fracture on previous imaging studies. 1

General/Family Practice Approval 72131 CT LUMBAR SPINE, LOW BACK 7

General/Family Practice Approval 72131 CT LUMBAR SPINE, LOW BACK

The patient is experiencing symptoms of radiculopathy for six weeks or more.; This study is not part of a myelogram or discogram.; This is not a preoperative or recent postoperative evaluation.; The patient does not have a history of severe low back trauma or lumbar injury.; This is a request for a lumbar spine CT. 1


This is a request for a lumbar spine CT.; The patient does not have a history of severe low back trauma or lumbar injury.; This is a preoperative or recent post-operative evaluation. 1



General/Family Practice Approval 72131 CT LUMBAR SPINE, LOW BACK This is a request for a lumbar spine CT.; The patient has a history of severe low back trauma or lumbar injury. 5


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; The initial onset of this was this morning 7/27/2015; It is not known if there has been any treatment or conservative therapy.; Pt is experiencing groin pain in right side along with nausea and vomitting.; 1

General/Family Practice Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 52

General/Family Practice Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient demonstrate neurological deficits.; It is not known if there has been a supervised trial of conservative management for at least six weeks.; No, this patient did not have a recent course of supervised physical Therapy.; The patient has failed a course of anti-inflammatory medication or steroids. 1




This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient demonstrate neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks.; No, this patient did not have a recent course of supervised physical Therapy.; The patient has failed a course of anti-inflammatory medication or steroids. 3


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient demonstrate neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks.; Yes, this patient had a recent course of supervised physical Therapy. 2


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; It is not known if there has been a supervised trial of conservative management for at least six weeks.; It is not known if this patient had a recent course of supervised physical Therapy.; It is not known if the patient has failed a course of anti-inflammatory medication or steroids.; It is not known if the patient had six weeks of Chiropractic care related to this episode.; <Enter Additional Clinical Information> 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks.; It is not known if this patient had a recent course of supervised physical Therapy.; The patient has failed a course of anti-inflammatory medication or steroids. 1






This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is reflex abnormality.; diminished reflex's in nerves; 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; ; 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; Right upper extremity weakness; Pain as characterized as severe, radiating, and has started a few weeks ago, has tried NSAID, muscle relaxers w/o relief has PT no improvement 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; There has been a supervised trial of conservative management for at least 6 weeks.; No, this patient did not have a recent course of supervised physical Therapy.; The patient has failed a course of anti-inflammatory medication or steroids. 2


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; There has been a supervised trial of conservative management for at least 6 weeks.; No, this patient did not have a recent course of supervised physical Therapy.; The patient has not failed a course of anti-inflammatory medication or steroids.; No, the patient did not have six weeks of Chiropractic care related to this episode.; Xray showed compression C2, C3, C4 1




This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; There has not been a supervised trial of conservative management for at least 6 weeks.; <Enter Additional Clinical Information> 1




This is a request for cervical spine MRI; Neurological deficits; The patient does have new or changing neurologic signs or symptoms.; The patient does have new signs or symptoms of bladder or bowel dysfunction. 1


This is a request for cervical spine MRI; Neurological deficits; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; Document exam findings here for neck pain, getting worse this past few weeks. She noticed that she is getting a lot of muscle spasm and headache due to her neck pain. The pain is sharp; Cervical- tight paracervical muscles The pain is sharp, radiating to her shoulder and upper back. There is also some numbness and tingling sensation that goes to her extremities. 1

General/Family Practice Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Neurological deficits; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 22


This is a request for cervical spine MRI; None of the above; No, the patient is not experiencing or presenting new symptoms of upper extremity weakness?; No, the patient is not demonstrating unilateral muscle wasting.; No, the patient is not experiencing or presenting new symptoms of Bowel or bladder dysfunction.; No, the patient is not experiencing new onset of parathesia diagnosed by a neurologist; No, the patient is not experiencing or presenting x-ray evidence of a recent fracture.; <Enter Additional Clinical Information> 1

General/Family Practice Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; None of the above; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 1

General/Family Practice Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Trauma or recent injury; It is not known if the patient have new or changing neurological signs or symptoms.; 1


This is a request for cervical spine MRI; Trauma or recent injury; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; ; 1

General/Family Practice Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for a neurological disorder.; 05/03/2013; There has been treatment or conservative therapy.; Patient has seen neurosurgeon but has to have new MRI's for him to see her.; Patient has neck/back pain with radiculopathy. she has history of chiari syndrome.; need new MRI thoracic and cervical for neurosurgeon to see her. She last had MRI's done in May of 2013. The symptoms have started again and needs evaluation. 1


This study is being ordered for a neurological disorder.; 3 weeks ago; There has not been any treatment or conservative therapy.; numbness to 3/4/5th digits of right hand with radiation upward in his right arm. Blurred vision. Family history of MS; 1


This study is being ordered for a neurological disorder.; 7/1/2015; There has been treatment or conservative therapy.; PT; Pain medication; anti-inflammatory; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; headache. occasionally gets more intense noticed right eye drooping for last week weakness on right side of face as well still having some numbness and tingling in right arm and pain in lower cervical area.; There has been treatment or conservative therapy.; Pt been to chiropractor a few times and has had multiple treatments but has gotten worse pain. Pt has taken otc NSAIDs & muscle relaxers with no relief. Also has been seen by Physical Therapy for several weeks.; Facial weakness on R side. Headache. Neck Pain. Paresthesia of upper limb. Ptosis.; Headache, occasionally gets more intense. right eye drooping for the last week weakness on right side of face as well still having some numbness and tingling in right arm and pain in lower cervical area. No relief with conservative therapy. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; ................; It is not known if there has been any treatment or conservative therapy.; dddddddddddd7; ddddddddddd 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/28/2015; There has not been any treatment or conservative therapy.; Facial numbness, headache, numbness and tingling down left arm; Saw Chiropractic on 9/28/15 difficulty swallowing 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; about 2 months ago; There has been treatment or conservative therapy.; 2 months of chiropractic care and 2 months of PT; numbness in both arms throughout the day but is worse at night, numbness in the lower back, radiating pain down the right leg. does have headaches but not sure if it has to do w/ the neck pain.; xrays came back abnormal so MDO wants to take a closer look 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; unknown.; There has been treatment or conservative therapy.; previous cervical fusion in 2009. Surgery in lower back in 2013.; lumbar,thoracic,cervical spine pain with numbness and tingling in his right arm; Has had an aspen device placed. Sharp pain in upper back, worse when he stands up "locks up". Pain is worse with excertion and gets bilateral low leg pain. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; years ago; There has not been any treatment or conservative therapy.; pain in neck, right hip pain, hurts to flex or stand,; planning to refer to neuro surgery 1


This study is being ordered for trauma or injury.; 08/01/2015; There has been treatment or conservative therapy.; meds, PT; pain LS & CS- with radiculopathy- paraesthesia, weakness; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for trauma or injury.; pt's first visit here was on 2/14/14 and she had been c/o of this then and prior to that date. this has been going on for some time now with no relief to otc, prescribed pain meds as well as inflammatory meds and therapy; There has been treatment or conservative therapy.; pt was ordered to do home therapy which consist of stretching and different forms of exercise to help relieve pain; pain in her neck with frequent h/s and numbness and tingling in her hands and arms as well as pain in her mid and lower back with pain in her legs along with numbness and tingling in her legs and bil feet; decrease rom in her arms and legs with constant pain and numbness and back pain 1

General/Family Practice Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST 17

General/Family Practice Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This is a request for a thoracic spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 1


This is a request for a thoracic spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; other medications as listed.; diclosenac 75mg; The patient has completed 6 weeks or more of Chiropractic care. 1


This is a request for a thoracic spine MRI.; The caller indicated the the study was not ordered for: Chronic Back pain, Trauma, Known or suspected tumor with or without metastasis, Follow up to or Pre-operative evalution, or Neurological deficits."; There are no documented clinical findings of immune system suppression.; The patient is not experiencing back pain associated with abdominal pain.; 1


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of abnormal gait. 1


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of asymmetric reflexes. 1


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks.; The patient is experiencing sensory abnormalities such as numbness or tingling.; The patient is not experiencing or presenting symptoms of abnormal gait, lower extremity weakness, asymmetric reflexes, fracture, radiculopathy or bowel or bladder dysfunction. 1




This is a request for a thoracic spine MRI.; The study is being ordered due to follow-up to surgery or fracture within the last 6 months.; "The patient has been seen by, or the ordering physician is, a neuro-specialist, orthopedist, or oncologist." 2


This is a request for a thoracic spine MRI.; The study is being ordered due to known tumor with or without metastasis.; "The patient is not being seen by or is the ordering physician an oncologist, neurologist, neurosurgeon, or orthopedist."; The patient does not have any neurological deficits.; PT HAD CT SCAN OF T SPINE DONE, CAME BACK WITH MASS, RADIOLOGIST RECOMMENEDED A MRI TO GET A BETTER LOOK AT THE MASS THAT WAS FOUND DURING CT. 1


This is a request for a thoracic spine MRI.; The study is being ordered due to Neurological deficits.; The patient is experiencing or presenting symptoms of abnormal gait. 1


This is a request for a thoracic spine MRI.; The study is being ordered due to Neurological deficits.; The patient is experiencing or presenting symptoms of asymmetric reflexes. 1


This is a request for a thoracic spine MRI.; The study is being ordered due to Neurological deficits.; The patient is not experiencing or presenting symptoms of abnormal gait, lower extremity weakness, asymmetric reflexes, fracture, radiculopathy or bowel or bladder dysfunction.; The patient is experiencing sensory abnormalities such as numbness or tingling.; There has been a supervised trial of conservative management for at least 6 weeks. 1


This is a request for a thoracic spine MRI.; The study is being ordered due to trauma or acute injury within 72 hours.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of recent fracture on previous imaging studies. 1


This study is being ordered for a neurological disorder.; 05/03/2013; There has been treatment or conservative therapy.; Patient has seen neurosurgeon but has to have new MRI's for him to see her.; Patient has neck/back pain with radiculopathy. she has history of chiari syndrome.; need new MRI thoracic and cervical for neurosurgeon to see her. She last had MRI's done in May of 2013. The symptoms have started again and needs evaluation. 1


This study is being ordered for a neurological disorder.; Onset: 4 years ago; There has not been any treatment or conservative therapy.; 1. back pain Onset: 4 years ago. The problem is worsening. Location of pain is upper back, middle back and lower back. Pain is radiated to the both hips.The patient describes the pain as discomforting. Symptoms are aggravated by sitting and standing.Th; MRI ordered. Kenolog 80mg injection given today. She has failed a lot of NSAID's. Further diagnostic evaluations ordered today include(s) MRI L-SPINE W/O CONTRAST to be performed, MRI T-SPINE W/O CONTRAST to be performed and THORACIC SPINE to be perfo 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 07/07/2015; There has been treatment or conservative therapy.; Medication, Cane; Pain , weakness , numbness ,; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2/24/2014; There has been treatment or conservative therapy.; physical therapy; back pain; stiffness , back pain , limited range of motion 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Patient reports onset onset approximately 3-4 years ago with no specific trigger at the time. She presented to the emergency room approximately a month ago with an episode of back pain which was affecting her ability to take deep breaths. She reports cons; There has been treatment or conservative therapy.; Chiropractic Therapy a month ago that did not help.; Pain with breathing, constant pain throughout spine that "feels like being punched", limited range of motion throughout lumbar spine, pain in thoracic and lumbar spine.; Client is diagnosed with lumbar radiculopathy, lumbago, and strain muscle and tendon of backwall of thorax. 1





General/Family Practice Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 137

General/Family Practice Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; Pt has findings consistent with L5 radiculopathy BILAT/ muscle membrane instability in the BILAT lower extremities consistent with lumbar nerve route pathology/ Per EMG studies; Pt has increased pain with radiculopathy / having numbness in the right lower extremities 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; right lower ext weak; none 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is x-ray evidence of a recent lumbar fracture. 3


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; It is not known if the patient has completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; The patient has completed 6 weeks or more of Chiropractic care. 1



General/Family Practice Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; It is unknown if the patient has acute or chronic back pain.; This procedure is being requested for Neurologic deficits 1


The study requested is a Lumbar Spine MRI.; It is unknown if the patient has acute or chronic back pain.; This procedure is being requested for None of the above; < Enter answer here - or Type In Unknown If No Info Given. > 1


The study requested is a Lumbar Spine MRI.; Known Tumor with or without metastasis; The patient been not been seen by or is not the ordering physician an oncologist, neurologist, neurosurgeon, or orthopedist.; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has not directed a home exercise program for at least 6 weeks.; none 1


The study requested is a Lumbar Spine MRI.; Neurological deficits; The patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; mostly right leg weakness; numbness and tingling in right toe, tingling down both legs 1


The study requested is a Lumbar Spine MRI.; Neurological deficits; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; Patient complains of low back pain. The location is primarily in the lumbar spine. He characterizes it as intermittent, moderate in intensity, sharp, and aching. This is a chronic problem, with essentially constant pain. He states that the current epi; Patient complains of low back pain. The location is primarily in the lumbar spine. He characterizes it as intermittent, moderate in intensity, sharp, and aching. This is a chronic problem, with essentially constant pain. He states that the current epi 1


The study requested is a Lumbar Spine MRI.; Neurological deficits; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 1


The study requested is a Lumbar Spine MRI.; None of the above; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; Document exam findings; < Enter answer here - or Type In Unknown If No Info Given. > 1

General/Family Practice Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient does NOT have acute or chronic back pain.; This procedure is being requested for Neurologic deficits 1


The study requested is a Lumbar Spine MRI.; The patient does NOT have acute or chronic back pain.; This procedure is being requested for None of the above; < Enter answer here - or Type In Unknown If No Info Given. > 1



General/Family Practice Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal nerve study involving the lumbar spine 4

General/Family Practice Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 39



General/Family Practice Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 103



General/Family Practice Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Chronic Low Back Pain and Sciatica 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; HX of back surgery, pain w/ radiculopathy Urinary incontinence. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Patient has a history of low back pain onset 12 yrs ago. States that she has weakness with radiation into hips and upper thighs. Patient has been given conservative therapy for 4 weeks has been doing this for 3 now and also has a EMG NCV ordered. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Patient was involved in an MVA x 6 months. Patient is suffering from back pain from this incident. 1

General/Family Practice Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; previous xray noted scliosis 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Pt had back surgery May 2015, fusion at 3 levels of lower spine. Pt completed 8 wks of PT within the last three months. Pt had a steroid injection on 9/14/15. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; The patient is constantly complaining of back pain. 1

General/Family Practice Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for a neurological disorder.; 7/1/2015; There has been treatment or conservative therapy.; PT; Pain medication; anti-inflammatory; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; lumbar spine 08/2011 knee 4/2012; There has been treatment or conservative therapy.; physical therapy and inseds; pain in knees aching and sharp,decreased mobility, irritated by bending ,walking,and standing ,joint tenderness,limping and popping . The Lumbar Spine: aggravated by everything , decreased mobility in back , limping and spasms in back , moderate and wors; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; Onset: 4 years ago; There has not been any treatment or conservative therapy.; 1. back pain Onset: 4 years ago. The problem is worsening. Location of pain is upper back, middle back and lower back. Pain is radiated to the both hips.The patient describes the pain as discomforting. Symptoms are aggravated by sitting and standing.Th; MRI ordered. Kenolog 80mg injection given today. She has failed a lot of NSAID's. Further diagnostic evaluations ordered today include(s) MRI L-SPINE W/O CONTRAST to be performed, MRI T-SPINE W/O CONTRAST to be performed and THORACIC SPINE to be perfo 1






This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 07/07/2015; There has been treatment or conservative therapy.; Medication, Cane; Pain , weakness , numbness ,; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2/24/2014; There has been treatment or conservative therapy.; physical therapy; back pain; stiffness , back pain , limited range of motion 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 3 months; There has been treatment or conservative therapy.; medication; pain; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; about 2 months ago; There has been treatment or conservative therapy.; 2 months of chiropractic care and 2 months of PT; numbness in both arms throughout the day but is worse at night, numbness in the lower back, radiating pain down the right leg. does have headaches but not sure if it has to do w/ the neck pain.; xrays came back abnormal so MDO wants to take a closer look 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; none; There has been treatment or conservative therapy.; pn meds; cronic back and neck pn, neuropathy, right leg weakness; none 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Patient reports onset onset approximately 3-4 years ago with no specific trigger at the time. She presented to the emergency room approximately a month ago with an episode of back pain which was affecting her ability to take deep breaths. She reports cons; There has been treatment or conservative therapy.; Chiropractic Therapy a month ago that did not help.; Pain with breathing, constant pain throughout spine that "feels like being punched", limited range of motion throughout lumbar spine, pain in thoracic and lumbar spine.; Client is diagnosed with lumbar radiculopathy, lumbago, and strain muscle and tendon of backwall of thorax. 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; years ago; There has not been any treatment or conservative therapy.; pain in neck, right hip pain, hurts to flex or stand,; planning to refer to neuro surgery 1


This study is being ordered for trauma or injury.; 08/01/2015; There has been treatment or conservative therapy.; meds, PT; pain LS & CS- with radiculopathy- paraesthesia, weakness; < Enter answer here - or Type In Unknown If No Info Given. > 1




This study is being ordered for trauma or injury.; Several years; It is not known if there has been any treatment or conservative therapy.; < Describe primary symptoms here - or Type In Unknown If No Info Given >; Patient has a cyst and tumors on his back 1

General/Family Practice Approval 72192 CT PELVIS WITHOUT CONTRAST 2

General/Family Practice Approval 72192 CT PELVIS WITHOUT CONTRAST

This is a request for a Pelvis CT.; This study is being ordered due to hematuria.; The patient has painful hematuria.; The patient has not had an IVP.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a Pelvis CT.; This study is being ordered due to known or suspected infection.; "The ordering physician is NOT a surgeon, gynecologist, urologist, gastroenterologist, or infectious disease specialist or PCP ordering on behalf of a specialist who has seen the patient."; "There are no physical findings or abnormal blood work consistent with peritonitis, pelvic inflammatory disease, or appendicitis."; "There are NO active, clinical findings or endoscopic findings of Crohn's disease, ulcerative colitis, or diverticulitis."; "There are no radiographical or ultrasound findings consistent with abnormal fluid collection, pelvic abscess, pelvic inflammation or ascites."; Ulcer through scrum 1


This is a request for a Pelvis CT.; This study is being ordered due to known or suspected infection.; "The ordering physician is NOT a surgeon, gynecologist, urologist, gastroenterologist, or infectious disease specialist or PCP ordering on behalf of a specialist who has seen the patient."; "There are physical findings or abnormal blood work consistent with peritonitis, pelvic inflammatory disease, or appendicitis."; rebound and tenderness 1


This is a request for a Pelvis CT.; This study is being ordered for some other reason than the choices given.; MRI lumbar spine report indicated marrow edema in the left sacral ala which may be due to a left sacral insufficiency fracture. Previously treated with Physical Therapy which didn't help. Previously treated with Corticosteroid Injections which helped. Pat 1

General/Family Practice Approval 72196 MRI PELVIS 4General/Family Practice Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is for pelvic trauma or injury. 1

General/Family Practice Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is for suspicion of pelvic inflammatory disease or abscess. 1

General/Family Practice Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is for suspicion of tumor, mass, neoplasm, or metastatic disease? 3

General/Family Practice Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is not for any of the listed indications.; < Enter answer here - or Type In Unknown If No Info Given. > 1

General/Family Practice Approval 72196 MRI PELVIS

This is a request for a Pelvis MRI.; The study is being ordered for suspicion of tumor, mass, neoplasm, or metastatic disease.; The patient had previous abnormal imaging including a CT, MRI or Ultrasound.; An abnormality was found in the ovary.; A cyst was noted on previous imaging.; ultrasound showed enlargement of left ovary with both anechoic cyst and complex cysts versus solid lesion, remmend dedicated MRI of pelvis 1

General/Family Practice Approval 72196 MRI PELVIS

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; had ct that showed possible cancer of the pancreas 1

General/Family Practice Approval 73200 CT ARM OR UPPER EXTREMITY 2

General/Family Practice Approval 73200 CT ARM OR UPPER EXTREMITY This is a request for an upper extremity, shoulder, scapula, elbow, hand, or wrist joint CT.; There is a history of upper extremity joint or long bone trauma or injury. 3

General/Family Practice Approval 73200 CT ARM OR UPPER EXTREMITY

This is a request for an upper extremity, shoulder, scapula, elbow, hand, or wrist joint CT.; There is not a history of upper extremity joint or long bone trauma or injury.; This is not a preoperative or recent postoperative evaluation.; There is suspicion of upper extremity neoplasm or tumor or metastasis. 2

General/Family Practice Approval 73206 CT ANGIOGRAPHY UPPER EXTREMITY Yes, this is a request for CT Angiography of the upper extremity. 1

General/Family Practice Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT

The request is for an upper extremity non-joint MRI.; This is not a preoperative or recent postoperative evaluation.; There is not suspicion of upper extremity neoplasm or tumor or metastasis.; There is no suspicion of upper extremity bone or soft tissue infection.; The ordering physician is not an orthopedist.; There is a history of upper extremity trauma or injury. 3

General/Family Practice Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT

The request is for an upper extremity non-joint MRI.; This is not a preoperative or recent postoperative evaluation.; There is not suspicion of upper extremity neoplasm or tumor or metastasis.; There is suspicion of upper extremity bone or soft tissue infection. 1

General/Family Practice Approval 73221 MRI JOINT OF UPPER EXTREMITY 30

General/Family Practice Approval 73221 MRI JOINT OF UPPER EXTREMITY

The patient has completed and failed a course of conservative treatment of at least 4 weeks.; The ordering physician is not an orthopedist.; There is documented findings of severe pain on motion.; Study being ordered due to non-acute or chronic pain.; The requested study is a Shoulder MRI. 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; continue left shoulder pain 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Developed Pain with Decreased Range of Motion(ROM) and Strength Along Subscapularis. Suspect Rotator Cuff Tear. Has not Improved in 3 Months. 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; has been on medications that are not helping 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Patient was in a MVA 2 years ago and has had trouble with his right shoulder since then. Patient has decreased ROM and is unable to lift his right arm above shoulder level. 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; right shoulder impingement. 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Rotator cuff tear, weakness, decrease range of motion, 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Shoulder injury 09/09/15 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Torn Rotator Cuff!! 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; It is not known if the patient has completed and failed a course of conservative treatment.; 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; It is not known if the patient has completed and failed a course of conservative treatment.; abn xray 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has completed and failed a course of conservative treatment of at least 4 weeks.; The ordering physician is an orthopedist. 4




The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has completed and failed a course of conservative treatment of at least 4 weeks.; The ordering physician is not an orthopedist.; There is no documented findings of severe pain on motion.; The patient does not have a documented limited range of motion on physical examination.; There are no documented findings of crepitus.; There are documented findings of swelling. 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has completed and failed a course of conservative treatment of at least 4 weeks.; The ordering physician is not an orthopedist.; There is no documented findings of severe pain on motion.; The patient has a documented limited range of motion on physical examination. 3


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; 4


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; Patient had an injury to his left shoulder 3 months ago. Patient fell off of tractor at home. 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; Patient has had pain greater than one month. Has been taking OTC meds for pain and has done home therapy with no success. 1


The requested study is a Shoulder MRI.; Study being ordered due to trauma within past 72 hours.; The patient has had recent plain films of the shoulder.; The plain films were normal.; The patient is experiencing joint locking or instability. 3


The requested study is a Shoulder MRI.; Study being ordered due to trauma within past 72 hours.; The patient has had recent plain films of the shoulder.; The plain films were not normal. 1

General/Family Practice Approval 73221 MRI JOINT OF UPPER EXTREMITY The requested study is a Shoulder MRI.; Study being ordered due to trauma within past 72 hours.; The patient has not had recent plain films of the shoulder.; 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; "This study is not being ordered prior to a planned or scheduled open surgery (joint replacement, etc.)."; 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; < Enter answer here - or Type In Unknown If No Info Given. > 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; PATIENT HAS CONTINUED PAIN WITH HIS LEFT SHOULDER. PATIENT HAS TRIED CONSERVATIVE TREATMENT. PATIENT HAS PAIN WITH ROM. PATIENT HAS TRIED PT, AND STERIOD INJECTIONS, ALONG WITH NSAIDS. 1


The requested study is a Shoulder MRI.; Study being ordered for suspicious mass/tumor/metastasis.; The patient has had recent plain films of the shoulder.; The plain films were normal.; The patient has not had a recent bone scan.; The patient has not had a recent CT of the shoulder.; There are physical findings (palpable mass) of a suspicious mass or known primary site of cancer. 1

General/Family Practice Approval 73221 MRI JOINT OF UPPER EXTREMITY The requested study is a Shoulder MRI.; Study is being ordered for known/suspected joint infection.; The plain films were not normal. 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 2


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from a recent injury.; There is a suspicion of tendon, ligament, rotator cuff injury or labral tear.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; pain radiates to arm 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from a recent injury.; There is a suspicion of tendon, ligament, rotator cuff injury or labral tear.; Surgery or arthrscopy is scheduled in the next 4 weeks. 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from an old injury.; The physician has directed conservative treatment for the past 6 weeks.; It is not known if the patient has completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient recevied medication other than joint injections(s) or oral analgesics.; ALIVE BIOFREEZE ASPRIN MOLTRIN; It is not known if the patient has completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; The home treatment did include exercise, prescription medication and follow-up office visits.; MORE PAIN, 9 MONTHS; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There has has been a history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does have an abnormal plain film study of the joint. 4


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There has has been a history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has been treated with and failed a course of four weeks of supervised physical therapy. 1


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does have an abnormal plain film study of the joint.; The patient has been treated with and failed a course of four weeks of supervised physical therapy. 1


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint. 1


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1


This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There has has been a history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does have an abnormal plain film study of the joint. 1


This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 7-1-15; There has been treatment or conservative therapy.; PHYSICAL THERAPY NSAIDS HOME EXERCISES AND STRETCHES; PAIN WITH ROM. UNABLE TO LIFT ARMS ABOVE HEAD. SHE HAS LIMITATIONS WITH MOTION; PATIENT IS NEEDING AN MRI TO SEE IF SHE POSSIBLY HAS ROTATOR CUFF TEARS. 2

General/Family Practice Approval 73225 MRA, MRI ANGIOGRAPHY UPPER EXTREMITY WITH/WITHOUT CONTRAST 1General/Family Practice Approval 73700 CT LEG OR LOWER EXTREMITY 5

General/Family Practice Approval 73700 CT LEG OR LOWER EXTREMITY

"There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion.; This is a request for a foot CT. 1


This is a request for a foot CT.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks. 2


This is a request for a foot CT.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion. 2


This is a request for a hip CT.; This study is not being ordered in conjunction with a pelvic CT.; There is not a suspected infection of the hip.; There is not a suspicion of AVN.; "There is a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the hip other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; There is not a mass adjacent to or near the hip.; The patient has not been treated with anti-inflammatory medication in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1


This is a request for a hip CT.; This study is not being ordered in conjunction with a pelvic CT.; There is not a suspected infection of the hip.; There is not a suspicion of AVN.; "There is a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; The patient has a documented limitation of their range of motion. 1


This is a request for a hip CT.; This study is not being ordered in conjunction with a pelvic CT.; There is not a suspected infection of the hip.; There is not a suspicion of AVN.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; The patient has a documented limitation of their range of motion.; The patient had an abnormal plain film study of the hip other than arthritis. 1

General/Family Practice Approval 73700 CT LEG OR LOWER EXTREMITY This is a request for a Lower Extremity CT.; This is a preoperative or recent postoperative evaluation. 1


This is a request for a Lower Extremity CT.; This is not a preoperative or recent postoperative evaluation.; There is no suspicion of a lower extremity neoplasm, tumor or metastasis.; There is no suspicion of lower extremity bone or joint infection.; There is a history of lower extremity joint or long bone trauma or injury. 1


This is a request for an ankle CT.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the ankle within the last two weeks. 1

General/Family Practice Approval 73706 CT ANGIOGRAPHY LOWER EXTREMITY 1General/Family Practice Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT 50

General/Family Practice Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This is a request for a foot MRI.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is a suspected tarsal coalition. 1


This is a request for a foot MRI.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks. 2




This is a request for a foot MRI.; The study is being ordered forfoot pain.; The study is being ordered for chronic pain.; The patient has had foot pain for over 4 weeks.; The patient has been treated with anti-inflammatory medication for at least 6 weeks.; No fracture has been identified as the cause of continued pain. Pt has had no relief despite conservative theraphy. 1


This is a request for a foot MRI.; The study is being ordered forfoot pain.; The study is NOT being ordered for chronic pain, acute pain, rule our tarsal coalition, known or suspected septic arthritis or oseteomylitis, tendonitis, neuroma or plantar fasciitis.; diabetic foot ulcer. 1

General/Family Practice Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is not an orthopedist.; Instability 6

General/Family Practice Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is not an orthopedist.; Limited range of motion 5


This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is not an orthopedist.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were normal. 6


This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is not an orthopedist.; Pain greater than 3 days; The patient has not had recent plain films of the knee.; Yes, patient has completed and failed a course of conservative treatment.; Physician directed course of non-steroidal anti-inflammatory medications 1

General/Family Practice Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is not an orthopedist.; Swelling greater than 3 days 6


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Instability; Yes, the member experience a painful popping, snapping, or giving away of the knee.; No, there is no known trauma involving the knee. 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; It is not known if there is a known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Instability 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; It is not known if there is a known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Limited range of motion 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; It is not known if there is a known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were not normal. 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; It is not known if there is a known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Pain greater than 3 days; The patient has not had recent plain films of the knee.; Yes, patient has completed and failed a course of conservative treatment.; Immobilization 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; It is not known if there is a known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Swelling greater than 3 days 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; It is not known if the member experience a painful popping, snapping, or giving away of the knee.; Limited range of motion 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; No, the member do not experience a painful popping, snapping, or giving away of the knee.; Locking 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; No, the member do not experience a painful popping, snapping, or giving away of the knee.; Swelling greater than 3 days 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Instability 5


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Limited range of motion 5


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Locking 3


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were normal. 3


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were not normal. 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Pain greater than 3 days; The patient has not had recent plain films of the knee.; No, patient has not completed and failed a course of conservative treatment.; LEFT KNEE PAIN FOR 7 DAYS WITH NO RELIEF 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Pain greater than 3 days; The patient has not had recent plain films of the knee.; Yes, patient has completed and failed a course of conservative treatment.; Physician directed course of non-steroidal anti-inflammatory medications 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Pain greater than 3 days; The patient has not had recent plain films of the knee.; Yes, patient has completed and failed a course of conservative treatment.; There is conservative treatment other than physical Therapy, physician directed course of non-steroidal medications, Immobilization or Physical directed exercise.; Pt is allergic to nsaids. He has taken steroids and pain pills. 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Swelling greater than 3 days 7


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Yes, there is a known trauma involving the knee.; Instability 14


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Yes, there is a known trauma involving the knee.; Limited range of motion 9


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Yes, there is a known trauma involving the knee.; Locking 7


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Yes, there is a known trauma involving the knee.; Pain greater than 3 days; It is not known if patient had recent plain films of the knee.; 1




This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Yes, there is a known trauma involving the knee.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were not normal. 2


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Yes, there is a known trauma involving the knee.; Pain greater than 3 days; The patient has not had recent plain films of the knee.; Yes, patient has completed and failed a course of conservative treatment.; Physician directed course of non-steroidal anti-inflammatory medications 3


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Yes, there is a known trauma involving the knee.; Pain greater than 3 days; The patient has not had recent plain films of the knee.; Yes, patient has completed and failed a course of conservative treatment.; There is no conservative treatment of Physical Therapy, physician directed course of non-steroidal medications, Immobilization or Physical directed exercise.; WILL FAX NOTES 1




This is a request for a Knee MRI.; Suspicious Mass or Suspected Tumor/ Metastasis; The patient has not had recent plain films of the knee.; The patient has not had a recent bone scan.; No, the patient did not have a recent ultrasound of the knee.; There are physical findings (palpable mass) of a suspicious mass or known primary site of cancer.; Mass felt upon examination accompanied with pain. 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient recevied medication other than joint injections(s) or oral analgesics.; anti inflammatories; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; The home treatment did include exercise, prescription medication and follow-up office visits.; no improvement for 6 weeks; daily use of prescribed anti inflammatories; unknown 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is described as chronic; The physician has not directed conservative treatment for the past 6 weeks.; 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; It is not know if surgery or arthrscopy is scheduled in the next 4 weeks.; MRI R knee w/o contrast. onset 2 days ago. pain with pop. pt states when putting pressure/weight bearing falls to the floor and tingling in toes. Pt complains of right knee pain secondary to medial meniscal tear and possible loose body. Previous injury 15 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; Patient fell approximately 6 weeks ago and injured knee. Has treated conservatively. Negative Xray 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; recent mva; locking was noted on pe 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; Unknown 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; Surgery or arthrscopy is scheduled in the next 4 weeks. 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from an old injury.; It is not known if the physician has directed conservative treatment for the past 6 weeks.; The patient had a twisting injury and has had pain in his knee for 6 months. His knee swells on and off daily with use. He reports the use of OTC NSAIDS with no relief. 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from an old injury.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient received oral analgesics.; It is not known if the patient has completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; The home treatment did include exercise, prescription medication and follow-up office visits.; Knee continues to swell and ce painful.; 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is not from a recent injury, old injury, chronic pain or a mass.; Severe L knee pain, very limited ROM, using crutch to get around, went to urgent care 09.03.15 x-rays done no findings. Worsing pain went to ER on 09.04.15 had CT done-small effusion NO fractures recommemded MRI for further evaluation. 1


This is a request for a Knee MRI.; There is no supsected meniscus,pre-op or post-op evaluation,non-acute Chronic Pain,supsected tumor or Aseptic Necrosis; The ordering physician is not an orthopedist.; Instability 3


This is a request for a Knee MRI.; There is no supsected meniscus,pre-op or post-op evaluation,non-acute Chronic Pain,supsected tumor or Aseptic Necrosis; The ordering physician is not an orthopedist.; Limited range of motion 1


This is a request for a Knee MRI.; There is no supsected meniscus,pre-op or post-op evaluation,non-acute Chronic Pain,supsected tumor or Aseptic Necrosis; The ordering physician is not an orthopedist.; Locking 2


This is a request for a Knee MRI.; There is no supsected meniscus,pre-op or post-op evaluation,non-acute Chronic Pain,supsected tumor or Aseptic Necrosis; The ordering physician is not an orthopedist.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were not normal. 1


This is a request for a Knee MRI.; There is no supsected meniscus,pre-op or post-op evaluation,non-acute Chronic Pain,supsected tumor or Aseptic Necrosis; The ordering physician is not an orthopedist.; Swelling greater than 3 days 1


This is a request for a lower extremity MRI.; This is not a pulsatile mass.; "There is evidence of tumor or mass from a previous exam, plain film, ultrasound, or previous CT or MRI." 1


This is a request for a lower extremity MRI.; This is not a pulsatile mass.; "There is no evidence of tumor or mass from a previous exam, plain film, ultrasound, or previous CT or MRI."; There is a suspicion of an infection.; The patient is taking antibiotics. 2


This is a request for a lower extremity MRI.; This is not a pulsatile mass.; "There is no evidence of tumor or mass from a previous exam, plain film, ultrasound, or previous CT or MRI."; There is not a suspicion of an infection.; The patient is not taking antibiotics.; This is a study for a fracture which does not show healing (non-union fracture).; This is not a pre-operative study for planned surgery. 1




This is a request for an Ankle MRI.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the ankle within the last two weeks. 3


This is a request for an Ankle MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the ankle within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the ankle other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has not been treated with anti-inflammatory medications in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1


This is a request for an Ankle MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the ankle within the last two weeks.; The patient has a documented limitation of their range of motion. 3


This is a request for an Ankle MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the ankle within the last two weeks.; The patient has a documented limitation of their range of motion.; The patient had an abnormal plain film study of the ankle other than arthritis. 1


This is a request for an Ankle MRI.; The study is requested for ankle pain.; Tendon or ligament injuryis not suspected.; There is not a suspicion of fracture not adequately determined by x-ray.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; Patient has undergone 6 weeks physical therapy and treatment with NSAIDS and ice and heat with no improvement. 1


This is a request for an Ankle MRI.; The study is requested for ankle pain.; There is a suspicion of tendon or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; Mr. GENTZ presents with ankle pain. It is primarily in the right ankle. Swelling is absent. It does not radiate. He characterizes it as intermittent, mild in severity, dull, and aching. It began 1 month ago. The precipitating event appears to have b 1


This is not a pre-operative study for planned surgery.; This is not a study for a fracture which does not show healing (non-union fracture).; The patient is not taking antibiotics.; There is not a suspicion of an infection.; "There is no evidence of tumor or mass from a previous exam, plain film, ultrasound, or previous CT or MRI."; This is not a pulsatile mass.; This is a request for a lower extremity MRI. 1


This study is being ordered for a neurological disorder.; 6 MONTHS AGO; There has been treatment or conservative therapy.; 7 WEEKS PHYSICAL THERAPY AND BEEN ON ANTI INFLAMMATORY MEDIACTION , ALSO ON PAIN MEDICATION FOR MORE THAN SIX MONTHS; swelling in both knees decreased range of motion 10 out of 10 for pain sharp shooting pain unable to walk without a cane or the help from someone; labs show a high level of Rheumatoid arthritis 2


This study is being ordered for a neurological disorder.; lumbar spine 08/2011 knee 4/2012; There has been treatment or conservative therapy.; physical therapy and inseds; pain in knees aching and sharp,decreased mobility, irritated by bending ,walking,and standing ,joint tenderness,limping and popping . The Lumbar Spine: aggravated by everything , decreased mobility in back , limping and spasms in back , moderate and wors; < Enter answer here - or Type In Unknown If No Info Given. > 2


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 3 months; There has been treatment or conservative therapy.; medication; pain; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 3 weeks; There has been treatment or conservative therapy.; Anti inflammatory over the counter, boot, and venous Doppler was performed; Pain; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; no date; There has been treatment or conservative therapy.; steroid and pain medication; pain numbness and weakness; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; over 3 months; There has been treatment or conservative therapy.; medications, wound care, daily cleanings, surgery,; pain and ulcer; < Enter answer here - or Type In Unknown If No Info Given. > 2


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; unknown; It is not known if there has been any treatment or conservative therapy.; right knee pain and c/o popping when she bends it, increased neck pain , headaches are increasing to a daily event; unknown 1


This study is being ordered for trauma or injury.; 08/18/15; There has not been any treatment or conservative therapy.; Knees: Inspection Right: no swelling and genu valgum deformity. Inspection Left: swelling and genu valgum deformity. Bony Palpation Right: tenderness of the superior pole patella, the lateral joint line, and the medial joint line and no tenderness of the ; Knees: Inspection Right: no swelling and genu valgum deformity. Inspection Left: swelling and genu valgum deformity. Bony Palpation Right: tenderness of the superior pole patella, the lateral joint line, and the medial joint line and no tenderness of the 2


This study is being ordered for trauma or injury.; 9-12-15; There has been treatment or conservative therapy.; Rest,Ice,anti-inflammatories. Pain meds.; Pain,difficulty walking,numbness,giving way; 1

General/Family Practice Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT 5

General/Family Practice Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT

This is a requests for a hip MRI.; The request is for hip pain.; The hip pain is due to a recent injury.; It is not known if there is a suspicion of tendon or ligament injury.; There is a suspicion of fracture not adequately determined by x-ray. 1


This is a requests for a hip MRI.; This study is being ordered in conjunction with a pelvic MRI.; "There is a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is a suspicion of AVN.; The patient is receiving long-term steriod therapy (Prednisone or Cortisone). 1


This is a requests for a hip MRI.; This study is being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is a suspicion of AVN.; The patient is receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion.; The patient had an abnormal plain film study of the hip other than arthritis. 1


This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is a suspicion of AVN. 1


This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion. 4


This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient does not have a documented limitation of their range of motion.; The patient had an abnormal plain film study of the hip other than arthritis. 1


This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion.; The patient had an abnormal plain film study of the hip other than arthritis. 3


This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion. 1


This study is being ordered for trauma or injury.; 9-12-15; There has been treatment or conservative therapy.; Rest,Ice,anti-inflammatories. Pain meds.; Pain,difficulty walking,numbness,giving way; 1

General/Family Practice Approval 74150 CT ABDOMEN WITHOUT CONTRAST 18

General/Family Practice Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered for a known tumor, cancer, mass, or rule out metastases.; It is not known if this is a request for follow up to a known tumor or abdominal cancer.; This is a request for initial staging of a known tumor other than prostate. 1


This is a request for an Abdomen CT.; This study is being ordered for a known tumor, cancer, mass, or rule out metastases.; No, this is not a request for follow up to a known tumor or abdominal cancer.; This is not a request for initial staging of a known tumor other than prostate.; There is no known prostate cancer with a PSA greater than 10.; No, there is a palpable or observed abdominal mass.; No,there is not an abdominal and pelvic or retroperitoneal mass that has been confirmed.; There are new signs or symptoms including hematuria, presenting with known cancer or tumor. 1

General/Family Practice Approval 74150 CT ABDOMEN WITHOUT CONTRAST This is a request for an Abdomen CT.; This study is being ordered for a kidney/ureteral stone.; There is a known or a strong suspicion of kidney or ureteral stones. 5

General/Family Practice Approval 74150 CT ABDOMEN WITHOUT CONTRAST This is a request for an Abdomen CT.; This study is being ordered for a kidney/ureteral stone.; This patient is experiencing hematuria.; The hematuria is newly diagnosed. 1




This is a request for an Abdomen CT.; This study is being ordered for a suspicious mass or tumor.; There is a suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; ABNORMAL ULTRASOUND...LESION FOUND LIVER LOBE 1


This is a request for an Abdomen CT.; This study is being ordered for a vascular disease.; The requested studies are being ordered for known or suspected aneurysms and are being ordered by a surgeon or by the attending physician on behalf of a surgeon. 1


This is a request for an Abdomen CT.; This study is being ordered for an infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease.; It is not known if the patient has been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; It is unknown if there are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; It is not known if there are findings that confirm hepatitis C.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for an Abdomen CT.; This study is being ordered for an infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease.; It is not known if the patient has been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis. 1


This is a request for an Abdomen CT.; This study is being ordered for an infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease.; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis. 8


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are clinical findings or indications of Hematuria.; It is not known whether the hematuria is newly diagnosed or known previous history.; There are NO new signs or symptoms.; 5/19- pt has lower quadrant pain to back, diharrea, nausea and has not released 1




This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Abd pain 1


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; ABDOMINAL PAIN 2


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Follow up 1


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; hematochezia nausea and vomiting w/ blood 1


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; NO 1


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; no info given . 1


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; RUQ tenderness and stabbing pain to site of previous surgery. 1


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; UNKNOWN 1

General/Family Practice Approval 74150 CT ABDOMEN WITHOUT CONTRAST This is a request for an Abdomen CT.; This study is being ordered for organ enlargement.; There is evidence of organ enlargement on ultrasound, plain film, or IVP. 2


This is a request for an Abdomen CT.; This study is being ordered for organ enlargement.; There is no evidence of organ enlargement on ultrasound, plain film, or IVP.; Abdominal pain 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Six months; There has been treatment or conservative therapy.; LAB done- antibiotics; N & V , ABD Pain severe; HX of cancer in family-pain severe, chills 1


This study is being ordered for trauma or injury.; 9/6/2015; There has been treatment or conservative therapy.; Pt was in hospital after she fell off motor cycle going 55 miles per hours.; Chest pain, abd pain post trauma; None 1

General/Family Practice Approval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST 3General/Family Practice Approval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST This is a request for CT Angiography of the Abdomen and Pelvis. 1General/Family Practice Approval 74175 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST 2General/Family Practice Approval 74175 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the abdomen. 3General/Family Practice Approval 74176 CT ABD & PELVIS W/O CONTRAST 93

General/Family Practice Approval 74176 CT ABD & PELVIS W/O CONTRAST

This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; It is not known if the patient has been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis. 2


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; It is unknown if there are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; There are known or endoscopic findings of Abscess. 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; It is unknown if there are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; There are known or endoscopic findings of Diverticulitis. 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; It is unknown if there are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; It is not known if there are findings that confirm hepatitis C.; 57 y/o AAF to clinic with a 1 week history of nausea, abdominal cramping, constipation. She has a follow-up appointment on 9/17/2015 with Dr. Gordon. She also c/o aching to her lower extremities. She has the sensation of nausea but she has not been able t 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; It is unknown if there are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; Lower abdominal pain since yesterday with fever last pm and nausea. Worse on left lower quadrant. + tenderness to lower R and L lower abdomen. 1




This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; There are known or endoscopic findings of Diverticulitis. 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; It is not known if there are findings that confirm hepatitis C.; Checking for a infection Abdominal pain 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; It is not known if there are findings that confirm hepatitis C.; MD is trying to r/o appendicitis. 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; <Enter Additional Clinical Information> 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; abdominal pain with diarrhea, antritis needs ct for further evaluation and to rule out diverticulitis 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; RLQ abdominal pain. Concerned about appendicitis. WIll get a CT STAT..,TENDERNESS AND RIGHT LOWER QUADRANT PAIN,NAUSEA,VOMITING X 3 DAYS,NOT EATING,ANOREXIA,BLOATING 1




This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; It is not known if there is a strong suspicion of kidney or ureteral stones.; This patient is experiencing hematuria. 1

General/Family Practice Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; There is a known or a strong suspicion of kidney or ureteral stones. 96


This is a request for an abdomen-pelvis CT combination.; Known Tumor, Cancer, Mass, or R/O metastases; It is not known if this is a request for follow up of a known tumor or cancer involving both the abdomen and pelvis or if this patient is undergoing active treatment.; This is not a request for initial staging of a known tumor other than prostate.; There is no known prostate cancer with a PSA greater than 10.; No, there is not a palpable or observed abdominal mass.; There is no abdominal and pelvic or retroperitoneal mass that has been confirmed by previous imaging other than a CT.; It is not known if there are new signs or symptoms including hematuria, presenting with known cancer or tumor.; Patient with a recent diagnosis of prostate cancer. Pre operative staging. 1


This is a request for an abdomen-pelvis CT combination.; Known Tumor, Cancer, Mass, or R/O metastases; This is a request for follow up of a known tumor or cancer involving both the abdomen and pelvis and the patient is undergoing active treatment. 7




This is a request for an abdomen-pelvis CT combination.; Known Tumor, Cancer, Mass, or R/O metastases; This is not a request for follow up of a known tumor or cancer involving both the abdomen and pelvis or if this patient is undergoing active treatment.; This is not a request for initial staging of a known tumor other than prostate.; There is no known prostate cancer with a PSA greater than 10.; No, there is not a palpable or observed abdominal mass.; There is no abdominal and pelvic or retroperitoneal mass that has been confirmed by previous imaging other than a CT.; There are no new signs or symptoms including hematuria, presenting with known cancer or tumor.; Follow up for left kidney cancer. Partial nephrectomy. 1



General/Family Practice Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Organ Enlargement; There is evidence of organ enlargement on ultrasound, plain film, or IVP. 2

General/Family Practice Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Other; There are clinical findings or indications of Diabetic patient with gastroparesis. 1

General/Family Practice Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Other; There are clinical findings or indications of Hematuria. 17


This is a request for an abdomen-pelvis CT combination.; Other; There are clinical findings or indications of unexplained weight loss of greater than 10% body weight in 1 month 7




This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; "simply ab pain 1




This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; 2 yrs ago OB/gyn noted hernia. Starting to have abdominal pain. Palpated on exam today. 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; abdominal and pelvic pain 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; abdominal pain and swelling, very bloated and cannot burp 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Abdominal pain has continued since July when she had her colonoscopy. The colonoscopy that was performed was negative. Mrs. Shirley Hunter does have a first degree family history of colorectal carcinoma. This patient is in quite a bit of pain and has been 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; ABDOMINAL PAIN, UPPER AND LOWER QUAD, NAUSEA AND VOMITTING, DIAHRREA, PAIN IN THE RIGHT FLANK FOR THE PAST TWO YEARS, GALL STONES 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; abn pelvic US with a multilocular cystic lesion on a ovary. Radiologist recommended CT of ABD/Pelvis with contrast 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Abnormal CT scan 04/04/14, CT from 4/14 noticed aortocaval cyst L1-2, had repeat CT 7/7/14, recommended repeat in 1 yr per radiologist, 1. As seen on the recent MRI, there is an aortocaval cystic lesion at the L1-2 level which measures 2.5 x 2.0 cm. I 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Abnormal radiology study with small right inguinal hernia identified. Report recommened CT. 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; chronic constipation, pain in the lower abdomen, pulling pain, patient is a diabetic 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; chronic diarrhea with abdominal pain and elevated WBC 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; generalized tenderness to light palpitation 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; LLQ tenderness and RLQ tenderness has had bilateral oophorectomy and hysterectomy Had normal US 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; lower abd pain, ultrasound done 9/30/2015, normal 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; MULTIPLE URINARY TRACT INFECTIONS NOT EFFECTIVE WITH ANTIBIOTIC THERAPY, RIGHT FLANK PAIN 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Patient experiencing ABD pain. U and L LWR Quad Pain. 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Positive US on 09/22/15 continued Abd pain. Seroma soft tissue at the site 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; pt has unexplained abdominal pain for past month. pt had normal EGD and colonoscopy. GI recommended imaging of abdomen. 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Started with LLQ/L groin pain for 1-2 months. Feels bloated. Once applying pressure to site, would obtain relief. No N/V. Would have intermittent diarrhea and cramping about once a week, lasting for 1-2 days. Watery stool, not bloody. Would have about 6 B 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Testicualar Pain 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; The patient has been complaining of right lower quad pain for a week, she has been having diarrhea. 1






This is a request for an abdomen-pelvis CT combination.; Pre-op or post op evaluation; The requested study is for post-operative evaluation.; The requested study is not a first follow up study for a post operative complication.; 1


This is a request for an abdomen-pelvis CT combination.; Pre-op or post op evaluation; The requested study is for pre-operative evaluation.; The study is NOT requested by a surgeon, specialist or PCP on behalf of a specialist who has seen the patient.; The pre-op evaluation is for planned or possible ventral hernia repair ordered by a surgeon. 2


This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; It is not known if there is a suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are new symptoms including hematuria. 1


This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; It is not known if there is a suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are new lab results or other imaging studies including ultrasound, Doppler or plain films findings. 1








This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are no new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; It is not known if there is a suspicion of an adrenal mass.; It is not known if this is a request to confirm a suspicious renal mass suggested by physical exam, lab studies, IVP or ultrasound.; <Enter Additional Clinical Information> 1


This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are no new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; It is not known if there is a suspicion of an adrenal mass.; This is not a request to confirm a suspicious renal mass suggested by physical exam, lab studies, IVP or ultrasound.; pt c/o golf ball size knot to umbilical/(r) mid abdomen with c/o discomfort 1


This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are no new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; There is a suspicion of an adrenal mass. 1


This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are no new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; There is not a suspicion of an adrenal mass.; This is a request to confirm a suspicious renal mass suggested by physical exam, lab studies, IVP or ultrasound. 2


This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are no new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; There is not a suspicion of an adrenal mass.; This is not a request to confirm a suspicious renal mass suggested by physical exam, lab studies, IVP or ultrasound.; <Enter Additional Clinical Information> 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; Hematuria 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; pt has a history of kidney stones. doctor thinks pt has one now. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; urinary straining. back pain. no fever. pt does have a history of kidney stones 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; There has been a physical exam.; The patient is male.; A rectal exam was not performed.; abdominal pain 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; It is not known if a pelvic exam was performed.; Abdominal pain, vomiting, diarrhea. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is male.; A rectal exam was not performed.; Assess chronic abdominal pain along with nausea and diarrhea 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is male.; A rectal exam was not performed.; pt has a history of inguinal hernia. large hiatal hernia. pt is being referred to a specialist. test to be done prior to appt. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; It is unknown if the patient had an Amylase or Lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were abnormal.; The urinalysis was positive for hematuria/blood. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; It is unknown if the patient had an Amylase or Lipase lab test.; A urinalysis has not been completed.; 2


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were abnormal.; The urinalysis was positive for hematuria/blood. 3


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were abnormal.; The urinalysis was positive for protein.; 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were normal.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were normal.; right flank pain, caexalate 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were normal.; Symptoms are re occurring . Pain the r lower lower quadrant 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient had an lipase lab test.; The results of the lab test were abnormal. 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is renal calculi, kidney or ureteral stone.; A urinalysis has not been completed.; fever for 3 days, increasing flank pain 1




This is a request for an abdomen-pelvis CT combination.; Trauma; This request is for follow up to abdominal and/or pelvic trauma ordered by a specialist or PCP on behalf of a specialist who has seen the patient. 2


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; follow up of metastatic colon cancer 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; ordering physician is a urology and we are doing a follow up for survanlence for cancer of the kidney. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; Pt has a history of carcinoid tumor of the colon. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; The initial onset of this was this morning 7/27/2015; It is not known if there has been any treatment or conservative therapy.; Pt is experiencing groin pain in right side along with nausea and vomitting.; 1

General/Family Practice Approval 74181 MRI ABDOMEN 5

General/Family Practice Approval 74181 MRI ABDOMEN

This request is for an Abdomen MRI.; This study is being ordered for known or suspected infection.; "The ordering physician is not a gastroenterologist, urologist, or infectious disease specialist."; "There are physical findings or abnormal blood work consistent with peritonitis, pancreatitis, or appendicitis."; history of pancreatitis, nausea and abdominal pain in right upper quadrant radiating to the back. 1


This request is for an Abdomen MRI.; This study is being ordered for Known Tumor.; "The ordering physician is not an oncologist, urologist, gastroenterologist, or surgeon."; This study is being ordered for follow-up.; The patient is not undergoing active treatment for cancer.; The patient is not presenting new symptoms.; The patient has had 3 or fewer follow-up abdomen MRIs.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for an Abdomen MRI.; This study is being ordered for organ enlargement.; There is an ultrasound or plain film evidence of an abdominal organ enlargement.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; Ms. Bullard presents in follow up from Office Visit with Dr Ketcher. The following radiology tests were done: abdominal CT ( 2 cm low density left adrenal nodule---She had CT 4 years ago at St Josephs now CHI showing 1 cm Adrenal nodule that she was not 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; Possible liver mass. possible splenic infarcts. 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; pt has abd pain, on US enlarged liver with large lesion and elevated liver functions on labwork 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; Pt has Hepatitis C, abdominal US showed echogenic lesions in hepatic lobe measure 1.8 x 1.9 cm within liver, indeterminate due to hepatitis C, follow up with abdomen MRI recommended by radiologist. 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; Pt has new suspicious mass on kidney and liver found on ultrasound. Radiologist has recommended an MRI of the abdomen for further evaluation 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; pt has us of abdomen with shows hyperechoic masses, suspect liver hemangioma but would like MRI to further evaluate 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; It is not known if there are documented physical findings consistent with an abdominal mass or tumor.; "The patient has had an abdominal ultrasound, CT, or MR study."; abnormal abd CT- mass 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; It is not known if there are documented physical findings consistent with an abdominal mass or tumor.; "The patient has had an abdominal ultrasound, CT, or MR study."; US report states small liver lesion likely medial segment left heaptic lobe near the midline. This is nonspecific. Further imaging workup could be performed with MRI pre and postcontrast. 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; The patient had previous abnormal imaging including a CT, MRI or Ultrasound.; A liver abnormality was found on a previous CT, MRI or Ultrasound.; It is unknown if there is suspicion of metastasis.; Pt is diagnosed with pancreatitis With liver spots. 1


This request is for an Abdomen MRI.; This study is not being ordered for known tumor, suspicious mass or suspected tumor/metastasis, organ enlargement, known or suspected vascular disease, hematuria, follow-up trauma, or a pre-operative evaluation.; Pt has liver lesion found on Ct. 1


This request is for an Abdomen MRI.; This study is not being ordered for known tumor, suspicious mass or suspected tumor/metastasis, organ enlargement, known or suspected vascular disease, hematuria, follow-up trauma, or a pre-operative evaluation.; this is for Hemangioma 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; had ct that showed possible cancer of the pancreas 1

General/Family Practice Approval 74185 MRA, MRI ANGIOGRAPHY ABDOMEN WITH/WITHOUT CONTRAST 1General/Family Practice Approval 74263 CT Colonography, screening 1General/Family Practice Approval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING 1General/Family Practice Approval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING Yes, this is a request for CT Angiography of the abdominal arteries. 2General/Family Practice Approval 77058 MRI breast,without and/or with contrast material(s);unilateral 1

General/Family Practice Approval 77058 MRI breast,without and/or with contrast material(s);unilateral

This is a request for Breast MRI.; This study is being ordered for a known history of breast cancer.; No, this is not an individual who has known breast cancer in the contralateral (other) breast.; No, this is not a confirmed breast cancer.; It is not known if this patient have axillary node adenocarcinoma.; hx double mastectomy less than a year ago, found mass, ultrasound on 8-24-15 showed a palpable area of concern in right breast upper outer quadrant 3cm x 2cm 1


This is a request for Breast MRI.; This study is being ordered for a known history of breast cancer.; No, this is not an individual who has known breast cancer in the contralateral (other) breast.; Yes, this is a confirmed breast cancer.; Yes, the results of this MRI (size and shape of tumor) affect the patient's further management. 1


This is a request for Breast MRI.; This study is being ordered for known breast lesions.; It is unknown if there are benign lesions in the breast associated with an increased cancer risk.; No, this is not an individual who has known breast cancer in the contralateral (other) breast.; No, this is not a confirmed breast cancer.; It is not known if this patient have axillary node adenocarcinoma.; pt with golf ball size mass, mammo was extremely abnormal, radiologist is requesting a mri to further eval 1

General/Family Practice Approval 77058 MRI breast,without and/or with contrast material(s);unilateral This is a request for Breast MRI.; This study is being ordered for known breast lesions.; There are benign lesions in the breast associated with an increased cancer risk. 1

General/Family Practice Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study 9

General/Family Practice Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study

This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is at least 65 years old.; The patient does not have diabetes.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; It is not known whether the patient has one or more of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; Shortness of breathe; Limited mobility 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for a post myocardial infarction evaluation.; The patient is presenting new symptoms of chest pain or increasing shortness of breath.; The patient has not had a nuclear cardiology study since having an MI. 1








This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is requested for congestive heart failure.; The member has known or suspected coronary artery disease.; The study is requested for suspected coronary artery disease.; The patient has 3 or more cardiac risk factors; The BMI is 40 or greater 1

General/Family Practice Approval 78813 PET IMAGING WHOLE BODY This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered to establish a cancer diagnosis. 1

General/Family Practice Approval 78813 PET IMAGING WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered to evaluate a solitary pulmonary nodule.; A nodule of less than 4 centimeters has not been identified on recent imaging 1

General/Family Practice Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY 2

General/Family Practice Approval 93307 TTHRC R-T IMG 2D +-M-MODE REC COMPL

This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; This study is being ordered for evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicative of heart disease.; This is for the initial evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicatvie of heart disease.; The patient has an abnormal EKG; This study is NOT being requested for the initial evaluation of frequent or sustained atrial or ventricular cardiac arrhythmias. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; This study is being ordered for evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicative of heart disease.; This is for the initial evaluation of abnormal symptoms, physical exam findings, or diagnostic studies (chest x-ray or EKG) indicatvie of heart disease.; The patient has high blood pressure; The patient does not have a history of a recent heart attack or hypertensive heart disease. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for another reason; This study is being ordered for evaluation of Pericardial Disease.; This is for the initial evaluation of a pericardial disease. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Congenital Heart Defect.; This is for initial diagnosis of congenital heart disease. 1



General/Family Practice Approval 93307 TTHRC R-T IMG 2D +-M-MODE REC COMPL This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Pulmonary Hypertension. 1

General/Family Practice Approval S8032 Low-dose Computed Tomography For Lung Cancer Screening

The patient does NOT have signs or symptoms of Lung Cancer.; The patient did NOT quit smoking in the past 15 years.; The patient has a 30 pack per year history of smoking.; This patient is a smoker or has a history of smoking.; The patient is between 55 and 80 years old.; This patient has NOT had a Low Dose CT for Lung Cancer Screening (S8032) in the past 11 months.; This request is for a Low Dose CT for Lung Cancer Screening (S8032) 1

General/Family Practice Approval S8032 Low-dose Computed Tomography For Lung Cancer Screening

This request is for a Low Dose CT for Lung Cancer Screening (S8032); This patient has NOT had a Low Dose CT for Lung Cancer Screening (S8032) in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient did NOT quit smoking in the past 15 years.; The patient does NOT have signs or symptoms of Lung Cancer. 1

General/Family Practice Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; 1

General/Family Practice Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; Benign positional vertigo, and numbness of the upper extremities. 1

General/Family Practice Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary

This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; dx: mental status change, weakness, unsteady gait, confusion answer here - or Type In Unknown If No Info Given. 1

General/Family Practice Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; vertigo 1

General/Family Practice Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; 2


This is a request for a brain/head CT.; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; Daily headaches for two years. Sometimes lasting 12 hours. Sometimes 10 out of 10 on pain scale, sometimes a 3 or 4. Most commonly behind his right eye.No vision defects. Medications have not helped. 1

General/Family Practice Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; passing out 1


This is a request for a brain/head CT.; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; PATIENT HAS 8-10 FRONTAL HEADACHES A WEEK. DIZZINESS, AND VISION CHANGES 1


This is a request for a brain/head CT.; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; Worst headache of her life x 3 weeks. 1


This is a request for a brain/head CT.; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; The patient does NOT have a recent onset (within the last 4 weeks) of neurologic symptoms.; It is not known if the headache is described as a “thunderclap” or the worst headache of the patient’s life.; none 1


This is a request for a brain/head CT.; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient does not have dizziness, one sided arm or leg weakness, the inability to speak, or vision changes.; Nausea light sensitivity 1


This is a request for a brain/head CT.; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient has dizziness.; 1


This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for something other than trauma or injury, evaluation of known tumor, stroke or aneurysm, infection or inflammation, multiple sclerosis or seizures.; The patient does not have dizziness, fatigue or malaise, sudden change in mental status, Bell's palsy, Congenital abnormality, loss of smell, hearing loss or vertigo.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for something other than trauma or injury, evaluation of known tumor, stroke or aneurysm, infection or inflammation, multiple sclerosis or seizures.; The patient has vertigo.; unknown 1




This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; chronic daily headaches 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; chronic headaches, accompanied by nausea, sensitive to light. 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; has had headaches off and on x 1 year 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; History of head injury. Golf-ball size knot on back of head. Knot has increased in size. 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; HX of headache since childhood, no previous CT or other imaging 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; Nightly frontal and occipital HA for 5 years that seem to happen after he eats supper. HA are not a/w weakness or any other neurologic sx but are severe enough to cause him to lay down in a dark quiet room. OTC meds improve but do not resolve HA. 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; Patient has headache with worsening, nausea and vomiting. 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; Patient is having headaches with nausea and vomiting. Patient has chronic sinusitis 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; persistant worstening headaches 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; pt c/o persistent daily headache for 2 years 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; shortness of breathe increase heart rate and anxiety with these headache 1




This is a request for a brain/head CT.; The study is requested for headache.; There is not headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; UNLATERAL HEADACHES ON THE LEFT SIDE, 30 MIN DURATIONS OCCURRING OCCASIONAL OVER THE LAST 4 MONTHS, RESULTS IN BURNING, MIGRAINES 1

General/Family Practice Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; The study is requested for new onset of seizures or newly identified change in seizure activity or pattern.; 1


This study is being ordered for Inflammatory/ Infectious Disease.; Enter date August 28th, 2015; There has been treatment or conservative therapy.; antihistamines and anti inflammatory medications; blurred vision, sinus pressure; suspected mastoiditis 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; CT CHEST-RIGHT UPPER LOBE LUNG NODULES WIT SMALL MASS ON CXR DONE 8/31/15. QUIT SMOKING 2010 AFTER 20 YRS. CT BRAIN-HYPONATREMIA, ALSO HAS FREQUENT SEVERE HEADACHES. HYPERTENTION; It is not known if there has been any treatment or conservative therapy.; ; 1



General/Family Practice Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This study is being ordered for trauma or injury.; ; There has been treatment or conservative therapy.; ; ; 1

General/Family Practice Disapproval 70480 CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC. Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 08/02/2015; There has been treatment or conservative therapy.; Antibiotics; Non mobile lymph node behind the ear mass is in the mastoid process. Patient states she feels tired all the time.; MRI's have been requested for surgical consult and to determine treatment. 1

General/Family Practice Disapproval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST Radiology Services Denied Not Medically Necessary This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is immune-compromised.; Patient has been seen since June for chronic sinusitis. 1

General/Family Practice Disapproval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as (sudden onset of 2 or more symptoms of nasal discharge, blockage or congestion, facial pain, pressure and reduction or loss of sense of smell, which are less than 12 wks in duration); It has been 14 or more days since onset AND the patient failed a course of antibiotic treatment; Patient is having headaches, she has received a course of antibiotic treatment with no improvement. 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as (sudden onset of 2 or more symptoms of nasal discharge, blockage or congestion, facial pain, pressure and reduction or loss of sense of smell, which are less than 12 wks in duration); It has been less than 14 days since onset; Patient has had several sinus infections this year, at least 4 times since april. 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are unknown.; 1


This study is being ordered for Inflammatory/ Infectious Disease.; Enter date August 28th, 2015; There has been treatment or conservative therapy.; antihistamines and anti inflammatory medications; blurred vision, sinus pressure; suspected mastoiditis 1

General/Family Practice Disapproval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for neck soft tissue CT.; It is unknown if there has been recent trauma or other injury to the neck.; It is unknown if there is suspicion of or known tumor, metastasis, lymphadenopathy, or mass.; It is unknown if there is a suspicion of an infection or abscess.; It is unknwon if this is being ordered by an ENT specialist. 1

General/Family Practice Disapproval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 5/2014; There has been treatment or conservative therapy.; Anti anflammotory; Neck and Lower back pain, Has medal in body cant have MRI; Increased and gotten worse 1

General/Family Practice Disapproval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary


General/Family Practice Disapproval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; ; It is not known if there has been any treatment or conservative therapy.; pt presented to the clinic today with THE WORST HEADACHE SHE HAS EVER HAD! holding her head in her hands, started through the night and has gotten worse as the day goes on; pt co the worst headache ever, and dr howard is wanting to make sure this is not a anurysum or a bleed of some kind. 1

General/Family Practice Disapproval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary Yes, this is a request for CT Angiography of the brain. 1

General/Family Practice Disapproval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary


General/Family Practice Disapproval 70540 MRI ORBIT/FACE/NECK W/O DYE Radiology Services Denied Not Medically Necessary

"This is a request for orbit,face, or neck soft tissue MRI.239.8"; The reason for the study is not for trauma, infection,cancer, mass, tumor, pre or post-operative evaluation; crepitus and pain with motion. Patient feels sharp, dull, tingling pain radiating and its worsening. 1


This study is being ordered for trauma or injury.; 08/25/2015; There has been treatment or conservative therapy.; applied heating pads,; The patient was dropped from shoulder height and landed on her chin. This happened 08/25/2015, gets a popping in her jaw, jaw pain and teeth are not right, also back pain.; unknown 1


This study is being ordered for trauma or injury.; 8 days ago; There has been treatment or conservative therapy.; < Describe treatment / conservative therapy here - or Type In Unknown If No Info Given >; Head trauma and blurred vision; < Enter answer here - or Type In Unknown If No Info Given. > 1

General/Family Practice Disapproval 70544 Mr angiography head w/o dye Radiology Services Denied Not Medically Necessary


General/Family Practice Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This request is for a Brain MRI; It is unknown if the study is being requested for evaluation of a headache.; Requested due to trauma or injury.; It is not known if there are new, intermittent symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; The trauma or injury to the head occured more than 1 week ago.; patient comes to our office with complaint of having bugs under skin, patient was given meds and referred to a dermatologist. patient also seeing doctor in little rock, and told that doctor that he had fell recently and hit his head and lost consciousnes 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; back pain, neck pain, moving up neck to ear, headaches 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; It is unknown if there recent neurological deficits on exam such as one sided weakness, speech impairments or vision defects.; There is a new and sudden onset of a headache less than 1 week not improved by medications.; It is not known if the headache is described as a “thunderclap” or the worst headache of the patient’s life.; Pt has been experiencing multiple headaches a week for the past couple months. Medicines does not seem to help much. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; It is unknown if there recent neurological deficits on exam such as one sided weakness, speech impairments or vision defects.; There is not a new and sudden onset of a headache less than 1 week not improved by medications.; It is not known if there is a family history (parent, sibling, or child) of stroke, aneurysm, or AVM (arteriovenous malformation); 1




This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; Pt having worsening headaches, with facial numbness and ringing of ears 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a sudden and severe headache.; The patient had a recent onset (within the last 3 months) of neurologic symptoms.; The patient does not have dizziness, one sided arm or leg weakness, the inability to speak, or vision changes.; The patient does not have HIV or cancer.; unknown 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient does not have dizziness, fatigue or malaise, sudden change in mental status, Bell's palsy, Congenital abnormality, loss of smell, hearing loss or vertigo.; 40 yr old pt with increasing memory loss; narcoleptic behavior; pt can not remember doing ADL's; falling asleep while performing ADL's; 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient does not have dizziness, fatigue or malaise, sudden change in mental status, Bell's palsy, Congenital abnormality, loss of smell, hearing loss or vertigo.; MRI head T1 showed abnormalities 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient has fatigue or malaise; concerned for pituitary tumor, increased fatigue 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; The lab results were normal; Pt is having worsening Memory loss, cognitive impairment 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; she has noticed some ongoing issues with memory loss, it is getting worse, she drives occasionally, she is not very active outside the home, she no problems cooking and taking care of the home, daughter states she forgets random things easily, she is resp 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; It is not known if a metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; Enter answer here - or Type In UBipolar I disorder, most recent episode (or current) depressed, moderate details; the diagnosis of depression was made several years ago. Presently, she feels a moderate degree of depression. Current medications include P 1




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing fatigue or malaise.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; The lab results were normal; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing fatigue or malaise.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; 4 years ago; There has been treatment or conservative therapy.; Medication Name Sig Desc Start Date Stop Date Refilled Calcium 600 + D(3) 600 mg-125 unit tablet take 1 tablet by oral route every day 03/02/2014 Premarin 0.625 mg/gram vaginal cream Insert 0.5mg intravaginally twice a week. 08/21/2014 0; patient is here to follow-up on her lower back pain. Mobic was not helpful. she also complains of chronic intermittent numbness on the right side of her scalp and face she has neck pain at times. She has no radiation of the pain into her shoulders or a; because of complaint of facial numbness and headache, will obtain MRI of the brain. we'll also obtain MRi of the L and C-spine because of her complaint of radiculopathy type pain. We'll try diclofenac for pain and discontinue Mobic. She will follow up 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Unknown; It is not known if there has been any treatment or conservative therapy.; left sided facial pain; Unknown 1

General/Family Practice Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary 1

General/Family Practice Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary

A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for follow up trauma.; The ordering physician a is NOT a Surgeon, Pulmonologist, or Cardiologist.; There is no radiologic evidence of mediastinal widening.; There is no physical or radiologic evidence of a chest wall abnormality.; pain behind should radiated to right upper back started after a weight lift injury ov 6/9/205, cyclobenzaprine, prednisone ,hydrocodone acetaminophen, worsening with movement pressure when laying on back ,tenderness with pressure on the scapula knife stab 1

General/Family Practice Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; patient is having posterior chest pain, 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Patient is having sharp pains below her left breast intermittent 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; patient seen in office on 09/21/2015 with complaints of upper back chest pain on left side when he takes a deep breath, lung sounds are abnormal with "rattling", patient is a chronic smoker, did not get xray of chest but suspect possible lung mass 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; There is NO radiologic evidence of non-resolving pneumonia for 6 weeks after antibiotic treatment was prescribed.; "There is no radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; There is no radiologic evidence of a lung abscess or empyema.; There is no radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; There is no radiologic evidence of asbestosis.; 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; There is NO radiologic evidence of non-resolving pneumonia for 6 weeks after antibiotic treatment was prescribed.; "There is no radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; There is no radiologic evidence of a lung abscess or empyema.; There is no radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; There is no radiologic evidence of asbestosis.; SHORTNESS OF BREATH AND COUGH 1


A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient has NOT had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient did NOT quit smoking in the past 15 years.; The patient has signs or symptoms suggestive of lung cancer such as an unexplained cough, coughing up blood, unexplained weight loss or other condition.; < Enter answer here - or Type In Unknown If No Info Given. > 1


A Chest/Thorax CT is being ordered.; This study is being ordered for vascular disease other than cardiac.; "The ordering physician is not a surgeon, pulmonologist, or cardiologist."; There is no radiologic evidence of mediastinal widening.; Patient to be evaluated for wheezing. She has asthma which was first diagnosed in adulthood. The frequency of daytime attacks averages several times per week. The frequency of nocturnal attacks averages several times per week. Her current asthma medic 1






A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; Patient had CXR in 2014 that showed multiple calcified areas. This was over read by radiology and they concurred with original diagnosis. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; significant weight loss, smoker,neoplasm? 1

General/Family Practice Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary This study is being ordered for a neurological disorder.; Unknown; There has not been any treatment or conservative therapy.; Unknown; Unknown 2


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; unknown; It is not known if there has been any treatment or conservative therapy.; hypertension; not given 2

General/Family Practice Disapproval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; Call does not know if there is a reason why the patient cannot have a Cervical Spine MRI.; 2


This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is a reason why the patient cannot have a Cervical Spine MRI.; This study is being ordered due to suspected tumor with or without metastasis.; There is no evidence of tumor or metastasis on a bone scan or x-ray.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is no reason why the patient cannot have a Cervical Spine MRI.; Neck pain , she has a fracture to her left ring finger. 1


This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is no reason why the patient cannot have a Cervical Spine MRI.; Patient has a cervical strain with numbness and tingling down both arms. 1


This study is being ordered for a neurological disorder.; 6-23-15; There has been treatment or conservative therapy.; The patient has been presribed tramadol and gabapentin. Neither of these have given her relief.; Low back back Pain radiating down legs Numbness; 1


This study is being ordered for a neurological disorder.; may, 2001; There has been treatment or conservative therapy.; Pt has seen a Chiropractor for 7 years; Low back pain, sciatica, lower extremity pain, stiffness, Right leg weakness; Unknown 1



General/Family Practice Disapproval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for trauma or injury.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for trauma or injury.; 03/06/2013; There has been treatment or conservative therapy.; patient has physical therapy, injection, medication, choripratic treatment.; patient was having lost of grip strength, neck pain and headache and shoulder pain and mid back pain.; unknown 1


This study is being ordered for trauma or injury.; 9/9/15; There has been treatment or conservative therapy.; Norco and flexoril; neck pain and back pain that radiates/ full ROM but chronic pain from neck down,; wants to rule out any broken discs, pt was bucked off of a horse 1

General/Family Practice Disapproval 72128 CT THORACIC SPINE, UPPER BACK NO CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; may, 2001; There has been treatment or conservative therapy.; Pt has seen a Chiropractor for 7 years; Low back pain, sciatica, lower extremity pain, stiffness, Right leg weakness; Unknown 1


This study is being ordered for a neurological disorder.; n/a; There has been treatment or conservative therapy.; NSAID's; Numbness Tingling L arm and leg; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/09/15; There has been treatment or conservative therapy.; the patient has been taking ibuprofen for pain; back pain, limited range of motion; 1


This study is being ordered for trauma or injury.; 03/06/2013; There has been treatment or conservative therapy.; patient has physical therapy, injection, medication, choripratic treatment.; patient was having lost of grip strength, neck pain and headache and shoulder pain and mid back pain.; unknown 1



General/Family Practice Disapproval 72131 CT LUMBAR SPINE, LOW BACK Radiology Services Denied Not Medically Necessary



This is a request for a lumbar spine CT.; The patient does not have a history of severe low back trauma or lumbar injury.; This is not a preoperative or recent postoperative evaluation.; This study is not part of a myelogram or discogram.; The patient is not experiencing symptoms of radiculopathy for six weeks or more.; There is no neurologic symptoms of bowel or urinary bladder dysfunction.; There is no suspicion of lumbar spine infection.; There is no suspicion of lumbar spine neoplasm or tumor or metastasis. 1


This study is being ordered for a neurological disorder.; 6-23-15; There has been treatment or conservative therapy.; The patient has been presribed tramadol and gabapentin. Neither of these have given her relief.; Low back back Pain radiating down legs Numbness; 1


This study is being ordered for a neurological disorder.; n/a; There has been treatment or conservative therapy.; NSAID's; Numbness Tingling L arm and leg; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/09/15; There has been treatment or conservative therapy.; the patient has been taking ibuprofen for pain; back pain, limited range of motion; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 5/2014; There has been treatment or conservative therapy.; Anti anflammotory; Neck and Lower back pain, Has medal in body cant have MRI; Increased and gotten worse 1



General/Family Practice Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient demonstrate neurological deficits.; It is not known if there has been a supervised trial of conservative management for at least six weeks.; No, this patient did not have a recent course of supervised physical Therapy.; It is not known if the patient has failed a course of anti-inflammatory medication or steroids.; It is not known if the patient had six weeks of Chiropractic care related to this episode.; 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 1




This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; 2


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; <Enter Additional Clinical Information> 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; Musculoskeletal:: Motor Strength and Tone: normal and normal tone. Joints, Bones, and Muscles: no contractures, malalignment, or bony abnormalities and limited ROM (cerv spine) and tenderness (C3-6 on left). Extremities: no cyanosis, edema, varicosities, 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; It is not known if there is weakness or reflex abnormality.; 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is no weakness or reflex abnormality.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is no weakness or reflex abnormality.; Conservative therapy and Chiropractor visits 3x 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is no weakness or reflex abnormality.; Neck pain with radiculopathy. Is doing physical therapy with no improvement. radiates down left arm. Needs MRI for further eval 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is no weakness or reflex abnormality.; SEVERE MIGRANE GREATER THAN 7MON. RIGHT SIDE IS WORSE THAT LEFT 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; Grip strength; 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; pain in shoulder; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; Positive for myalgias, back pain, arthralgias and neck pain. Negative for joint swelling and neck stiffness. Skin: Negative for color change and rash. Cervical back: He exhibits decreased range of motion and pain.; Pt here for a f/u to recent MVA. He states about one week ago he was involved in a rollover accident. He was taken to the ER and had both a head CT and a neck CT performed. The CTs noted no acute hemorrhaging or fractures. He states since the accident his 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; She continues to have trouble with numbness and tingling in the upper extremities and trouble with his grip.; therapy made her pain worse 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; It is not known if the patient has had back pain for over 4 weeks.; 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has not seen the doctor more then once for these symptoms.; 3. musculoskeletal pain Onset: 2 months ago. Location: neck. There is no radiation. The pain is stinging pain. Additional information: he has a neck surgery on C3 and C4. She has a cadaver bone, a plate and 3 screws (2004). Over the past 2 months s 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; It is not known if the patient has completed 6 weeks of physical therapy?; The patient has been treated with medication.; other medications as listed.; ; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; The home treatment did include exercise, prescription medication and follow-up office visits.; ; 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has not directed conservative treatment for the past 6 weeks.; Has a congenital fusion at facet joint at c2,c3 and c3,c4, has degenerative changes with foraminal stenosis at c4 and c5-c6 and c7 from a past CT; doctor wants to follow up 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has NOT had back pain for over 4 weeks.; acute neck pain 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; It is not known if there has been a supervised trial of conservative management for at least six weeks.; No, this patient did not have a recent course of supervised physical Therapy.; It is not known if the patient has failed a course of anti-inflammatory medication or steroids.; No, the patient did not have six weeks of Chiropractic care related to this episode.; unknown 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; There has been a supervised trial of conservative management for at least 6 weeks.; No, this patient did not have a recent course of supervised physical Therapy.; The patient has not failed a course of anti-inflammatory medication or steroids.; No, the patient did not have six weeks of Chiropractic care related to this episode.; 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; There has not been a supervised trial of conservative management for at least 6 weeks.; n/a 1




This is a request for cervical spine MRI; Neurological deficits; No, the patient is not experiencing or presenting new symptoms of upper extremity weakness?; No, the patient is not demonstrating unilateral muscle wasting.; No, the patient is not experiencing or presenting new symptoms of Bowel or bladder dysfunction.; No, the patient is not experiencing new onset of parathesia diagnosed by a neurologist; No, the patient is not experiencing or presenting x-ray evidence of a recent fracture.; prednisone pack, tingling and numbness in back, takes over the counter Ibuprofen, 1

General/Family Practice Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This is a request for cervical spine MRI; Neurological deficits; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 2


This is a request for cervical spine MRI; None of the above; No, the patient is not experiencing or presenting new symptoms of upper extremity weakness?; No, the patient is not demonstrating unilateral muscle wasting.; No, the patient is not experiencing or presenting new symptoms of Bowel or bladder dysfunction.; No, the patient is not experiencing new onset of parathesia diagnosed by a neurologist; No, the patient is not experiencing or presenting x-ray evidence of a recent fracture.; <Enter Additional Clinical Information> 2


This is a request for cervical spine MRI; None of the above; No, the patient is not experiencing or presenting new symptoms of upper extremity weakness?; No, the patient is not demonstrating unilateral muscle wasting.; No, the patient is not experiencing or presenting new symptoms of Bowel or bladder dysfunction.; No, the patient is not experiencing new onset of parathesia diagnosed by a neurologist; No, the patient is not experiencing or presenting x-ray evidence of a recent fracture.; PAIN WITH RANGE OF MOTION IN NECK WITH FORWARD REFLEXTION, EXTENSION AND ROTATION. 1


This is a request for cervical spine MRI; Trauma or recent injury; The patient does not have new or changing neurologic signs or symptoms.; The patient has NOT had back pain for over 4 weeks.; patient recently fell and heard loud "pop" in neck--since then has experienced headaches, back pain and pain in neck and left arm. Pain worsens with movement or activity. Decreased range of motion. 1


This is a request for cervical spine MRI; Trauma or recent injury; Yes, the patient have new or changing neurological signs or symptoms.; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 2


This study is being ordered for a neurological disorder.; 08/19/2015; There has been treatment or conservative therapy.; Anti-inflammatories, pain meds.; Parathesia to extremities, ankle pain.; None. 1


This study is being ordered for a neurological disorder.; 09/29/2014; There has been treatment or conservative therapy.; patient has preformed greater than 2 mo of physical therapy exercises plus medication for relief including nsaid, pain medication, muscle relaxer. all with no relief of sx.; pain in neck, shoulders and mid upper back. numbness radiates down bilat arms.; pain/numbness is effecting quality of life 1




This study is being ordered for a neurological disorder.; 6/19/2015; There has been treatment or conservative therapy.; Physical therapy. Pain medications, Hydrocodone. Reducing activity.; Numbness, bi-lateral leg pain.; 1


This study is being ordered for a neurological disorder.; 8/11/2015; There has been treatment or conservative therapy.; at home lumbar strengthening exercises along with anti inflammatory medication; radiating pain from cervical and lumbar spine; 1


This study is being ordered for a neurological disorder.; months ago; There has been treatment or conservative therapy.; patient has been to chiropractor and has been to physical therapy; pain in neck with numbess down lt arm pain in lower back with numbness down right leg; 1


This study is being ordered for a neurological disorder.; UNKNOWN; There has been treatment or conservative therapy.; MEDICATION AND EXERCISES; EVALUATION WITH PAIN MGMT DR. KHAN FOR EVALUATION FOR CERVICAL TPI AND GREATER OCCIPITAL NERVE BLOCKS F/U ORDERED CERVICAL SPINE MRI AND LUMBAR SPINE MRI WITHOUT CONTRAST FOR RADICULOPATHY WITH NECK AND LOW BACK PAIN; BACK PAIN 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; There has been treatment or conservative therapy.; < Describe treatment / conservative therapy here - or Type In Unknown If No Info Given >; Neck and back pain for over 2 years; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; There has been treatment or conservative therapy.; Anti-inflammatory; pain meds; nerve blocks; at home exercise; Spinal blocks past 4 years; defecated disk l spine Bulging disk c spine scoliosis t spine; < Enter answer here - or Type In Unknown If No Info Given. > 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 5/5/2014; There has been treatment or conservative therapy.; PAIN MEDICATIONS, MUSCLE RELAXER, ANTI-INFLAMMATORY, STERIODS; NECK PAIN BACK PAIN LUMBAR RADICLULAPOTHY; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 6/23/2015; There has been treatment or conservative therapy.; Injections; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 8/18/2015; There has been treatment or conservative therapy.; medications,; passing out and neck and back pain, severe headaches.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 9/15/2015; It is not known if there has been any treatment or conservative therapy.; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; about 7 years ago, was seeing a neurologist in NY and was having PT but insurance ran out.; There has not been any treatment or conservative therapy.; The patient low back pain, arthralgia, weakness, numbness, sleep disturbance, blurred vision and sciatica. Weakness/numbness in lower extremities.; Limited ROM, and pain 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; chronic-initial date unknown; It is not known if there has been any treatment or conservative therapy.; Chronic neck and back pain, abdominal pain with tenderness and nausea, weight loss.; Pt has had lumbar and cervical spine x-ray which were both negative. Abdominal pain is worsening. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; first presented 10/21/2013; There has been treatment or conservative therapy.; Pain meds, PT; chronic back pain, bulging and herniated dics, nerve impingment in neck, stenosis. MRI perfomed 2012 of the spine shows abnormalities in all sections of spine.; < Enter answer here - or Type In Unknown If No Info Given. > 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; none; There has been treatment or conservative therapy.; pn meds; cronic back and neck pn, neuropathy, right leg weakness; none 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Unknown; It is not known if there has been any treatment or conservative therapy.; left sided facial pain; Unknown 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; UNKNOWN; There has been treatment or conservative therapy.; MEDICATION THERAPY AND PHYSICAL THERAPY; complaining of worsening neck and lower back pain; has paresthesias in R arm and radiation of pain into R buttock; UNNKNOWN 1


This study is being ordered for trauma or injury.; 8/28/2015 tree limb fell on him; There has been treatment or conservative therapy.; Physical therapy 3x week for 3 weeks, muscle relaxers. PT did not help.; neck pain, back pain, has trouble raising arm.; unknown 1


This study is being ordered for trauma or injury.; June 2015; There has been treatment or conservative therapy.; Pt has has home exercises along with cyclobenzaprine and hydrocodone acetaminophen; Pain and tingling down the left arm radiating from the cervical spine. Numbness in fingers. Symptoms have worsened since inital therapy.; 1

General/Family Practice Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for a thoracic spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has not directed conservative treatment for the past 6 weeks.; Mbr has scoliosis this is to prepare for visit with neuro 1


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; It is not known if the patient has any neurological deficits.; The patient is experiencing sensory abnormalities such as numbness or tingling.; It is not known if there has been a supervised trial of conservative management for at least six weeks.; The patient has failed a course of anti-inflammatory medication or steroids.; It is not known how many follow-up thoracic spine MRIs the patient has had.; Enter Additional Clinical InformCC: Mike is a 62 year old White male. He presents with. HPI: Mike presents with mid back pain. The discomfort is most prominent in the lower thoracic spine. It does not radiate. He characterizes it as intermi 1


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; It is not known if the patient has any neurological deficits.; The patient is not experiencing sensory abnormalities such as numbness or tingling.; kyphosis, to rule out fracture/compression PAIN TO BOTH THORACIC AND LUMBAR abnormal X-RAY thoracic spine 1




This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of lower extremity weakness documented on physical exam.; 2


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of lower extremity weakness documented on physical exam.; came in for severe back pain on top of his chronic LBP. he accidentally twisted his back when he was reaching for something in his truck and tried to handed to his son. He heard his back popped, and fell. He got bruised on his Left upper back. The pain is 1


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is not experiencing or presenting symptoms of abnormal gait, lower extremity weakness, asymmetric reflexes, fracture, radiculopathy or bowel or bladder dysfunction.; The patient is experiencing sensory abnormalities such as numbness or tingling.; There has been a supervised trial of conservative management for at least 6 weeks. 1


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does not have any neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; The patient has not failed a course of anti-inflammatory medication or steroids.; Pt had a 4 wheeler accident 1 yr ago, has had upper back pain ever since, worsened over 6 months. Pt was given anti-inflammorties and steroids (oral) 1


This study is being ordered for a neurological disorder.; ; It is not known if there has been any treatment or conservative therapy.; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1

General/Family Practice Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for a neurological disorder.; 09/29/2014; There has been treatment or conservative therapy.; patient has preformed greater than 2 mo of physical therapy exercises plus medication for relief including nsaid, pain medication, muscle relaxer. all with no relief of sx.; pain in neck, shoulders and mid upper back. numbness radiates down bilat arms.; pain/numbness is effecting quality of life 1






This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; ; There has not been any treatment or conservative therapy.; ; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 07/08/2015; There has been treatment or conservative therapy.; Physical therapy; Sciatic pain from hip to back, agitated by physical therapy.; Sciatic pain from hip to back, agitated by physical therapy. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 8/15/15; There has been treatment or conservative therapy.; pain medication, muscle relaxers, heat, ice, NSAIDS.; back pain with left sided sciatica; Pt can only do limited activity due to the back pain. Pain is affected her job. 1






This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Greater than 2 months ago.; There has been treatment or conservative therapy.; No improvement with muscle relaxers and pain medication.; back pain; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; more than 15 years ago; There has been treatment or conservative therapy.; tried over the counter medications started on patches 8/31/2015 Lyrica 8/31/2015; low back pain in the lumbar and thoracic pain and numbness in right lower leg worse when walking; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; UNKNOWN; There has been treatment or conservative therapy.; MEDICATIONS, XRAYS, PT, REST; NO; NO 1


This study is being ordered for trauma or injury.; Aug 3rd , 2015; There has been treatment or conservative therapy.; Pain meds , tramadol.; pt has lower back pain radiating down left leg.; None 1


This study is being ordered for trauma or injury.; Trauma 02/01/2015; There has been treatment or conservative therapy.; Flexoril, 8/17/15 STEROID SHOT< IB 800MGS x 8hrs Ultram 50mg veery 4-6 hrs prn pain, x-ray (normal) scoliosis, slight s shape on t spine; Continues to have pain, continue to take meds, patient was last seen on 21st, seen 2x; < Enter answer here - or Type In Unknown If No Info Given. > 1

General/Family Practice Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has had back pain for over 4 weeks.; she very unsure of case 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has not seen the doctor more then once for these symptoms.; Unresolved back pain, MRI recommended for further evaluation, Had steroid injections and medications that has not provided relief for the patient 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; It is not known if the physician has directed conservative treatment for the past 6 weeks.; tenderness to lumbosacral spine on palpation , home exercises discussed in plan 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; It is not known if the physician has directed a home exercise program for at least 6 weeks.; 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has a new foot drop.; It is not known if the patient has new signs or symptoms of bladder or bowel dysfunction.; It is not known if there is x-ray evidence of a lumbar recent fracture.; It is not known if there is weakness or reflex abnormality.; Bypassed after first question 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; It is not known if there is weakness or reflex abnormality.; The Pt is in back pain. The Pt needs a neurosurgeon, but the surgeon wants an updated mri. 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; It is not known if there is weakness or reflex abnormality.; 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is no weakness or reflex abnormality.; abnormal xray l4-5 narrowing, low back pain 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is no weakness or reflex abnormality.; numbness and tingling in legs 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is reflex abnormality.; deep tendon reflexes: 2/4 left patellar, 2/4 right patellar, 2/4 left Achilles, 2/4 right Achilles;; PT HAS RIDICULAR LEFT LEG PAIN, PARATHESIA, PAIN RADIATES TO LEFT BUTTOCK, TO THIGH TO CALF, DOWN TO ANKLE AND FOOT PT HAS HAS STEROID INJECTION THAT HAS NOT HELPED PAIN, PAIN CONTINUES TO WORSEN, NOTHING HELPS WITH PAIN. PAIN WORSENS WITH FLEXION, B 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is reflex abnormality.; Musculoskeletal: Positive for back pain.Neurological: Positive for numbness. He exhibits decreased range of motion, tenderness and spasm Aching and burning Radiates to: L posterior upper leg Chronicity: NewAssociated symptoms: numbness Patient Name Sex ; Patient Name Sex DOB Scantling, Charles P Male 6/13/1981 Study Result Final INTERPRETATION CT SCAN OF THE LUMBAR SPINE WITHOUT CONTRAST 9/4/2015: CLINICAL HISTORY: Low back pain. History of lumbar surgery. Performed at 2.5 mm intervals t 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; ; 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; LROM, weakness; none 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; Muscle spasm radiating down L side.; Back pain 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; PATIENT FELL RECENTLY DUE TO LEG WEAKNESS. PAIN RADIATING DOWN RIGHT LEG. LS XRAY INDICATES LS SPONDYLOSIS.; 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; pt has weakness and pain in his lower legs which we think could be from his back; pt feel from 16 feet onto the floor hurting his back and has pain that radiates to his lower legs 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; R leg weakness and tingling and numbness.; Pt has failed PT and nsaids and still having trouble 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; It is not known if the patient has had back pain for over 4 weeks.; 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has not seen the doctor more then once for these symptoms.; history of stones, pain in back that radiates into the leg, just meds: citalopram , no cons treatment 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has not seen the doctor more then once for these symptoms.; Recent x-ray results note degenerative disc disease. Recommend MRI. 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has not seen the doctor more then once for these symptoms.; Seen 09/23/2015 as second opinion regarding back surgery; pain even when sitting; has had injections 1




The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has not directed a home exercise program for at least 6 weeks.; < Enter answer here - or Type In Unknown If No Info Given. > 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has not directed a home exercise program for at least 6 weeks.; none 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has not directed conservative treatment for the past 6 weeks.; lumbar pain w/dd change; hx compression fx; no relief from pain med 1

General/Family Practice Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; It is unknown if the patient has acute or chronic back pain.; This procedure is being requested for None of the above; bypass 1


The study requested is a Lumbar Spine MRI.; It is unknown if the patient has acute or chronic back pain.; This procedure is being requested for None of the above; hip pain and lower extremity pain. 1


The study requested is a Lumbar Spine MRI.; Neurological deficits; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; ; 2


The study requested is a Lumbar Spine MRI.; Neurological deficits; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; moderate intensity in leg,aggravating symptoms include walking and standing,radiating pain down left thigh; 1


The study requested is a Lumbar Spine MRI.; None of the above; It is not known if the patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has had back pain for over 4 weeks.; Bypassed 1


The study requested is a Lumbar Spine MRI.; None of the above; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; It is not known was medications were used in treatment.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has not directed a home exercise program for at least 6 weeks.; patient has back pain. 1


The study requested is a Lumbar Spine MRI.; The patient does NOT have acute or chronic back pain.; This procedure is being requested for None of the above; patient is having hip pain radiating from right leg to the knee 1



General/Family Practice Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 1

General/Family Practice Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 3

General/Family Practice Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; 4




The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; 2 week history of worsening back pain with radiation to leg. Failed NSAIDS. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; bilateral lower extremity pain, foot numbness, unable to sleep. 1

General/Family Practice Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; burning sensation, traveling down leg. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; chronic low back pain. was followed by pain dr in another state and now wishes to be referred to one in Arkansas. Has to have mri to be referred. previous records are not available at this time 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Decreased range of motion, tenderness, and spasm. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Enter answer here - or Type In Unknown If No Info low back pain with radiculopathy had some numbness in left toes three four and five 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Fall, pain limiting movement. Hard standing and bending. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; HAS HAD LOW BACK PAIN FOR THE PAST FEW YEARS FELT A POP IN HER BACK 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Having low back pain and only able to at attend 3 physical therapy appointments. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Low back pain, unable to sleep at night due to the pain. Lower back exhibited tenderness on palpation. Pain is consistent with irritated disc in lower back. Patient has failed anti inflammatories. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Lower back pain with left leg numbness. No recent injuries or trauma. Lumbar spasm/strain. 1

General/Family Practice Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; numbness in right leg / 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; patient has been on muscle relaxers/naproxen since 08/19/15 with no relief. Has tried moist heat as well. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; patient has ddd of lumbar spine, low back pain and muscle spasms to back 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Patient has had pain since 08/20/15. She has had a trial of medicine/heat/rest since then and it has not improved. She has weakness with right leg numbness. Pain while walking with no previous back problems. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; patient has reducular bylateral leg pain, restless leg symptoms and vircus vains. 1

General/Family Practice Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; patient having bilateral leg pain and tingling. 1

General/Family Practice Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Radiculopathy. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; right thigh numbness and burning taking some muscle relaxers 1


The study requested is a Lumbar Spine MRI.; Trauma or recent injury; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has NOT had back pain for over 4 weeks.; approx 8/28 was at the dump when he was hit in the back by the scoop of a backhoe, and was taken by ambulance to ED at Washington Regional Hosp. Then seen in ED at Mercy on 9/9/15 for continued pain - had CT of cervical spine and head - given naproxyn and 1


The study requested is a Lumbar Spine MRI.; Trauma or recent injury; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; It is not known if there is weakness or reflex abnormality.; 1


The study requested is a Lumbar Spine MRI.; Trauma or recent injury; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is no weakness or reflex abnormality.; leg numbness, shoulder pain, decrease sensation to both legs, unable to stand for 20 minutes had injections with no relief 1


This study is being ordered for a neurological disorder.; ; It is not known if there has been any treatment or conservative therapy.; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1

General/Family Practice Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1




This study is being ordered for a neurological disorder.; 6/19/2015; There has been treatment or conservative therapy.; Physical therapy. Pain medications, Hydrocodone. Reducing activity.; Numbness, bi-lateral leg pain.; 1


This study is being ordered for a neurological disorder.; 8/11/2015; There has been treatment or conservative therapy.; at home lumbar strengthening exercises along with anti inflammatory medication; radiating pain from cervical and lumbar spine; 1


This study is being ordered for a neurological disorder.; low back pain for several years with the most recent flare up of 5 months; It is not known if there has been any treatment or conservative therapy.; right lower back pain that radiates into tighs, constant, sharp, throbbing, aching & burning; she tripped and fell about 5 months ago causing flare up; radicular right hip/leg pain; swelling above hip joint; decreased range of motion with right hip flexio; low back pain radiating down right leg no releif with nsaids taken OTC - numbness to right uipper thigh to knee 1


This study is being ordered for a neurological disorder.; months ago; There has been treatment or conservative therapy.; patient has been to chiropractor and has been to physical therapy; pain in neck with numbess down lt arm pain in lower back with numbness down right leg; 1


This study is being ordered for a neurological disorder.; UNKNOWN; There has been treatment or conservative therapy.; MEDICATION AND EXERCISES; EVALUATION WITH PAIN MGMT DR. KHAN FOR EVALUATION FOR CERVICAL TPI AND GREATER OCCIPITAL NERVE BLOCKS F/U ORDERED CERVICAL SPINE MRI AND LUMBAR SPINE MRI WITHOUT CONTRAST FOR RADICULOPATHY WITH NECK AND LOW BACK PAIN; BACK PAIN 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; There has been treatment or conservative therapy.; < Describe treatment / conservative therapy here - or Type In Unknown If No Info Given >; Neck and back pain for over 2 years; < Enter answer here - or Type In Unknown If No Info Given. > 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; ; There has not been any treatment or conservative therapy.; ; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 07/08/2015; There has been treatment or conservative therapy.; Physical therapy; Sciatic pain from hip to back, agitated by physical therapy.; Sciatic pain from hip to back, agitated by physical therapy. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1-9-2013; There has been treatment or conservative therapy.; HIP REPLACEMENT, THERAPY, MEDICATION; PAIN AT REST AND LYING DOWN, LBP, HIP PAIN; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2 weeks for shoulder several years for lumbar spine; There has been treatment or conservative therapy.; Steroids, joint injections, pain medication, and surgery on her back; Low back pain, right shoulder pain, and radiculopathy of the lumbar spine; Unknown 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 5/5/2014; There has been treatment or conservative therapy.; PAIN MEDICATIONS, MUSCLE RELAXER, ANTI-INFLAMMATORY, STERIODS; NECK PAIN BACK PAIN LUMBAR RADICLULAPOTHY; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 6/23/2015; There has been treatment or conservative therapy.; Injections; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 8/15/15; There has been treatment or conservative therapy.; pain medication, muscle relaxers, heat, ice, NSAIDS.; back pain with left sided sciatica; Pt can only do limited activity due to the back pain. Pain is affected her job. 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 9/15/2015; It is not known if there has been any treatment or conservative therapy.; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; about 7 years ago, was seeing a neurologist in NY and was having PT but insurance ran out.; There has not been any treatment or conservative therapy.; The patient low back pain, arthralgia, weakness, numbness, sleep disturbance, blurred vision and sciatica. Weakness/numbness in lower extremities.; Limited ROM, and pain 1






This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Greater than 2 months ago.; There has been treatment or conservative therapy.; No improvement with muscle relaxers and pain medication.; back pain; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; more than 15 years ago; There has been treatment or conservative therapy.; tried over the counter medications started on patches 8/31/2015 Lyrica 8/31/2015; low back pain in the lumbar and thoracic pain and numbness in right lower leg worse when walking; < Enter answer here - or Type In Unknown If No Info Given. > 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; UNKNOWN; There has been treatment or conservative therapy.; MEDICATION THERAPY AND PHYSICAL THERAPY; complaining of worsening neck and lower back pain; has paresthesias in R arm and radiation of pain into R buttock; UNNKNOWN 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; UNKNOWN; There has been treatment or conservative therapy.; MEDICATIONS, XRAYS, PT, REST; NO; NO 1


This study is being ordered for trauma or injury.; 8/28/2015 tree limb fell on him; There has been treatment or conservative therapy.; Physical therapy 3x week for 3 weeks, muscle relaxers. PT did not help.; neck pain, back pain, has trouble raising arm.; unknown 1


This study is being ordered for trauma or injury.; 8/8/2010; There has not been any treatment or conservative therapy.; spasm ridiculopathy; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for trauma or injury.; April 2015; There has not been any treatment or conservative therapy.; Pt is having numbness, no feeling, dizziness, back pain and has had seizures since the fall.; MDO wants to determine if there is any injury to the back and any contribution to the brain that is causing the seizures. 1


This study is being ordered for trauma or injury.; Aug 3rd , 2015; There has been treatment or conservative therapy.; Pain meds , tramadol.; pt has lower back pain radiating down left leg.; None 1


This study is being ordered for trauma or injury.; Trauma 02/01/2015; There has been treatment or conservative therapy.; Flexoril, 8/17/15 STEROID SHOT< IB 800MGS x 8hrs Ultram 50mg veery 4-6 hrs prn pain, x-ray (normal) scoliosis, slight s shape on t spine; Continues to have pain, continue to take meds, patient was last seen on 21st, seen 2x; < Enter answer here - or Type In Unknown If No Info Given. > 1

General/Family Practice Disapproval 72196 MRI PELVIS Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 06/12/15; There has been treatment or conservative therapy.; PATIENT HAS BEEN RECIEVING PAIN MEDICATION AND ANTI-INFLAMITORY MEDICATION FROM PRIMARY CARE PHYSICIAN.; WEAKNESS HIP PAIN LOWER BACK PAIN; PATIENTS PAIN IS WORSENING AND NOT GETTING BETTER. 1

General/Family Practice Disapproval 72196 MRI PELVIS Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; 8/8/2010; There has not been any treatment or conservative therapy.; spasm ridiculopathy; < Enter answer here - or Type In Unknown If No Info Given. > 1

General/Family Practice Disapproval 73200 CT ARM OR UPPER EXTREMITY Radiology Services Denied Not Medically Necessary

This is a request for an upper extremity, shoulder, scapula, elbow, hand, or wrist joint CT.; There is not a history of upper extremity joint or long bone trauma or injury.; This is not a preoperative or recent postoperative evaluation.; There is not suspicion of upper extremity neoplasm or tumor or metastasis.; There is not suspicion of upper extremity bone or joint infection.; The ordering physician is not an orthopedist or rheumatologist. 1

General/Family Practice Disapproval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; ; There has not been any treatment or conservative therapy.; right shoulder/upper extremity pain; right arm drop; ROM limited with pain; unknown 1

General/Family Practice Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary

The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; < Enter answer here - or Type In Unknown If No Info Given. > 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Decrease mobility joint tenderness, lifting moving or pushing worsens, going on for months 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; hurting for two weeks, hit in the shoulder during football 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Pain 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Patient has been having Rt. shoulder pain that has now started moving down the right side of her body. Dr. Perser is requesting she have a MRI 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; PATIENT IS IN A LOT OF PAIN WITH NO RELIEF.MEDS GIVEN. 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; pt stated pain started 6/24/15 and was seen in ER. The ER treated for pulled muscle. Pt still experiencing pain and need further testing for eval. 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; pt was in accident approx 8 years ago where first injury to shoulder was noted. Pt stated he did not have any testing at that time. Since the accident, pt still experiences pain and aggravation with everyday activities. pt had xray performed on 8/13/15 wi 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; < Enter answer here - or Type In Unknown If No Info Given. > 2


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; Pain, limited rom. 1

General/Family Practice Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary The requested study is a Shoulder MRI.; Study is being ordered for known/suspected joint infection.; The plain films were not normal. 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient received oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has not directed a home exercise program for at least 6 weeks.; PATIENT HAS LEFT SHOULDER PAIN THAT IS GOING UP INTO HER NECK FOR MORE THAN A WEEK. HER LEFT SHOULDER CATCHES WHEN SHE RAISES IT UP, PAINFUL WITH MOVEMENT.SHE IS HAVING PAIN WITH ABDUCTION. 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from a recent injury.; It is not known if there is a suspicion of tendon, ligament, rotator cuff injury, or labral tear.; It is not known if there is a suspicion of fracture not adequately determinjed by x-ray.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; 1


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has not experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 2


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1/2015; There has been treatment or conservative therapy.; PT, Rx meds; Pain, knee is moving to the ankle, problems sleeping along with joint tenders and swelling. shoulder has limited range of motion.; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2 weeks for shoulder several years for lumbar spine; There has been treatment or conservative therapy.; Steroids, joint injections, pain medication, and surgery on her back; Low back pain, right shoulder pain, and radiculopathy of the lumbar spine; Unknown 1


This study is being ordered for trauma or injury.; ; There has not been any treatment or conservative therapy.; right shoulder/upper extremity pain; right arm drop; ROM limited with pain; unknown 1


This study is being ordered for trauma or injury.; June 2015; There has been treatment or conservative therapy.; Pt has has home exercises along with cyclobenzaprine and hydrocodone acetaminophen; Pain and tingling down the left arm radiating from the cervical spine. Numbness in fingers. Symptoms have worsened since inital therapy.; 1

General/Family Practice Disapproval 73700 CT LEG OR LOWER EXTREMITY Radiology Services Denied Not Medically Necessary

This is a request for a Lower Extremity CT.; This is not a preoperative or recent postoperative evaluation.; There is no suspicion of a lower extremity neoplasm, tumor or metastasis.; There is no suspicion of lower extremity bone or joint infection.; There is not a history of lower extremity joint or long bone trauma or injury.; large quality of fluid and pain 1

General/Family Practice Disapproval 73700 CT LEG OR LOWER EXTREMITY Radiology Services Denied Not Medically Necessary

This is a request for a Lower Extremity CT.; This is not a preoperative or recent postoperative evaluation.; There is no suspicion of a lower extremity neoplasm, tumor or metastasis.; There is suspicion of lower extremity bone or joint infection. 1

General/Family Practice Disapproval 73706 CT ANGIOGRAPHY LOWER EXTREMITY Radiology Services Denied Not Medically Necessary Yes, this is a request for CT Angiography of the lower extremity. 1General/Family Practice Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary 1

General/Family Practice Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary

This is a request for a foot MRI.; The study is being ordered forfoot pain.; The study is being ordered for chronic pain.; The patient has had foot pain for over 4 weeks.; The patient has been treated with anti-inflammatory medication for at least 6 weeks.; patient has been having chronic left ankle pain for over a week Dr. Barron is needing an MRI to see if he has a tendon tear. 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Yes, there is a known trauma involving the knee.; Pain greater than 3 days; It is not known if patient had recent plain films of the knee.; patient fell and with exam finding consistent with meniscal tear 1




This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient received oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; The home treatment did include exercise, prescription medication and follow-up office visits.; Pt instructed to do home exercises to alleviate pain. Did not help. Pt is actually experiencing more pain, popping, and weak sensation in her knee.; 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; Pain is having severe knee pain and unable to put weight on this leg to get up. She has edema throughout this leg. Pain extending through knee down to ankle and up to thigh. 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from an old injury.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient received oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; It is not known if the The home treatment included exercise, prescription medication and follow-up office visits.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a Knee MRI.; There is no supsected meniscus,pre-op or post-op evaluation,non-acute Chronic Pain,supsected tumor or Aseptic Necrosis; The ordering physician is not an orthopedist.; Pain greater than 3 days; The patient had recent plain films of the knee.; The results of the plain films is not known.; No, patient has not completed and failed a course of conservative treatment.; PATIENT FELL AND HAS PAIN ON HER LEFT KNEE FOR OVER 3 DAYS NOW 1




This is a request for an Ankle MRI.; The study is requested for ankle pain.; There is a suspicion of tendon or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; Patient has swelling and worsening pain for longer than one month for this injury. Conservative treatment wih NSAIDS, ace wrap, rest and ice have not proven efficacy. 1


This is a request for an Ankle MRI.; The study is requested for ankle pain.; There is a suspicion of tendon or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; unknown 1


This study is being ordered for a neurological disorder.; 08/19/2015; There has been treatment or conservative therapy.; Anti-inflammatories, pain meds.; Parathesia to extremities, ankle pain.; None. 1


This study is being ordered for a neurological disorder.; 1-10-2012; There has been treatment or conservative therapy.; anti-inflammatory and pain meds; Increased pain with numbness and tingling in legs and feet; 2


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; ; There has been treatment or conservative therapy.; Describe treatment / conservative therapy here - or Type patient has taken advil and oxycodone had physical therapy after surgery and uses sopas and ice when swollen; ; 2


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1/2015; There has been treatment or conservative therapy.; PT, Rx meds; Pain, knee is moving to the ankle, problems sleeping along with joint tenders and swelling. shoulder has limited range of motion.; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; about a year; There has been treatment or conservative therapy.; home exercise; knee pain, popping; referred to PT 2

General/Family Practice Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary This study is being ordered for trauma or injury.; ; There has been treatment or conservative therapy.; ; ; 2


This study is being ordered for trauma or injury.; Initial onset was around 8-16-15. Dr. Fletcher reports that on today's visit , 9-23-15, pt has limited ROM on right knee with popping and an effusion to right knee. Then on left ankle, pt has limited ROM with pain. Possible partial tear.; There has been treatment or conservative therapy.; Pt has been wearing a knee brace. Using ice and taking Aleve and Tyelol.; Pain with ROM to right knee and left ankle. With popping to right knee.; Effusion of right knee and left ankle. Hx of swelling and pain near archilles 2

General/Family Practice Disapproval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT Radiology Services Denied Not Medically Necessary

This is a requests for a hip MRI.; The request is for hip pain.; The hip pain is chronic.; The member has not failed a 4 week course of conservative management in the past 3 months.; OTC medications tenderness to palptation tenderness in thigh 1


This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the hip other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; There is not a mass near the hip.; The patient has not been treated with anti-inflammatory medications in conjunction with this complaint.; This is not for pre-operative planning. 1


This study is being ordered for a neurological disorder.; 03/20/2015; There has been treatment or conservative therapy.; Therapy, medication and neuro surgeon; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 2


This study is being ordered for a neurological disorder.; low back pain for several years with the most recent flare up of 5 months; It is not known if there has been any treatment or conservative therapy.; right lower back pain that radiates into tighs, constant, sharp, throbbing, aching & burning; she tripped and fell about 5 months ago causing flare up; radicular right hip/leg pain; swelling above hip joint; decreased range of motion with right hip flexio; low back pain radiating down right leg no releif with nsaids taken OTC - numbness to right uipper thigh to knee 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 05/2014; There has been treatment or conservative therapy.; Pt has been seen by chiropractor, meds and heat therapy.; Pt has LBP and in hips.; < Enter answer here - or Type In Unknown If No Info Given. > 2


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 06/12/15; There has been treatment or conservative therapy.; PATIENT HAS BEEN RECIEVING PAIN MEDICATION AND ANTI-INFLAMITORY MEDICATION FROM PRIMARY CARE PHYSICIAN.; WEAKNESS HIP PAIN LOWER BACK PAIN; PATIENTS PAIN IS WORSENING AND NOT GETTING BETTER. 1


This study is being ordered for trauma or injury.; 10/2014; There has been treatment or conservative therapy.; meds,; pain, problems bending joints; < Enter answer here - or Type In Unknown If No Info Given. > 2

General/Family Practice Disapproval 74150 CT ABDOMEN WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an Abdomen CT.; This study is being ordered for a suspicious mass or tumor.; It is not known if there is a suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; It is not known if there are new symptoms including hematuria.; There are no new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; There is not a suspicion of an adrenal mass.; This is not a request to confirm a suspicious renal mass suggested by physical exam, lab studies, IVP or ultrasound.; Possible mass-not palpable. Retroperitonial. 1


This is a request for an Abdomen CT.; This study is being ordered for a suspicious mass or tumor.; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are new lab results or other imaging studies including ultrasound, Doppler or plain films findings. 1


This is a request for an Abdomen CT.; This study is being ordered for an infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; There are no findings that confirm hepatitis C.; Patient treated for h-pylori ion 7/2015, pain never subsided 1




This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; No relief of pain 1


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; r/o rectum bleeding and blood in stool 1


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; This is a chronic problem. The current episode started more than 1 month ago. The onset quality is gradual. The problem occurs constantly. The problem has been unchanged. The pain is located in the LUQ and RUQ. The pain is at a severity of 3/10. The pain 1

General/Family Practice Disapproval 74150 CT ABDOMEN WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This is a request for an Abdomen CT.; This study is being ordered for organ enlargement.; There is evidence of organ enlargement on ultrasound, plain film, or IVP. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; significant weight loss, smoker,neoplasm? 1

General/Family Practice Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; It is not known if the patient has been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; <Enter Additional Clinical Information> 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; It is unknown if there are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; It is not known if there are findings that confirm hepatitis C.; 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; It is unknown if there are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; <Enter Additional Clinical Information> 1




This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; <Enter Additional Clinical Information> 2


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; bright rectal bleeding sever abdominal pain elevated white blood cell count nausea 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; Expand All Collapse All Subjective: Patient ID: Brian L King is a 45 y.o. male. HPI Mr. King comes in for a HTN follow-up visit. He has been compliant with his medications, and he reports no tolerability issues. He does complain of LLQ abdom 1


This is a request for an abdomen-pelvis CT combination.; Known Tumor, Cancer, Mass, or R/O metastases; This is not a request for follow up of a known tumor or cancer involving both the abdomen and pelvis or if this patient is undergoing active treatment.; This is not a request for initial staging of a known tumor other than prostate.; There is no known prostate cancer with a PSA greater than 10.; No, there is not a palpable or observed abdominal mass.; There is no abdominal and pelvic or retroperitoneal mass that has been confirmed by previous imaging other than a CT.; There are no new signs or symptoms including hematuria, presenting with known cancer or tumor.; 1






This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Abdominal pain with diarrhea x 3 months, vomiting x 4 months. 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; caller is calling from the IP 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; decreased appetite, 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; history of colon cancer LUQ tightness and pain severe constipation Need to make sure there is no bowel obstruction 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; mbr has pain for year and can feel a bulge in abdomen left side abnormal ultrasound and weight loss but abdomen is bulging out 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; pt has hx of myxoma, experiencing L hip and L leg pain, last CT 10 yrs ago 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Pt. is having ongoing issues with abdominal pain and weight gain. 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; RUQ pain- started 2-3 mo ago- has discomfort over the R flank area under the ribs - has been constant, feels like pressure, but worse when he is sitting, relieved when standing. No N/V/D, no fevers, no change in BM pattern, no heartburn, not related to e 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; severe abd pain 1




This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are no new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; It is not known if there is a suspicion of an adrenal mass.; This is not a request to confirm a suspicious renal mass suggested by physical exam, lab studies, IVP or ultrasound.; <Enter Additional Clinical Information> 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; It is not known if the pain is acute or chronic.; This is the first visit for this complaint.; It is unknown if the patient had an Amylase or Lipase lab test.; A urinalysis has not been completed.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; There has been a physical exam.; The patient is female.; A pelvic exam was performed.; The results of the exam were abnormal.; patient seen in ER 9/8/15 with abd/pelvic pain, continues to have pain in the right lower quadrant with nauses, vomiting, no appitite 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; recently DX herpes simplex virus 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; Treated for H-Pylori in 7/2015. Still having abdominal pain but no h-pylori 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is male.; A rectal exam was not performed.; REPORTS 3 B/M X1 WEEK. INCREASED ABDOMINAL PAIN, DISCOMFORT, WAXES/WANES, INCREASE BLOATING, ABDOMINAL CRAMPS 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; It is unknown if the patient had an Amylase or Lipase lab test.; It is not known if a urinalysis has been completed.; 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were abnormal.; It is not known if the urinalysis was positive for billirubin, ketones, nitrites, hematuria/blood, glucose or protein.; History of colon cancer 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has not been completed.; None 2


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient had an lipase lab test.; The results of the lab test were abnormal. 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is known tumor.; The patient is female.; This study is being ordered for follow-up.; The patient has NOT completed a course of chemotherapy or radiation therapy within the past 90 days.; The patient is not presenting new symptoms.; The last Abdomen/Pelvis CT was performed within the past 10 months.; Provider requested short term follow-up of new pulmonary nodule 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is renal calculi, kidney or ureteral stone.; A urinalysis has not been completed.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for an abdomen-pelvis CT combination.; Trauma; This request is not for follow up to abdominal and/or pelvic trauma ordered by a specialist or PCP on behalf of a specialist who has seen the patient.; There is no recent trauma with physical findings or abnormal blood work indicating either peritonitis or abscess.; There are no physical findings or lab results indicating an intra-abdominal bleed.; Patient fell directly on his abdomen, felt like his stomach twisted and turned when he fell, is affecting his breathing! 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 4/15/2015; There has been treatment or conservative therapy.; Patient has been treated with MDP and Flonase. Patient has seen cardiologist to rule out heart disease causing vertigo and weakness. The patient also has seen an ENT who has performed an ENG exam, posturography and audiometric testing.; Patient complains of chronic vertigo and weakness.; After consulting with specialist, it's in agreement the patient would benefit from and MRI of the brain. 1



General/Family Practice Disapproval 75571 Corornary Artery Calcium Score, EBCT Radiology Services Denied Not Medically Necessary This is a request for a CT scan for evalutation of coronary calcification.; 1

General/Family Practice Disapproval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study Radiology Services Denied Not Medically Necessary



This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The caller indicated that the study was not ordered for: Known or suspected coronary artery disease, post myocardial infarction evaluation, pre operative or post operative (Cardiac surgery, angioplasty or stent) evaluation.; Chest pain; smoker; uncontrolled diabetic 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The caller indicated that the study was not ordered for: Known or suspected coronary artery disease, post myocardial infarction evaluation, pre operative or post operative (Cardiac surgery, angioplasty or stent) evaluation.; Had angina for greater than 2 weeks, smoker, hypertension. 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The caller indicated that the study was not ordered for: Known or suspected coronary artery disease, post myocardial infarction evaluation, pre operative or post operative (Cardiac surgery, angioplasty or stent) evaluation.; R/O CAD 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; The CAD diagnosis was esablished by something other than, a previous cardiac surgery / angioplasty, a previous MI, congestive heart failure or a previous stress echocardiogram, nuclear cardiology study or a stress EKG.; Known CAD due to excess calcium score, evaluation 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is not presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has not had a recent stress echocardiogram.; The patient has not had a recent abnormal EKG consistent with CAD.; 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; < Enter answer here - or Type In Unknown If No Info Given. > 4


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; early onset heart disease in family 1




This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is not requested for pre op evaluation, cardiac mass, CHF, septal defects, or valve disorders.; The member does not have known or suspected coronary artery disease 2

General/Family Practice Disapproval 93350 ECHO TTHRC R-T 2D -+M-MODE COMPLETE REST&STRS Radiology Services Denied Not Medically Necessary

This is a request for a Stress Echocardiogram.; The member does not have known or suspected coronary artery disease; None of the listed reasons for the study were selected 1

Geriatrics Approval 70450 CT BRAIN, HEAD 1

Gynecologic Oncology Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for known tumor. 1

Gynecologic Oncology Approval 74176 CT ABD & PELVIS W/O CONTRAST



This is a request for an abdomen-pelvis CT combination.; Pre-op or post op evaluation; The requested study is for post-operative evaluation.; The requested study is not a first follow up study for a post operative complication.; Attending note: This is a 62-year-old woman who had 2 episodes of acute abdominal pain the last which brought her to the emergency department in Clarksville. There she had a CT scan of the abdomen and pelvis which showed a complex pelvic mass consistent w 1




This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is none of the listed reasons.; Kathleen S Pyeatt is a 43 y/o white female who is s/p TAH/BSO/radical debulking/appendectomy/argon beam ablation/lysis of adhesions/cystoscopy/resection of tumor from sigmoid colon (by Dr. Mizell) on 9/23/14. She completed 6 cycles of neoadjuvant Taxol/Ca 1

Gynecologic Oncology Approval 78813 PET IMAGING WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for Cervical Cancer.; This study is being ordered for subsequent treatment. 1

Gynecologic Oncology Approval 78813 PET IMAGING WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is not being ordered for Cervical CA, Brain Cancer/Tumor or Mass, Thyroid CA or other solid tumor. 1

Gynecologic Oncology Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for Cervical Cancer.; It is unknown why the study is being ordered. 1


This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for Cervical Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made). 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Ovarian or Esophageal Cancer.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 1 PET Scans has already been performed on this patient for this cancer. 1

Hematologist/Oncologist Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; patient has fever; fatique; nausea and vomting 1

Hematologist/Oncologist Approval 70450 CT BRAIN, HEAD

This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for something other than trauma or injury, evaluation of known tumor, stroke or aneurysm, infection or inflammation, multiple sclerosis or seizures.; The patient does not have dizziness, fatigue or malaise, sudden change in mental status, Bell's palsy, Congenital abnormality, loss of smell, hearing loss or vertigo.; Nausea and vomiting unrelated to anything else, 1



Hematologist/Oncologist Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for known or suspected brain tumor, mass or cancer.; There is a suspected or known brain tumor. 1


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have not been performed on the member in the past 3 months. 3


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Reoccurrence of cancer; Other tests such as laboratory or ultrasound or patient symptoms indicate that the cancer may be present or reoccurring. 1


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have not been performed on the member in the past 3 months. 26

Hematologist/Oncologist Approval 70450 CT BRAIN, HEAD This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; 2

Hematologist/Oncologist Approval 70450 CT BRAIN, HEAD This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Esophageal Cancer. 1

Hematologist/Oncologist Approval 70450 CT BRAIN, HEAD This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Kidney Cancer. 1

Hematologist/Oncologist Approval 70450 CT BRAIN, HEAD This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec 1

Hematologist/Oncologist Approval 70450 CT BRAIN, HEAD This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Restaging Melanoma 1

Hematologist/Oncologist Approval 70450 CT BRAIN, HEAD This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Restaging upon completion of therapy 1

Hematologist/Oncologist Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Pt has lung cancer with bone mets. 2

Hematologist/Oncologist Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST

This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Pt. has Lymphocytic Leukemia and nodular lymphoma of the head, face and neck. Both are chronic and active. 1

Hematologist/Oncologist Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST 1

Hematologist/Oncologist Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST









This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; 2






This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has not been established.; Other tests such as laboratory or ultrasound or patient symptoms indicate that the cancer may be present or reoccurring. 1

Hematologist/Oncologist Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; 2



Hematologist/Oncologist Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Restaging Melanoma 1

Hematologist/Oncologist Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Restaging upon completion of therapy 1


This study is being ordered for Inflammatory/ Infectious Disease.; 5/15/2015; There has not been any treatment or conservative therapy.; HPI Mrs. Galdamez is here today for a follow up of her enlarged pelvic lymph nodes post biopsy. Veronica had been in overall good medical health other than reflux until 5/15/2015 went she went to establish care with a primary care provider and was found w; Pelvic lymph node Hot on PET 1

Hematologist/Oncologist Approval 70540 MRI ORBIT/FACE/NECK W/O DYE

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Evaluation of patient with Head and Neck Cancer. 1


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Initial Staging of Cancer; Imaging studies have not been performed on the member in the past 3 months. 2



Hematologist/Oncologist Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 3

Hematologist/Oncologist Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST







This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; There are NO recent neurological deficits on exam such as one sided weakness, speech impairments or vision defects.; There is not a new and sudden onset of a headache less than 1 week not improved by medications.; It is not known if there is a family history (parent, sibling, or child) of stroke, aneurysm, or AVM (arteriovenous malformation); Enter answer here - or Type In Unpt states she has had a migraine x 2 weeks, with stiff burning pain to neck. pt saw PCP, Dr. Small in Dardanelle. had echo and stress test for chest pain 2 weeks ago, saw Dr. Wang, pt stated results were ok. pt denies ches 1








This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; The results of the lab tests are unknown.; 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; New patient, for testicular cancer, metastatic disease post surgical 1




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing fatigue or malaise.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; The lab results were abnormal 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of tumor; A biopsy has been completed to determine tumor tissue type. 9


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of tumor; A biopsy has not been completed to determine tumor tissue type.; There are not recent neurological symptoms such as one-sided weakness, speech impairments, or vision defects.; There is not a new and sudden onset of headache (less than 1 week) not improved by pain medications.; The tumor is not a pituitary tumor or pituitary adenoma.; Preoperative evaluation of patient with a Solitary Pulmonary Nodule. 1

Hematologist/Oncologist Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; This study is being ordered for a tumor. 3


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; 4month follow up after previous scans to evaluate disease. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; < Enter answer here - or Type In Unknown If No Info Given. > 1




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Evaluation of patient with Head and Neck Cancer. 1







Hematologist/Oncologist Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; evaluation of patient with esophageal cancer 1

Hematologist/Oncologist Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Lung Cancer. 3

Hematologist/Oncologist Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; evaluation of patient with sclc 1

Hematologist/Oncologist Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Stage IV Breast Cancer. 1

Hematologist/Oncologist Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with stage IV Lung Cancer. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1 year ago but getting worse.; There has not been any treatment or conservative therapy.; Headache and intracranial presure; Evaluation of patient with with new severe headaches. 1

Hematologist/Oncologist Approval 71250 CT CHEST, THORAX 19

Hematologist/Oncologist Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for hemoptysis.; The patient has had a chest x-ray recently. 1

Hematologist/Oncologist Approval 71250 CT CHEST, THORAX

A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; PATIENT WITH KNOWN PREVIOUS LUNG NODULE, C/O SHORTNESS OF BREATH AND FATIGUE. FORMER SMOKER, QUIT IN 2013. 1




A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "There is no radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; There is no radiologic evidence of a lung abscess or empyema.; There is no radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; There is no radiologic evidence of asbestosis.; History of Synovial Cell Sarcoma now with Anemia and SOB. 1

Hematologist/Oncologist Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for known tumor. 25


A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient has NOT had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; The patient is 54 years old or younger.; 1


A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient has NOT had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; The patient is 54 years old or younger.; intermittent low back and flank pain 1






A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; Evaluation of patient with a Solitary Pulmonary nodule. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; Evaluation of patient with Lung Nodules. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Evaluation of patient with an SPN. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; evaluation of patient with breast cancer with worsening signs faxing rec 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Follow up for restaging. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; NONE 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; restage pts malignant neoplasm of retroperitoneum. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; restage renal cell cancer after completion of a round of chemo therapy 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Restaging following CHEMO/ CHEMO was finished on 9-2-2015 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; It is unknown if the diagnosis of cancer or tumor has been established.; Reoccurrence of cancer; It is unknown if other tests such as laboratory or ultrasound or patient symptoms indicate that the cancer may be present or reoccurring.; < Enter answer here - or Type In Unknown If No Info Given. > 1




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; Evaluation of patient with Lung Cancer. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; Follow up scans to evaluate disease response to treatment. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; Pt has rectal cancer. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; Scans to evaluate disease response to treatment. 1






This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Initial Staging of Cancer; It is unknown if imaging studies have been performed on the member in the past 3 months.; Chronic pancreatitis and weight loss 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Reoccurrence of cancer; Other tests such as laboratory or ultrasound or patient symptoms do not indicate that the cancer may be present or reoccurring.; < Enter answer here - or Type In Unknown If No Info Given. > 1




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Evaluation of patient with Lung Cancer. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; evaluation of patient with melanoma 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; evaluation of patient with NSCLC 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Evaluation of patient with Stage IV Breast Cancer. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; evaluation of pt with lung cancer -faxing rec 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; FOLLOW UP, RESTAGING, FROM ANOTHER PHYSICIAN 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; IMPRESSION: Slight increase in ascites along the upper aspect of the abdomen adjacent to the liver but with stable to improved omental caking in the anterior mid abdomen. CT PELVIS 7/28/2015: Multiple axial images were performed through the pelvis a 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; none 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Patient had chemo treatment X 4 treatment restaging to see if chemo treatment is working 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Patient has been on new chemotherapy and needs to be assessed 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Patient is beginning Cycle 7 of innotecan, Avastin on 9/7/2015. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Patient is complaining of pain all over body, no energy, and no appetite. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Patient reports fever, chills, and hematuria. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Pt has lung cancer with mets. Restaging. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Scans are ordered for restaging and completion of chemotherapy to see if chemo needs to be continued or if the regimen needs to be changed 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; unknown 2




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; It is unknown if imaging studies have been performed on the member in the past 3 months.; BLADDER CA POST CYSTECTOMY. FOLLOW UP SCANS ARE RECOMMENDED. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; It is unknown if imaging studies have been performed on the member in the past 3 months.; unknown 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has not been established.; Other tests such as laboratory or ultrasound or patient symptoms do not indicate that the cancer may be present or reoccurring.; patient has a history of colon cancer diagnosed in 2004. Last CT scan showed a pulmonary nodule. Yearly surveillence in an asymptomatic patient. 1




This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Evaluation of patient with a brain mass. 1













Hematologist/Oncologist Approval 71250 CT CHEST, THORAX This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; 2

Hematologist/Oncologist Approval 71250 CT CHEST, THORAX This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Kidney Cancer. 1

Hematologist/Oncologist Approval 71250 CT CHEST, THORAX This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec 1



Hematologist/Oncologist Approval 71250 CT CHEST, THORAX This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Restaging Melanoma 1

Hematologist/Oncologist Approval 71250 CT CHEST, THORAX This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Restaging upon completion of therapy 1

Hematologist/Oncologist Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST


Hematologist/Oncologist Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Yes, this is a request for a Chest CT Angiography.; This study is requested to evaluate suspected pulmonary embolus. 7

Hematologist/Oncologist Approval 71550 MRI CHEST

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Would like to see the patient back again in the 1st week of September for next followup and evaluation with initiation of the next high-dose chemotherapy and stem cell transplantation 1





Hematologist/Oncologist Approval 72131 CT LUMBAR SPINE, LOW BACK


Hematologist/Oncologist Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 1

Hematologist/Oncologist Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Neurological deficits; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 1

Hematologist/Oncologist Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST



This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Follow up after chemo and evaluation with initiation of next high dose chemo therapy and stem cell transplant. Ms. Hackney was diagnosed with IgA kappa multiple myeloma, low-risk CD2 molecular subtype, with initial renal failure, hypercalcemia, sever 1




This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Restaging Multiple Myeloma 1




This study is being ordered for trauma or injury.; 12/05/2014; There has been treatment or conservative therapy.; NORCO PAIN MED, PHYSICAL THERAPY, HOME STRECHING, WARM AND COLD COMPRESS; NECK PAIN, UNABLE TO RAISE ARMS ABOVE HEAD, DECREASED ROM, AND PAIN RADIATING, LOSS OF FEELING, IN HIPS, TINGLING, DECREASED ROM ON PELVIS, LOSS OF MUSCLE STRENGTH; 1

Hematologist/Oncologist Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This is a request for a thoracic spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has NOT had back pain for over 4 weeks.; Evaluation of patient with Tongue Cancer with new back pain 1

Hematologist/Oncologist Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST This is a request for a thoracic spine MRI.; Suspected Tumor with or without Metastasis; There is evidence of tumor or metastasis on a bone scan or x-ray. 1


This is a request for a thoracic spine MRI.; The study is being ordered due to known tumor with or without metastasis.; "The patient is being seen by or is the ordering physician an oncologist, neurologist, neurosurgeon, or orthopedist."; This study is being ordered for staging. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; evaluation of patient with lung cancer for progression of disease 1









Hematologist/Oncologist Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 4

Hematologist/Oncologist Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST



This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; evaluation of patient with lung cancer for progression of disease 1











Hematologist/Oncologist Approval 72192 CT PELVIS WITHOUT CONTRAST

This is a request for a Pelvis CT.; This study is being ordered for known tumor, cancer, mass, or rule-out metastasis.; "The ordering physician is an oncologist, urologist, gynecologist, gastroenterologist or surgeon or PCP ordering on behalf of a specialist who has seen the patient."; This study is not being ordered for initial staging.; The patient is not undergoing active treatment for cancer.; The patient is not presenting new signs (e.g. lab findings or imaging) or symptoms.; The patient has had 3 or fewer pelvis CTs.; Pt. has uterine cancer, being ordered for surveillance. 1





Hematologist/Oncologist Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is for suspicion of tumor, mass, neoplasm, or metastatic disease? 2

Hematologist/Oncologist Approval 72196 MRI PELVIS

This is a request for a Pelvis MRI.; The request is not for any of the listed indications.; patient with a known history of ovarian cancer from 2002. asymptomatic. yearly surveillence. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Treatment with melphalan 200 milligrams per meter squared was initiated on July 21, 2015. Dr wants to see the patient back again in the 1st week of September for next followup and evaluation with initiation of the next high-dose chemotherapy and stem ce 1









Hematologist/Oncologist Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT The request is for an upper extremity non-joint MRI.; This is a preoperative or recent postoperative evaluation. 1

Hematologist/Oncologist Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT

The request is for an upper extremity non-joint MRI.; This is not a preoperative or recent postoperative evaluation.; There is suspicion of upper extremity neoplasm or tumor or metastasis. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Treatment with melphalan 200 milligrams per meter squared was initiated on July 21, 2015. Dr wants to see the patient back again in the 1st week of September for next followup and evaluation with initiation of the next high-dose chemotherapy and stem ce 1





Hematologist/Oncologist Approval 73221 MRI JOINT OF UPPER EXTREMITY 1

Hematologist/Oncologist Approval 73700 CT LEG OR LOWER EXTREMITY This is a request for a Lower Extremity CT.; This is a preoperative or recent postoperative evaluation. 1

Hematologist/Oncologist Approval 73700 CT LEG OR LOWER EXTREMITY


Hematologist/Oncologist Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This is a request for a Knee MRI.; Suspicious Mass or Suspected Tumor/ Metastasis; The patient has not had recent plain films of the knee.; The patient has not had a recent bone scan.; No, the patient did not have a recent ultrasound of the knee.; There are physical findings (palpable mass) of a suspicious mass or known primary site of cancer.; Patient has breast cancer and is having significiant knee pain. 1

Hematologist/Oncologist Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT


Hematologist/Oncologist Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT

This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is receiving long-term steriod therapy (Prednisone or Cortisone). 1

Hematologist/Oncologist Approval 74150 CT ABDOMEN WITHOUT CONTRAST 5

Hematologist/Oncologist Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered for a known tumor, cancer, mass, or rule out metastases.; No, this is not a request for follow up to a known tumor or abdominal cancer.; This is not a request for initial staging of a known tumor other than prostate.; There is no known prostate cancer with a PSA greater than 10.; No, there is a palpable or observed abdominal mass.; No,there is not an abdominal and pelvic or retroperitoneal mass that has been confirmed.; There are new signs or symptoms including hematuria, presenting with known cancer or tumor. 1





Hematologist/Oncologist Approval 74150 CT ABDOMEN WITHOUT CONTRAST This is a request for an Abdomen CT.; This study is being ordered for organ enlargement.; There is evidence of organ enlargement on ultrasound, plain film, or IVP. 2




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; restage renal cell cancer after completion of a round of chemo therapy 1







Hematologist/Oncologist Approval 74176 CT ABD & PELVIS W/O CONTRAST 10

Hematologist/Oncologist Approval 74176 CT ABD & PELVIS W/O CONTRAST





This is a request for an abdomen-pelvis CT combination.; Known Tumor, Cancer, Mass, or R/O metastases; This is not a request for follow up of a known tumor or cancer involving both the abdomen and pelvis or if this patient is undergoing active treatment.; This is not a request for initial staging of a known tumor other than prostate.; There is no known prostate cancer with a PSA greater than 10.; No, there is not a palpable or observed abdominal mass.; There is an abdominal and pelvic or retroperitoneal mass that has been confirmed by previous imaging other than a CT. 2


This is a request for an abdomen-pelvis CT combination.; Known Tumor, Cancer, Mass, or R/O metastases; This is not a request for follow up of a known tumor or cancer involving both the abdomen and pelvis or if this patient is undergoing active treatment.; This is not a request for initial staging of a known tumor other than prostate.; There is no known prostate cancer with a PSA greater than 10.; No, there is not a palpable or observed abdominal mass.; There is no abdominal and pelvic or retroperitoneal mass that has been confirmed by previous imaging other than a CT.; There are no new signs or symptoms including hematuria, presenting with known cancer or tumor.; 1 year follow up scan to evaluate known cancer. 1




This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; jaundice 1




This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are no new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; There is not a suspicion of an adrenal mass.; This is not a request to confirm a suspicious renal mass suggested by physical exam, lab studies, IVP or ultrasound.; Known pelvic adenopathy, scan to follow up. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; It is not known if the pain is acute or chronic.; This is the first visit for this complaint.; It is unknown if the patient had an Amylase or Lipase lab test.; A urinalysis has not been completed.; lung cancer needs to see if it has spread 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; It is not known if a urinalysis has been completed.; had a 5 cm transfer colon carcinoma, pathology with low grade adenocarcinoma that was stage 2 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is suspicious mass or suspected tumor or metastasis.; The patient did NOT have an abnormal abdominal Ultrasound, CT or MR study.; Yearly surveillance per NCCN guildelines. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Follow up for restaging. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; NONE 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; restage pts malignant neoplasm of retroperitoneum. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Restaging following CHEMO/ CHEMO was finished on 9-2-2015 1




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; Evaluation of patient with Lung Cancer. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; Follow up scans to evaluate disease response to treatment. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; Pt has rectal cancer. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; Scans to evaluate disease response to treatment. 1






This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Initial Staging of Cancer; It is unknown if imaging studies have been performed on the member in the past 3 months.; Chronic pancreatitis and weight loss 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Reoccurrence of cancer; Other tests such as laboratory or ultrasound or patient symptoms do not indicate that the cancer may be present or reoccurring.; < Enter answer here - or Type In Unknown If No Info Given. > 1




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Evaluation of patient with Lung Cancer. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; evaluation of patient with melanoma 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; evaluation of patient with NSCLC 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Evaluation of patient with Stage IV Breast Cancer. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; evaluation of pt with lung cancer -faxing rec 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; FOLLOW UP, RESTAGING, FROM ANOTHER PHYSICIAN 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; IMPRESSION: Slight increase in ascites along the upper aspect of the abdomen adjacent to the liver but with stable to improved omental caking in the anterior mid abdomen. CT PELVIS 7/28/2015: Multiple axial images were performed through the pelvis a 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; none 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Patient had chemo treatment X 4 treatment restaging to see if chemo treatment is working 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Patient has been on new chemotherapy and needs to be assessed 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Patient is beginning Cycle 7 of innotecan, Avastin on 9/7/2015. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Patient is complaining of pain all over body, no energy, and no appetite. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Patient reports fever, chills, and hematuria. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Pt has lung cancer with mets. Restaging. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; Scans are ordered for restaging and completion of chemotherapy to see if chemo needs to be continued or if the regimen needs to be changed 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; unknown 2




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; It is unknown if imaging studies have been performed on the member in the past 3 months.; BLADDER CA POST CYSTECTOMY. FOLLOW UP SCANS ARE RECOMMENDED. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; It is unknown if imaging studies have been performed on the member in the past 3 months.; unknown 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has not been established.; Other tests such as laboratory or ultrasound or patient symptoms do not indicate that the cancer may be present or reoccurring.; patient has a history of colon cancer diagnosed in 2004. Last CT scan showed a pulmonary nodule. Yearly surveillence in an asymptomatic patient. 1

















Hematologist/Oncologist Approval 74176 CT ABD & PELVIS W/O CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; 2

Hematologist/Oncologist Approval 74176 CT ABD & PELVIS W/O CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Kidney Cancer. 1

Hematologist/Oncologist Approval 74176 CT ABD & PELVIS W/O CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec 1



Hematologist/Oncologist Approval 74176 CT ABD & PELVIS W/O CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Restaging Melanoma 1

Hematologist/Oncologist Approval 74176 CT ABD & PELVIS W/O CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Restaging upon completion of therapy 1


This study is being ordered for Inflammatory/ Infectious Disease.; 5/15/2015; There has not been any treatment or conservative therapy.; HPI Mrs. Galdamez is here today for a follow up of her enlarged pelvic lymph nodes post biopsy. Veronica had been in overall good medical health other than reflux until 5/15/2015 went she went to establish care with a primary care provider and was found w; Pelvic lymph node Hot on PET 1

Hematologist/Oncologist Approval 74181 MRI ABDOMEN

This request is for an Abdomen MRI.; This study is being ordered for Known Tumor.; "The ordering physician is an oncologist, urologist, gastroenterologist, or surgeon."; This study is being ordered for staging.; evaluation of patient with Basal cell carcinoma of skin of other and unspecified parts of face and nodules found on ct a/p. faxing rec 1


This request is for an Abdomen MRI.; This study is being ordered for Known Tumor.; "The ordering physician is an oncologist, urologist, gastroenterologist, or surgeon."; This study is being ordered for staging.; Unknown 1




This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has not had an abdominal ultrasound, CT, or MR study."; Evaluation of liver lesions, elevated CA-19. 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are no documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; Pt with known bladder cancer and liver lesion found on CT. Needs MRI for stability of liver lesion. 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are no documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has not had an abdominal ultrasound, CT, or MR study."; Newly diagnosed rectal cancer with recent PET scan showing abnormalities in liver, suggesting follow up imaging for better picture. 1


This request is for an Abdomen MRI.; This study is not being ordered for known tumor, suspicious mass or suspected tumor/metastasis, organ enlargement, known or suspected vascular disease, hematuria, follow-up trauma, or a pre-operative evaluation.; Yearly surveillence in a patient with a history of ovarian cancer. asympomatic. 1



Hematologist/Oncologist Approval 76390 Mr spectroscopy 1Hematologist/Oncologist Approval 77058 MRI breast,without and/or with contrast material(s);unilateral 1

Hematologist/Oncologist Approval 77058 MRI breast,without and/or with contrast material(s);unilateral



This is a request for Breast MRI.; This study is being ordered for a known history of breast cancer.; Yes, this is an individual who has known breast cancer in the contralateral (other) breast. 1


This is a request for Breast MRI.; This study is being ordered for known breast lesions.; It is unknown if there are benign lesions in the breast associated with an increased cancer risk.; No, this is not an individual who has known breast cancer in the contralateral (other) breast.; No, this is not a confirmed breast cancer.; No, this patient does not have axillary node adenocarcinoma.; Yes, there are anatomic factors (deformity or extreme density) that make a simple mammogram impossible. 1

Hematologist/Oncologist Approval 77084 Magnetic resonance imaging, bone marrow blood supply

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Evaluation of Bone Marrow for staging 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Would like to see the patient back again in the 1st week of September for next followup and evaluation with initiation of the next high-dose chemotherapy and stem cell transplantation 1





Hematologist/Oncologist Approval 78472 CARDIAC OR HEART BLOOD POOL IMAGING 4

Hematologist/Oncologist Approval 78472 CARDIAC OR HEART BLOOD POOL IMAGING

This is a request for a MUGA scan.; This study is being ordered for Chemotherapy.; Chemotherapy has been initiated or completed.; The last MUGA scan was performed more than 3 months ago.; "There is not a change in cardiac signs or symptoms (shortness of breath, etc.)."; The patient will be undergoing more chemotherapy.; unknown 1


This is a request for a MUGA scan.; This study is being ordered for Chemotherapy.; Chemotherapy has been initiated or completed.; The last MUGA scan was performed more than 3 months ago.; It is not known if there is a change in cardiac signs or symptoms.; The patient will be undergoing more chemotherapy.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a MUGA scan.; This study is being ordered for Chemotherapy.; Chemotherapy has been initiated or completed.; The last MUGA scan was performed within the last 3 months.; 2


This is a request for a MUGA scan.; This study is being ordered for Chemotherapy.; Chemotherapy has been initiated or completed.; The patient has not had a previous MUGA scan.; "There is a change in cardiac signs or symptoms (shortness of breath, etc.)."; 2


This is a request for a MUGA scan.; This study is being ordered for Chemotherapy.; Chemotherapy has been initiated or completed.; The patient has not had a previous MUGA scan.; "There is not a change in cardiac signs or symptoms (shortness of breath, etc.)."; The patient will be undergoing more chemotherapy.; 4


This is a request for a MUGA scan.; This study is being ordered for Chemotherapy.; Chemotherapy has been initiated or completed.; The patient has not had a previous MUGA scan.; "There is not a change in cardiac signs or symptoms (shortness of breath, etc.)."; The patient will not be undergoing more chemotherapy.; 1


This is a request for a MUGA scan.; This study is being ordered for Known Cardiomyopathy/ Myocarditis.; There are EKG findings consistent with cardiomyopathy or myocarditis.; History of breast cancer with secondary cardiomyopathy. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Determine extent of malignency. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Patient was given a strong chemo prior to stem cell collection and needs follow up imaging to see how well the chemo worked. 1



Hematologist/Oncologist Approval 78813 PET IMAGING WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This is for evaluation of axillary lymph nodes. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This is NOT for an evaluation of axillary lymph nodes.; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 1 PET Scans has already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; More than 4 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; 1 PET Scans has already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Colo-rectal Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This would be the first PET Scan performed on this patient for this cancer. 4


This is a request for a Tumor Imaging PET Scan; This study is being requested for Colo-rectal Cancer.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 2 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Melanoma.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 3 PET Scans have already been performed on this patient for this cancer. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; 4month follow up after previous scans to evaluate disease. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Determine extent of malignency. 1

Hematologist/Oncologist Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY 6

Hematologist/Oncologist Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for an other solid tumor.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for an other solid tumor.; This study is being ordered for subsequent treatment. 1


This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for an other solid tumor.; This study is being ordered to establish a cancer diagnosis.; The suspicion of cancer is based on a diagnostic/lab test. 1


This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for an other solid tumor.; This study is being ordered to establish a cancer diagnosis.; The suspicion of cancer is based on a more than 1 of the following; diagnostic test, imaging sstudy, or biopsy.; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for an other solid tumor.; This study is being ordered to establish a cancer diagnosis.; The suspicion of cancer is based on an imaging study.; This would be the first PET Scan performed on this patient for this cancer. 1




This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This is for evaluation of axillary lymph nodes. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This is NOT for an evaluation of axillary lymph nodes.; This would be the first PET Scan performed on this patient for this cancer. 3


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; It is unknown if the patient completed a course of treatment initiated in the last 8 weeks or are experiencing new signs or symptoms. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 2 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 3 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; More than 4 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; 2 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; More than 4 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; This would be the first PET Scan performed on this patient for this cancer. 3


This is a request for a Tumor Imaging PET Scan; This study is being requested for Breast Cancer.; This study is being ordered for subsequent treatment.; The study is NOT being ordered after completing a course of treatment initiated in the last 8 weeks or because they are experiencing new singns or symptoms. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Colo-rectal Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; 1 PET Scans has already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Colo-rectal Cancer.; This study is being ordered for subsequent treatment.; It is unknown if the patient completed a course of treatment initiated in the last 8 weeks or are experiencing new signs, symptoms or a rising CEA. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Colo-rectal Cancer.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 3 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Colo-rectal Cancer.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs, symptoms indicating a reoccurrence of cancer or a rising CEA.; 1 PET Scans has already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Colo-rectal Cancer.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs, symptoms indicating a reoccurrence of cancer or a rising CEA.; 2 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Colo-rectal Cancer.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs, symptoms indicating a reoccurrence of cancer or a rising CEA.; 3 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Head/Neck Cancer.; The patient does NOT have Thyroid or Brain cancer.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 2 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Head/Neck Cancer.; The patient does NOT have Thyroid or Brain cancer.; This study is being ordered for subsequent treatment.; The study is NOT being ordered after completing a course of treatment initiated in the last 8 weeks or because they are experiencing new singns or symptoms. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This would be the first PET Scan performed on this patient for this cancer. 4


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered for subsequent treatment.; It is unknown if the patient has been diagnosed with small cell or non small cell lung cancer. 3


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered for subsequent treatment.; The patient has been diagnosed with NON small lung cancer.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; 1 PET Scans has already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered for subsequent treatment.; The patient has been diagnosed with NON small lung cancer.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered for subsequent treatment.; The patient has been diagnosed with small cell lung cancer. 1

Hematologist/Oncologist Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered to establish a cancer diagnosis. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered to evaluate a solitary pulmonary nodule.; A nodule of less than 4 centimeters has been identified on recent imaging; The solitary pulmonary nodule was identified on an imaging study in the last 30 days.; This would be the first PET Scan performed on this patient for this cancer. 4


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered to evaluate a solitary pulmonary nodule.; A nodule of less than 4 centimeters has been identified on recent imaging; The solitary pulmonary nodule was NOT identified on an imaging study in the last 30 days. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This would be the first PET Scan performed on this patient for this cancer. 3


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 1 PET Scans has already been performed on this patient for this cancer. 5


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 2 PET Scans have already been performed on this patient for this cancer. 1






This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; More than 4 PET Scans have already been performed on this patient for this cancer. 2


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; 1 PET Scans has already been performed on this patient for this cancer. 4


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; 2 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; 3 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; More than 4 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for subsequent treatment.; The study is NOT being ordered after completing a course of treatment initiated in the last 8 weeks or because they are experiencing new singns or symptoms. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered to establish a cancer diagnosis.; The suspicion of cancer is based on a more than 1 of the following; diagnostic test, imaging sstudy, or biopsy.; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Melanoma.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This is NOT for evaluation of regional lymph nodes.; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Melanoma.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Ovarian or Esophageal Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Soft Tissue Sarcoma, Pancreatic or Testicular Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Soft Tissue Sarcoma, Pancreatic or Testicular Cancer.; This study is being ordered for subsequent treatment. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Soft Tissue Sarcoma, Pancreatic or Testicular Cancer.; This study is being ordered to establish a cancer diagnosis.; The suspicion of cancer is based on a more than 1 of the following; diagnostic test, imaging sstudy, or biopsy.; This would be the first PET Scan performed on this patient for this cancer. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Evaluation of patient with an SPN. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; evaluation of patient with breast cancer with worsening signs faxing rec 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; initial staging of esophageal cancer 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Patient was given a strong chemo prior to stem cell collection and needs follow up imaging to see how well the chemo worked. 1




This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Evaluation of patient with Head and Neck Cancer. 1


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Evaluation of patient with Lymphoma of the spleen. 1


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Evaluation of patient with Stage IV Colon Cancer. 1


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Evaluation of patient with Tongue Cancer. 1


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; faxing rec 2


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Newly diagnosed breast cancer. Staging. 1


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; sending rec. 1

Hematologist/Oncologist Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; evaluation of patient with esophageal cancer 1

Hematologist/Oncologist Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Esophageal Cancer. 1

Hematologist/Oncologist Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Lung Cancer. 3

Hematologist/Oncologist Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; evaluation of patient with sclc 1

Hematologist/Oncologist Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Stage IV Breast Cancer. 1

Hematologist/Oncologist Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with stage IV Lung Cancer. 1

Hematologist/Oncologist Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec 1

Hematologist/Oncologist Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary

This is a request for a brain/head CT.; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; The patient does NOT have a recent onset (within the last 4 weeks) of neurologic symptoms.; The headache is not described as a “thunderclap” or the worst headache of the patient’s life.; 1

Hematologist/Oncologist Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; initial staging of esophageal cancer 1

Hematologist/Oncologist Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec. 1

Hematologist/Oncologist Disapproval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST Radiology Services Denied Not Medically Necessary


Hematologist/Oncologist Disapproval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec 1

Hematologist/Oncologist Disapproval 70540 MRI ORBIT/FACE/NECK W/O DYE Radiology Services Denied Not Medically Necessary

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Evaluation of Bone Marrow for staging 1

Hematologist/Oncologist Disapproval 70544 Mr angiography head w/o dye Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1 year ago but getting worse.; There has not been any treatment or conservative therapy.; Headache and intracranial presure; Evaluation of patient with with new severe headaches. 1

Hematologist/Oncologist Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary

A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Pt has persistant cough w abnormal weigh loss. Pt is a smoker (1/4 a pack per day) Smokes since age 15 and has elavated CEA 9.1 (08/24/15) Hoarse. 1

Hematologist/Oncologist Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; will send rec 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; faxing rec 1






This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Evaluation of patient with stage IV Cervical Cancer. 1










This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; sending rec. 1

Hematologist/Oncologist Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; evaluation of patient with esophageal cancer 1

Hematologist/Oncologist Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Esophageal Cancer. 1

Hematologist/Oncologist Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Lung Cancer. 3

Hematologist/Oncologist Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; evaluation of patient with sclc 1

Hematologist/Oncologist Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Stage IV Breast Cancer. 1

Hematologist/Oncologist Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with stage IV Lung Cancer. 1

Hematologist/Oncologist Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec 1

Hematologist/Oncologist Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec. 1

Hematologist/Oncologist Disapproval 72196 MRI PELVIS Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; 12/05/2014; There has been treatment or conservative therapy.; NORCO PAIN MED, PHYSICAL THERAPY, HOME STRECHING, WARM AND COLD COMPRESS; NECK PAIN, UNABLE TO RAISE ARMS ABOVE HEAD, DECREASED ROM, AND PAIN RADIATING, LOSS OF FEELING, IN HIPS, TINGLING, DECREASED ROM ON PELVIS, LOSS OF MUSCLE STRENGTH; 1

Hematologist/Oncologist Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary











This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; sending rec.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI. 1

Hematologist/Oncologist Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; evaluation of patient with esophageal cancer 1

Hematologist/Oncologist Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Esophageal Cancer. 1

Hematologist/Oncologist Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Lung Cancer. 3

Hematologist/Oncologist Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; evaluation of patient with sclc 1

Hematologist/Oncologist Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Stage IV Breast Cancer. 1

Hematologist/Oncologist Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with stage IV Lung Cancer. 1

Hematologist/Oncologist Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec 1

Hematologist/Oncologist Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec. 1

Hematologist/Oncologist Disapproval 78813 PET IMAGING WHOLE BODY Radiology Services Denied Not Medically Necessary



This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; 1 PET Scans has already been performed on this patient for this cancer. 1





Hematologist/Oncologist Disapproval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY Radiology Services Denied Not Medically Necessary

This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for Cervical Cancer.; This study is being ordered for subsequent treatment. 1




This is a request for a Tumor Imaging PET Scan; This study is being requested for Head/Neck Cancer.; The patient does NOT have Thyroid or Brain cancer.; This study is being ordered for subsequent treatment.; It is unknown if the patient completed a course of treatment initiated in the last 8 weeks or are experiencing new signs or symptoms. 1






This is a request for a Tumor Imaging PET Scan; This study is being requested for Soft Tissue Sarcoma, Pancreatic or Testicular Cancer.; This study is being ordered for subsequent treatment. 1





Hematologist/Oncologist Disapproval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Evaluation of patient with Kidney Cancer. 1

Hematologist/Oncologist Disapproval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec 1

Hematologist/Oncologist Disapproval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY Radiology Services Denied Not Medically Necessary This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; faxing rec. 1

Hospital Disapproval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study Radiology Services Denied Not Medically Necessary


Infectious Diseases Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 1Infectious Diseases Approval 71250 CT CHEST, THORAX 1Infectious Diseases Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 1Infectious Diseases Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 1Infectious Diseases Approval 73200 CT ARM OR UPPER EXTREMITY 2Infectious Diseases Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT 1

Infectious Diseases Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for Inflammatory/ Infectious Disease.; 12/6/2014; There has not been any treatment or conservative therapy.; back pain; unknown 1

Infectious Diseases Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for Inflammatory/ Infectious Disease.; 12/6/2014; There has not been any treatment or conservative therapy.; back pain; unknown 1

Internal Medicine Approval 70450 CT BRAIN, HEAD 5

Internal Medicine Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; Pt has facial trembling. 1

Internal Medicine Approval 70450 CT BRAIN, HEAD

This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; Pt has new c/o of memory impairment. States he has had cognitive I impairment x 1 yr worse recently. Short term impairment - says one day he was in truck and forgot where he was at. Difficulty remembering peoples' names, forgets what he was going to sa 1


This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for trauma or injury.; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient has one sided arm or leg weakness. 1


This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for trauma or injury.; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient has vision changes.; since the patient fell on 9/9, he complains of headache and blurred vision 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; Patient had syncopal episode on yesterday, and continues to have weakness and headache. 1




This is a request for a brain/head CT.; The study is requested for headache.; There is not headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; pt has had headaches for the past 3 weeks. Was in a mva and that's when it started. Does not help when he takes otc pain reliever. 1

Internal Medicine Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for known or suspected bleed such as subdural hematoma or subarachnoid bleed. 2

Internal Medicine Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for known or suspected brain tumor, mass or cancer.; There is a suspected or known brain tumor. 1


This is a request for a brain/head CT.; The study is requested for recent head trauma or injury.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; 1




This study is being ordered for trauma or injury.; 9/1/2015; There has been treatment or conservative therapy.; Patient has tried NSAIDS and it has not helped.; Headache, neck pain, injury, syncopal episode.; Patient had a football injury yesterday, experiencing headache, lethargy, neck pain, and syncope. 1

Internal Medicine Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST 1

Internal Medicine Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST

"This request is for face, jaw, mandible CT.239.8"; "There is not a history of serious facial bone or skull, trauma or injury.fct"; "There is not a suspicion of neoplasm, tumor or metastasis.fct"; "There is not a suspicion of bone infection, [osteomyelitis].fct"; This is a preoperative or recent postoperative evaluation. 1


"This request is for face, jaw, mandible CT.239.8"; "There is not a history of serious facial bone or skull, trauma or injury.fct"; "There is not a suspicion of neoplasm, tumor or metastasis.fct"; "There is suspicion of bone infection, [osteomyelitis].fct" 1





Internal Medicine Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST 1

Internal Medicine Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST


Internal Medicine Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST


Internal Medicine Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST 1Internal Medicine Approval 70540 MRI ORBIT/FACE/NECK W/O DYE 1

Internal Medicine Approval 70540 MRI ORBIT/FACE/NECK W/O DYE "This is a request for orbit,face, or neck soft tissue MRI.239.8"; The study is ordered for trauma or injury of the orbit, face or neck soft tissue 1

Internal Medicine Approval 70540 MRI ORBIT/FACE/NECK W/O DYE

This is a request for an Orbit MRI.; There is not a history of orbit or face trauma or injury.; There is not a suspicion of an infection or abscess.; This examination is NOT being requested to evaluate lymphadenopathy or mass.; There is not a suspicion of a bone infection (osteomyelitis).; There is a suspicion of an orbit or face neoplasm, tumor, or metastasis. 1

Internal Medicine Approval 70540 MRI ORBIT/FACE/NECK W/O DYE

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; SEE NOTES; It is not known if there has been any treatment or conservative therapy.; SEE NOTES; SEE NOTES 1

Internal Medicine Approval 70544 Mr angiography head w/o dye 2

Internal Medicine Approval 70544 Mr angiography head w/o dye This is a request for a Brain MRA.; There is an immediate family history of aneurysm. 1

Internal Medicine Approval 70544 Mr angiography head w/o dye

This is a request for a head and neck MR Angiogram.; There is not an immediate family history of aneurysm.; The patient does not have a known aneurysm.; The patient has not had a recent MRI or CT for these symptoms.; There has not been a stroke or TIA within the past two weeks.; "There is not a sudden onset of one-sided weakness, speech impairment, vision defects or severe dizziness."; This patient does not have an abnormal ultrasound of the neck. 1

Internal Medicine Approval 70547 Mr angiography neck w/o dye

This is a request for a head and neck MR Angiogram.; There is not an immediate family history of aneurysm.; The patient does not have a known aneurysm.; The patient has not had a recent MRI or CT for these symptoms.; There has not been a stroke or TIA within the past two weeks.; "There is not a sudden onset of one-sided weakness, speech impairment, vision defects or severe dizziness."; This patient does not have an abnormal ultrasound of the neck. 1

Internal Medicine Approval 70547 Mr angiography neck w/o dye

This is a request for a Neck MR Angiography.; The patient has not had a recent MRI or CT for these symptoms.; There has not been a stroke or TIA within the past two weeks.; "There is a sudden onset of one-sided weakness, speech impairment, vision defects or severe dizziness." 1

Internal Medicine Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 16

Internal Medicine Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This is a request for an Internal Auditory Canal MRI.; There is a suspected Acoustic Neuroma or tumor of the inner or middle ear. 1

Internal Medicine Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; It is not known if there are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Recurring headaches with nosebleeds 1







Internal Medicine Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; 1




This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; dizziness, blurry vision, nausea 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; worsening headache loss of balance weight loss 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a sudden and severe headache.; The patient has NOT had a recent onset (within the last 3 months) of neurologic symptoms.; unknown 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; This headache is not described as sudden, severe or chronic recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects. 1




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient has Bell's Palsy.; There is a new and sudden onset of a headache less than 1 week not improved by medications.; The headache is described as a “thunderclap” or the worst headache of the patient’s life. 1










This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of tumor; A biopsy has not been completed to determine tumor tissue type.; There are not recent neurological symptoms such as one-sided weakness, speech impairments, or vision defects.; There is a new and sudden onset of headache (less than 1 week) not improved by pain medications.; It is not known if the headache is described as a “thunderclap” or the worst headache of the patient’s life.; patient with known lesion of left frontal lobe of brain needs to have follow up MRI brain 1




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of tumor; It is not known if a biopsy has been completed to determine tumor tissue type.; There are recent neurological symptoms such as one-sided weakness, speech impairments, or vision defects. 1




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; 09/14/2015; There has been treatment or conservative therapy.; aspirin and plavex; slurred speech headaches suspected blood clot confusion disorientation; none 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; SEE NOTES; It is not known if there has been any treatment or conservative therapy.; SEE NOTES; SEE NOTES 1

Internal Medicine Approval 71250 CT CHEST, THORAX 13

Internal Medicine Approval 71250 CT CHEST, THORAX

A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for follow up trauma.; The ordering physician a is NOT a Surgeon, Pulmonologist, or Cardiologist.; There is no radiologic evidence of mediastinal widening.; There is physical or radiologic evidence of a chest wall abnormality. 1



Internal Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Chronic ear wave suction 1

Internal Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; has been reporting coughing up blood 1

Internal Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; n/a 1

Internal Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; None 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; pleural thickening in right hemithorax in right lobe per ct done in March 2015. this is a follow up for that 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; she questional destiney behind the heart shadows 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The caller doesn't know if the ordering physician is a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "There is no radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; There is no radiologic evidence of a lung abscess or empyema.; There is no radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; There is no radiologic evidence of asbestosis.; < Enter answer here - or Type In Unknown If No Info Given. > 1




A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is no radiologic evidence of non-resolving pneumonia.; "There is no radiologic evidence of sarcoidosis, tuberculosis or fungal infection."; There is no radiologic evidence of a lung abscess or empyema.; There is radiologic evidence of pneumoconiosis e.g. black lung disease or silicosis.; The patient is presenting new signs or symptoms. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; "The ordering physician is NOT a surgeon, pulmonologist or PCP ordering on behalf of a specialist who has seen the patient."; There is radiologic evidence of non-resolving pneumonia after at least 4 weeks of treatment. 1

Internal Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for known tumor. 1




A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient has NOT had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient did NOT quit smoking in the past 15 years.; The patient has signs or symptoms suggestive of lung cancer such as an unexplained cough, coughing up blood, unexplained weight loss or other condition.; Chronic obstructive pulmonary disease 1


A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient has NOT had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient did NOT quit smoking in the past 15 years.; The patient has signs or symptoms suggestive of lung cancer such as an unexplained cough, coughing up blood, unexplained weight loss or other condition.; copd sob neg cardiac stress test neg chest x ray caugh weight loss 1


A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient has NOT had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient did NOT quit smoking in the past 15 years.; The patient has signs or symptoms suggestive of lung cancer such as an unexplained cough, coughing up blood, unexplained weight loss or other condition.; COPD related symtoms: dyspnea, cough, wheezing and fatigue are chronic from a past smoking habit quitting smoking in December 2013. He finds albuterol inhaler helpful but does not use the flovent or atrovent inhalers as much. He is exposed to noxious fu 1

Internal Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for suspected pulmonary Embolus. 2




A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; 1





Internal Medicine Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 9/10/2014 had abdominal aortic aneurysm surgery and 2 months later had a episode of atrial fibrillation.; There has been treatment or conservative therapy.; Wore a 30 day event monitor to evaluate for atrial fibrillation burden. 3 month follow-up appointments; His blood pressure has been elevated in the 140s at home. Being seen for follow-up from episode of atrial fibrillation after his abdominal aortic aneurysm surgery in Sept 2014.; Follow-up from aortic aneurysm surgery and atrial fibrillation episode. 1

Internal Medicine Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST

Yes, this is a request for a Chest CT Angiography.; It is not known whether this study is requested to evaluate suspected pulmonary embolus.; This study is being ordered for another reason besides Known or Suspected Congenital Abnormality, Known or suspected Vascular Disease.; Pt c/o SOB, Dyspnea, and Chest Pain with and without activitiy 1

Internal Medicine Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Yes, this is a request for a Chest CT Angiography.; This study is requested to evaluate suspected pulmonary embolus. 5

Internal Medicine Approval 71550 MRI CHEST 1Internal Medicine Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST 2

Internal Medicine Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST

This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; Call does not know if there is a reason why the patient cannot have a Cervical Spine MRI.; FOOTBALL INJURY, EXPERIENCING HEADACHES, LETHARGY, NECK PAIN, AND SYNCOPE 1

Internal Medicine Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST

This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is no reason why the patient cannot have a Cervical Spine MRI.; < Enter answer here - or Type In Unknown If No Info Given. > 1

Internal Medicine Approval 72131 CT LUMBAR SPINE, LOW BACK This is a request for a lumbar spine CT.; The patient has a history of severe low back trauma or lumbar injury. 2

Internal Medicine Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 12

Internal Medicine Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient demonstrate neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; Reported by patient. Location: numbness in the right arm Quality: pain also in the top of the shoulder on the right Duration: 3 weeks Context: does manual labor for work, has to sue the left arm for some of her work projects now but usually is all 1




This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does have new signs or symptoms of bladder or bowel dysfunction. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is no weakness or reflex abnormality.; < Enter answer here - or Type In Unknown If No Info Given. > 1




This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; There has been a supervised trial of conservative management for at least 6 weeks.; No, this patient did not have a recent course of supervised physical Therapy.; The patient has not failed a course of anti-inflammatory medication or steroids.; Yes, the patient had six weeks of Chiropractic care related to this episode. 1







Internal Medicine Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Neurological deficits; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 1


This study is being ordered for trauma or injury.; 07/17/2015; There has been treatment or conservative therapy.; Physical Therapy starting 8/5/2015. Anti inflammatory.; Degeneration of intervertebral disc.; Patient has had both Cervical and lumbar x-rays and CT. 1


This study is being ordered for trauma or injury.; 12/16/14; There has been treatment or conservative therapy.; NSAIDS, muscle relaxers, ice and heat therapy, narcotic pain medication and physical therapy; Chronic pain with radiation to her shoulders.; We have exhausted all conservative therapy and she is still in pain. 1

Internal Medicine Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST 3

Internal Medicine Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This study is being ordered for trauma or injury.; 12/16/14; There has been treatment or conservative therapy.; NSAIDS, muscle relaxers, ice and heat therapy, narcotic pain medication and physical therapy; Chronic pain with radiation to her shoulders.; We have exhausted all conservative therapy and she is still in pain. 1

Internal Medicine Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This study is being ordered for trauma or injury.; MARCH 2015; There has been treatment or conservative therapy.; CHIROPRACTOR OXYCODONE-ACETAMINOPHEN; WORSENING PAIN MID AND LOWER BACK. SNOWBOARDING ACCIDENT. CONTINUED PAIN. NEGATIVE XR IN JULY.; 1. back pain Onset: 4 months ago. Severity level is 7. The problem is worsening. It occurs persistently. Location of pain is middle back and lower back. Additional information: she had a snowboarding accident in March in which she landed on her tailbon 1

Internal Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 28

Internal Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has a new foot drop.; The patient does have new signs or symptoms of bladder or bowel dysfunction. 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; Document exam findings; < Enter answer here - or Type In Unknown If No Info Given. > 1





Internal Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal nerve study involving the lumbar spine 2

Internal Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 3

Internal Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 12

Internal Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; back pain 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Patient is having trouble working with this pain and she has been seeing a chiropractor. 1


This study is being ordered for trauma or injury.; 07/17/2015; There has been treatment or conservative therapy.; Physical Therapy starting 8/5/2015. Anti inflammatory.; Degeneration of intervertebral disc.; Patient has had both Cervical and lumbar x-rays and CT. 1


This study is being ordered for trauma or injury.; MARCH 2015; There has been treatment or conservative therapy.; CHIROPRACTOR OXYCODONE-ACETAMINOPHEN; WORSENING PAIN MID AND LOWER BACK. SNOWBOARDING ACCIDENT. CONTINUED PAIN. NEGATIVE XR IN JULY.; 1. back pain Onset: 4 months ago. Severity level is 7. The problem is worsening. It occurs persistently. Location of pain is middle back and lower back. Additional information: she had a snowboarding accident in March in which she landed on her tailbon 1

Internal Medicine Approval 72196 MRI PELVIS 1

Internal Medicine Approval 73200 CT ARM OR UPPER EXTREMITY

This is a request for an upper extremity, shoulder, scapula, elbow, hand, or wrist joint CT.; There is not a history of upper extremity joint or long bone trauma or injury.; This is not a preoperative or recent postoperative evaluation.; There is suspicion of upper extremity neoplasm or tumor or metastasis. 1

Internal Medicine Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT

The request is for an upper extremity non-joint MRI.; This is not a preoperative or recent postoperative evaluation.; There is not suspicion of upper extremity neoplasm or tumor or metastasis.; There is no suspicion of upper extremity bone or soft tissue infection.; The ordering physician is not an orthopedist.; There is a history of upper extremity trauma or injury. 1

Internal Medicine Approval 73221 MRI JOINT OF UPPER EXTREMITY 8

Internal Medicine Approval 73221 MRI JOINT OF UPPER EXTREMITY

The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Patient has had shoulder pain for 1 month, not improved with NSAIDs, has loss of range of motion and decreased strength. 1




The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has completed and failed a course of conservative treatment of at least 4 weeks.; The ordering physician is not an orthopedist.; There is no documented findings of severe pain on motion.; The patient has a documented limited range of motion on physical examination. 1






This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; ; It is not known if there has been any treatment or conservative therapy.; ; 2

Internal Medicine Approval 73706 CT ANGIOGRAPHY LOWER EXTREMITY Yes, this is a request for CT Angiography of the lower extremity. 1Internal Medicine Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT 12

Internal Medicine Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT





This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion. 1


This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has not been treated with anti-inflammatory medications in conjunction with this complaint.; This is not for pre-operative planning. 1


This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is not an orthopedist.; Redness; The patient has not had recent plain films of the knee.; Yes, patient has completed and failed a course of conservative treatment.; Physician directed course of non-steroidal anti-inflammatory medications 1

Internal Medicine Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is not an orthopedist.; Swelling greater than 3 days 2


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; It is not known if there is a known trauma involving the knee.; No, the member do not experience a painful popping, snapping, or giving away of the knee.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were normal. 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; It is not known if there is a known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Instability 1


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; No, the member do not experience a painful popping, snapping, or giving away of the knee.; Swelling greater than 3 days 1




This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; Yes, there is a known trauma involving the knee.; Limited range of motion 1






This is a request for a lower extremity MRI.; This is not a pulsatile mass.; "There is no evidence of tumor or mass from a previous exam, plain film, ultrasound, or previous CT or MRI."; There is not a suspicion of an infection.; The patient is not taking antibiotics.; This is a study for a fracture which does not show healing (non-union fracture).; This is a pre-operative study for planned surgery. 1


This is a request for an Ankle MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the ankle within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the ankle other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint. 1


This is a request for an Ankle MRI.; The study is requested for ankle pain.; Tendon or ligament injuryis not suspected.; There is not a suspicion of fracture not adequately determined by x-ray.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; has two weeks of right ankle pain with swelling, knot felt on ankle, unexplained pain in the ankle, walking problems 1


This is a request for bilateral foot MRI.; Osteomyelitis of ankle or foot, left, acute intact distal pulses, moves all extremities equally, normal strength, normal tone, L foto with distal 2nd toe with ulceration, R foot with 1st MTP joint with plantar surface ulcerations. R and L foot ulcerat; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has used a cane or crutches for greater than four weeks. 2

Internal Medicine Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT


Internal Medicine Approval 74150 CT ABDOMEN WITHOUT CONTRAST 4

Internal Medicine Approval 74150 CT ABDOMEN WITHOUT CONTRAST This is a request for an Abdomen CT.; This study is being ordered for a kidney/ureteral stone.; There is a known or a strong suspicion of kidney or ureteral stones. 1

Internal Medicine Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered for a suspicious mass or tumor.; It is not known if there is a suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; It is not known if there are new symptoms including hematuria.; It is not known if there are new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; It is not known if there is a suspicion of an adrenal mass.; It is not known if this is a request to confirm a suspicious renal mass suggested by physical exam, lab studies, IVP or ultrasound.; < Enter answer here - or Type In Unknown If No Info Given. > 1




This is a request for an Abdomen CT.; This study is being ordered for a suspicious mass or tumor.; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are new lab results or other imaging studies including ultrasound, Doppler or plain films findings. 1






This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Trying to check out her gallbladder. 1

Internal Medicine Approval 74150 CT ABDOMEN WITHOUT CONTRAST This study is being ordered for a kidney/ureteral stone.; There is a known or a strong suspicion of kidney or ureteral stones.; This is a request for an Abdomen CT. 1

Internal Medicine Approval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 9/10/2014 had abdominal aortic aneurysm surgery and 2 months later had a episode of atrial fibrillation.; There has been treatment or conservative therapy.; Wore a 30 day event monitor to evaluate for atrial fibrillation burden. 3 month follow-up appointments; His blood pressure has been elevated in the 140s at home. Being seen for follow-up from episode of atrial fibrillation after his abdominal aortic aneurysm surgery in Sept 2014.; Follow-up from aortic aneurysm surgery and atrial fibrillation episode. 1

Internal Medicine Approval 74176 CT ABD & PELVIS W/O CONTRAST 21

Internal Medicine Approval 74176 CT ABD & PELVIS W/O CONTRAST



This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; There are known or endoscopic findings of Diverticulitis. 1


This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; epigastric pain and diarrhea for several days 1



Internal Medicine Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; There is a known or a strong suspicion of kidney or ureteral stones. 16

Internal Medicine Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Organ Enlargement; There is evidence of organ enlargement on ultrasound, plain film, or IVP. 3


This is a request for an abdomen-pelvis CT combination.; Organ Enlargement; There is no evidence of organ enlargement on ultrasound, plain film, or IVP.; GASTROINTESTINAL: normal bowel sounds; no masses or tenderness; hepatomegaly present, with liver edge palpable 4 cm below the RCM; no abdominal or inguinal hernia; PT HAS BEEN HAVING UPPER AND LOWER ABD PAIN 1

Internal Medicine Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Other; There are clinical findings or indications of Hematuria. 4


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Abdominal pain, tenderness on exam 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Concerning irritable bowel syndrome, this has been a problem for the past 2 weeks. She estimates the stool frequency at 5 to 6 per day. Stools are described as loose and watery. Associated symptoms include abdominal bloating, abdominal cramping, arthra 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Constipation and abdomnial pain 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Diabetic - N & V- CT 2013 SHOWED LIVER LESIONS- ADB pain 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; nausea, vomiting, cramping 1










This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were abnormal.; The urinalysis was positive for protein.; < Enter answer here - or Type In Unknown If No Info Given. > 1






This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; UNKNOWN; It is not known if there has been any treatment or conservative therapy.; GENERALIZED BACK PAIN ELEVATED AMYLASE AND LIPASE 20 POUND WEIGHT LOSS IN SIX MONTHS; 1

Internal Medicine Approval 74181 MRI ABDOMEN 2

Internal Medicine Approval 74181 MRI ABDOMEN


Internal Medicine Approval 74181 MRI ABDOMEN

This request is for an Abdomen MRI.; This study is not being ordered for known tumor, suspicious mass or suspected tumor/metastasis, organ enlargement, known or suspected vascular disease, hematuria, follow-up trauma, or a pre-operative evaluation.; Cortisol level is elevated. 1

Internal Medicine Approval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING Yes, this is a request for CT Angiography of the abdominal arteries. 2Internal Medicine Approval 77058 MRI breast,without and/or with contrast material(s);unilateral 1

Internal Medicine Approval 77058 MRI breast,without and/or with contrast material(s);unilateral

This is a request for Breast MRI.; This study is being ordered as a screening examination for known family history of breast cancer.; There is a pattern of breast cancer history in at least two first-degree relatives (parent, sister, brother, or children). 2

Internal Medicine Approval 77058 MRI breast,without and/or with contrast material(s);unilateral This is a request for Breast MRI.; This study is being ordered for known breast lesions.; There are benign lesions in the breast associated with an increased cancer risk. 1

Internal Medicine Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study 5

Internal Medicine Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is diabetic. 1

Internal Medicine Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study

This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; It is not known whether the patient has one or more of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; seen in office 8/14 complaining of palpitations - had EKG done which showed LVH. ECHO done 8/31 was ok. Returned to office 9/11/15 still having palpitations, having some dyspnea on exertion, and acute chest pain at times. Provider would like monitor and N 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient is less than 45 years old.; The patient is not diabetic.; The patient has not had a recent exercise treadmill test that was positive.; The patient has NONE of the following: heart transplant, aortic aneurysm, carotid artery narrowing or stenosis, and/ or peripheral vascular disease or narrowed blood vessels in the legs.; 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The caller indicated that the study was not ordered for: Known or suspected coronary artery disease, post myocardial infarction evaluation, pre operative or post operative (Cardiac surgery, angioplasty or stent) evaluation.; The patient complains of an episode of chest discomfort that occurred 3 days ago. She states that she was at Wal-Mart and was walking across the store. She complained of sudden onset of chest discomfort and tightness. The patient states that when she stop 1




This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is not presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has not had a recent stress echocardiogram.; The patient has not had a recent abnormal EKG consistent with CAD.; Patient has bilateral iliac artery stenosis.He complains of pain, cramping, and tingling in his legs, he sees CV surgery for his PVD. Patient complains of palpitations with activity, abuses tobacco, and is treated for hyperlipidemia. Suspect patient has 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient had a recent non-nuclear stress test.; There are no documented clinical findings of hyperlipidemia.; "Patient is not clinically obese, nor has an emphysematous chest configuration."; There are no documented clinical findings of hypertension.; The patient is not diabetic.; The patient is female. 1




This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; Cardiovascular: Cardiovascular: no arm pain on exertion or ankle edema and palpitations, shortness of breath when walking, and light-headed on standing; chest pain. Smoking Status: Current every day smoker Hypertension: Y 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient does not have a physical limitation to exercise.; The patient has not had previous cardiac surgery or angioplasty.; Shortness of breath on exertion/fatigue: Patient has significant and progressive symptoms that are limiting activity. He says that if he goes out to do any kind of work he will become short of breath fairly quickly and break out in a sweat. Some occasiona 1






This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; There are documented clinical findings of hyperlipidemia.; The patient has a physical limitation to exercise. 1

Internal Medicine Approval 78813 PET IMAGING WHOLE BODY This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered to establish a cancer diagnosis. 2

Internal Medicine Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY 1

Internal Medicine Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for an other solid tumor.; This study is being ordered to establish a cancer diagnosis.; The suspicion of cancer is based on a diagnostic/lab test. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Melanoma.; This study is being ordered to establish a cancer diagnosis.; This is for evaluation of regional lymph nodes. 1



Internal Medicine Approval S8032 Low-dose Computed Tomography For Lung Cancer Screening 1

Internal Medicine Approval S8032 Low-dose Computed Tomography For Lung Cancer Screening

This request is for a Low Dose CT for Lung Cancer Screening (S8032); This patient has NOT had a Low Dose CT for Lung Cancer Screening (S8032) in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient did NOT quit smoking in the past 15 years.; The patient does NOT have signs or symptoms of Lung Cancer. 1


This request is for a Low Dose CT for Lung Cancer Screening (S8032); This patient has NOT had a Low Dose CT for Lung Cancer Screening (S8032) in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient did NOT quit smoking in the past 15 years.; The patient has signs or symptoms of Lung Cancer.; No, I do not want to request a Chest CT instead of a Low Dose CT for Lung Cancer Screening (S8032).; Trying to R/O lung cancer 1


This request is for a Low Dose CT for Lung Cancer Screening (S8032); This patient has NOT had a Low Dose CT for Lung Cancer Screening (S8032) in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient quit smoking in the past 15 years.; The patient does NOT have signs or symptoms of Lung Cancer. 1


This request is for a Low Dose CT for Lung Cancer Screening (S8032); This patient has NOT had a Low Dose CT for Lung Cancer Screening (S8032) in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient quit smoking in the past 15 years.; The patient has signs or symptoms of Lung Cancer.; No, I do not want to request a Chest CT instead of a Low Dose CT for Lung Cancer Screening (S8032).; < Enter answer here - or Type In Unknown If No Info Given. > 1

Internal Medicine Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; none 1

Internal Medicine Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; Syncope episodes and dizziness 1

Internal Medicine Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; None 1

Internal Medicine Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary



This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; gets weekly migraines for 3-4 days at time and hyperpara thyroid 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; Pt has a chronic HA, not improved with medications. Medications tried include Topamax, Imitrex 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; tick bite on neck that didn't heal soft area on scalp deformity-headaches 1




This study is being ordered for a neurological disorder.; 2010; There has been treatment or conservative therapy.; Maxalt 5 mg tablet take 1 tablet by oral route once, may repeat at 2 hour intervals; do not exceed 30 mg in 24 hours 09/30/2014; HEADACHES He deveolped vascular headaches about 2010 and they have gradually worsened. He now is having almost daily and they are more severe and are unusaul in character and severity. He will need another CNS scan. 2. VERTIGO He has deveolped ve; Headache (784.0). He will need a CT angiogram of the brain and a CT of the brain at the same time. 1


This study is being ordered for a neurological disorder.; 7/21/2015; There has been treatment or conservative therapy.; meds, At home exercise.; abnormal gait, back pain, headaches, vertigo; symptoms have worsened despite treatments 1



Internal Medicine Disapproval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 8/13/2015; There has been treatment or conservative therapy.; medications; right side ear pain/chills/maxillary pain/ears popping/; < Enter answer here - or Type In Unknown If No Info Given. > 1

Internal Medicine Disapproval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 8/13/2015; There has been treatment or conservative therapy.; medications; right side ear pain/chills/maxillary pain/ears popping/; < Enter answer here - or Type In Unknown If No Info Given. > 1

Internal Medicine Disapproval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; 9/1/2015; There has been treatment or conservative therapy.; Patient has tried NSAIDS and it has not helped.; Headache, neck pain, injury, syncopal episode.; Patient had a football injury yesterday, experiencing headache, lethargy, neck pain, and syncope. 1

Internal Medicine Disapproval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; 2010; There has been treatment or conservative therapy.; Maxalt 5 mg tablet take 1 tablet by oral route once, may repeat at 2 hour intervals; do not exceed 30 mg in 24 hours 09/30/2014; HEADACHES He deveolped vascular headaches about 2010 and they have gradually worsened. He now is having almost daily and they are more severe and are unusaul in character and severity. He will need another CNS scan. 2. VERTIGO He has deveolped ve; Headache (784.0). He will need a CT angiogram of the brain and a CT of the brain at the same time. 1

Internal Medicine Disapproval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary


Internal Medicine Disapproval 70544 Mr angiography head w/o dye Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; 09/14/2015; There has been treatment or conservative therapy.; aspirin and plavex; slurred speech headaches suspected blood clot confusion disorientation; none 1

Internal Medicine Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested due to trauma or injury.; It is not known if there are new, intermittent symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; The trauma or injury to the head occured more than 1 week ago.; Pt had blunt force trauma to the head over a year ago; now having memory loss 1


This study is being ordered for a neurological disorder.; 02/18/2015; There has been treatment or conservative therapy.; medication and therapy; neck pain, dizziness,fatigue; try to rule out MS 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 6 to 8 weeks or longer; There has not been any treatment or conservative therapy.; visual disturbances, neck pain ,and arm parathesia; Unknown 1

Internal Medicine Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary

A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient has NOT had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; The patient is 54 years old or younger.; Screening for lung cancer. 1

Internal Medicine Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/25/2014; There has not been any treatment or conservative therapy.; NOURISHMENT-CACHETIC.O/W NORMAL,8LBS WEIGHT LOSS IN LAST YEAR.; Pt has lost 8lb liver a one year period. No factors resulting in weight stabalization or gain. Pt is diabetic. Associated with cold intolerance and fatigue. Denies night sweats. No family hx of cancer to his knowledge. R/O:MASS 1

Internal Medicine Disapproval 72131 CT LUMBAR SPINE, LOW BACK Radiology Services Denied Not Medically Necessary


Internal Medicine Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient demonstrate neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; This patient presents to the clinic complaining of migraine headaches. Patient has a history of herniated cervical discs and degenerative disc disease, and had surgery about 11 months ago. The patient c/o severe neck pain x 1 month. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; Head injury 3 weeks ago and is now having HA every day to keep her up at night. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; Pt has had a recent fracture and it also shows that he has tender with the neck. chronic neck pain 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; ; 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; Musculoskeletal: Positive for back pain, arthralgias, gait problem, neck pain and neck stiffness.; She reports that she has always considered herself healthy. But does have some chronic arthritis that is due to a motor vehicle accident that she had in 2005. She has had assorted treatment modalities for her injuries including long time Nsaid use, muscle 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; Neck pain noted. The location of discomfort is both sides of the neck. It radiates to the intrascapular area. The pain is characterized as moderate in intensity, constant, and stabbing. Initial onset was 3 weeks ago. There was no obvious precipitatin; 1


This study is being ordered for a neurological disorder.; 02/18/2015; There has been treatment or conservative therapy.; medication and therapy; neck pain, dizziness,fatigue; try to rule out MS 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; ; There has been treatment or conservative therapy.; PAIN MGT , ORTHO APP, MEDICATION,; TENDERNESS & INFUSION; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 6 to 8 weeks or longer; There has not been any treatment or conservative therapy.; visual disturbances, neck pain ,and arm parathesia; Unknown 1


This study is being ordered for trauma or injury.; 11/14/2014; There has been treatment or conservative therapy.; Prednisone, Norco, and Cyclobenzaprine; Back pain with radiculopathy. Both arms and hand going numb.; Patient has had MRI of lumbar region. Impression: Mild disk bulge at L4/L5 with mild disk height loss and desiccation. Patient has diagnosis of 722.4 Degeneration of cervical intervertebral disc. 1

Internal Medicine Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; It is not known if the patient has any neurological deficits.; The patient is experiencing sensory abnormalities such as numbness or tingling.; There has been a supervised trial of conservative management for at least 6 weeks. 1


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of lower extremity weakness documented on physical exam.; none 1

Internal Medicine Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 05/01/2015; There has been treatment or conservative therapy.; Physical therapy; neck and back pain; 1


This study is being ordered for trauma or injury.; 09/02/2015; There has been treatment or conservative therapy.; XRAY AND NAPROXEN AND STEROID PACK; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for trauma or injury.; 11/14/2014; There has been treatment or conservative therapy.; Prednisone, Norco, and Cyclobenzaprine; Back pain with radiculopathy. Both arms and hand going numb.; Patient has had MRI of lumbar region. Impression: Mild disk bulge at L4/L5 with mild disk height loss and desiccation. Patient has diagnosis of 722.4 Degeneration of cervical intervertebral disc. 1

Internal Medicine Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for trauma or injury.; Couple months ago; There has been treatment or conservative therapy.; xray; Pain, stiffness, stabbing pain; 1

Internal Medicine Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is reflex abnormality.; decreased deep tendon reflexes and decreased range of motion; back pain not improved by conservative therapy, pain radiates bilaterally 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is reflex abnormality.; patient has limited flexion 10-15 degree.; unknown 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; It is not known if there is weakness or reflex abnormality.; Patient has failed 6 weeks of physical therapy and conservative treatment with anti inflammatory without releaf. Patient has history of herniated disk repair. 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is reflex abnormality.; 2% rt. knee and ankle jerk; pt. chronic low back pain, worsening and is radiating to legs; despite pain medication 1



Internal Medicine Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; bulging disc 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Enter answer here - or Type In Unknown If No InPatient complains of low back pain. The location is primarily in the lumbar spine. It does not radiate. He characterizes it as moderate in intensity, sharp, and aching. He states that the current episode 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; She complains of lower back pain, which she says has bothered her off and on for 2 or 3 years, but it is just getting worse. She denies any history of any major trauma. She was bucked off a horse a few years ago and that was probably the biggest trauma sh 1

Internal Medicine Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for a neurological disorder.; 7/21/2015; There has been treatment or conservative therapy.; meds, At home exercise.; abnormal gait, back pain, headaches, vertigo; symptoms have worsened despite treatments 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; There has been treatment or conservative therapy.; < Describe treatment / conservative therapy here - or Type In Unknown If No Info Given >; increased pain in lower back that's radiating to right hip; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; ; There has been treatment or conservative therapy.; PAIN MGT , ORTHO APP, MEDICATION,; TENDERNESS & INFUSION; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 05/01/2015; There has been treatment or conservative therapy.; Physical therapy; neck and back pain; 1


This study is being ordered for trauma or injury.; 09/02/2015; There has been treatment or conservative therapy.; XRAY AND NAPROXEN AND STEROID PACK; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1

Internal Medicine Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for trauma or injury.; Couple months ago; There has been treatment or conservative therapy.; xray; Pain, stiffness, stabbing pain; 1

Internal Medicine Disapproval 72192 CT PELVIS WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for a Pelvis CT.; This study is being ordered because of a suspicious mass/ tumor.; There are NO documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor.; "The patient has NOT had a pelvic ultrasound, barium, CT, or MR study."; patient reports she has a cyst in her left groin that has been there for a while she feels like it is growing It is currently not painful. but it is very concerning 1

Internal Medicine Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary

The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; Joe is in clinic today with complaints of pain in his right shoulder. He does prop it up in bed to read his Bible and thinks this might have aggravated the situation, he has limited ROM in shoulder 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is described as chronic; The physician has not directed conservative treatment for the past 6 weeks.; xray was done, was normal 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 04/06/2015 elbow 09/19/2014 knee; There has been treatment or conservative therapy.; OTC meds, prescription meds, physical therapy was for over 6 weeks; pain, swelling, decrease of motion; 1

Internal Medicine Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary



This is a request for an Ankle MRI.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the ankle within the last two weeks.; The patient has a documented limitation of their range of motion. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 04/06/2015 elbow 09/19/2014 knee; There has been treatment or conservative therapy.; OTC meds, prescription meds, physical therapy was for over 6 weeks; pain, swelling, decrease of motion; 1

Internal Medicine Disapproval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; There has been treatment or conservative therapy.; < Describe treatment / conservative therapy here - or Type In Unknown If No Info Given >; increased pain in lower back that's radiating to right hip; < Enter answer here - or Type In Unknown If No Info Given. > 1

Internal Medicine Disapproval 74150 CT ABDOMEN WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary


Internal Medicine Disapproval 74150 CT ABDOMEN WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; ABDOMINAL PAIN AND ABNORMAL FINDINGS 1

Internal Medicine Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an abdomen-pelvis CT combination.; Known Tumor, Cancer, Mass, or R/O metastases; This is not a request for follow up of a known tumor or cancer involving both the abdomen and pelvis or if this patient is undergoing active treatment.; This is not a request for initial staging of a known tumor other than prostate.; There is no known prostate cancer with a PSA greater than 10.; yes, there is a palpable or observed abdominal mass.; There has been a recent previous abdominal and or pelvis CT scan.; This would be a repeat of a CT of the abdomen and or pelvis within 6 weeks.; Patient had Abd & Pelvis CT on 8/15/15 for eval of kidney stones. This CT revealed a suspicious mass and MRI imaging was recommended by radiologist to further address the mass. MRI revealed an enlarging retroperitoneal solid soft tissue mass. Because t 1




This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Chronic constipation and weight gain 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; follow up appointment for pancreatic cyst 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; lower abdominal pain/ has pre existing condition 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/25/2014; There has not been any treatment or conservative therapy.; NOURISHMENT-CACHETIC.O/W NORMAL,8LBS WEIGHT LOSS IN LAST YEAR.; Pt has lost 8lb liver a one year period. No factors resulting in weight stabalization or gain. Pt is diabetic. Associated with cold intolerance and fatigue. Denies night sweats. No family hx of cancer to his knowledge. R/O:MASS 1

Internal Medicine Disapproval 75571 Corornary Artery Calcium Score, EBCT Radiology Services Denied Not Medically Necessary This is a request for a CT scan for evalutation of coronary calcification.; family hx/ early heart diagnosis/ elvated crp/positive apo e3 and 34/ 1

Internal Medicine Disapproval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study Radiology Services Denied Not Medically Necessary

This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; It is not known if the patient has had a stress echocardiogram within the past eight weeks.; < Enter answer here - or Type In Unknown If No Info Given. > 1

Internal Medicine Disapproval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study Radiology Services Denied Not Medically Necessary

This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for suspected CAD.; The patient is presenting with symptoms of atypical chest pain and/or shortness of breath.; The patient has not had a recent non-nuclear stress test.; The patient has a physical limitation to exercise.; There are no documented clinical findings of hyperlipidemia.; "Patient is not clinically obese, nor has an emphysematous chest configuration."; There are no documented clinical findings of hypertension.; The patient is not diabetic.; The patient is male.; PT HAD A RECENT FALL AND HAS CONCUSSION IN HEAD 1

Internal Medicine Disapproval S8032 Low-dose Computed Tomography For Lung Cancer Screening Radiology Services Denied Not Medically Necessary

This request is for a Low Dose CT for Lung Cancer Screening (S8032); This patient has NOT had a Low Dose CT for Lung Cancer Screening (S8032) in the past 11 months.; The patient is 54 years old or younger.; The study is being ordered for screening of lung cancer. 1

Interventional Radiologists Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 1Interventional Radiologists Approval 73221 MRI JOINT OF UPPER EXTREMITY 1

Interventional Radiologists Approval 73221 MRI JOINT OF UPPER EXTREMITY

The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is described as chronic; The physician has not directed conservative treatment for the past 6 weeks.; Unknown 1

Interventional Radiologists Approval 74176 CT ABD & PELVIS W/O CONTRAST


Nephrology Approval 70450 CT BRAIN, HEAD 1Nephrology Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST 1

Nephrology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This request is for a Brain MRI; It is unknown if the study is being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing hearing loss.; It is not known if the patient had a normal audiogram.; < Enter answer here - or Type In Unknown If No Info Given. > 1

Nephrology Approval 72131 CT LUMBAR SPINE, LOW BACK 1

Nephrology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST


Nephrology Approval 74150 CT ABDOMEN WITHOUT CONTRAST 1Nephrology Approval 74175 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST 1Nephrology Approval 74176 CT ABD & PELVIS W/O CONTRAST 4Neurological Surgery Approval 70450 CT BRAIN, HEAD 5

Neurological Surgery Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for evaluation of known tumor. 1

Neurological Surgery Approval 70450 CT BRAIN, HEAD

This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for something other than trauma or injury, evaluation of known tumor, stroke or aneurysm, infection or inflammation, multiple sclerosis or seizures.; The patient has a congenital abnormality.; The patient has not undergone treatment for a congenital abnormality (such as hydrocephalus or craniosynostosis).; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient has one sided arm or leg weakness. 1


This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for stroke or aneurysm.; This study is being ordered for screening for aneurysm or AVM.; 1



Neurological Surgery Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for Hydrocephalus or congenital abnormality. 2

Neurological Surgery Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for known or suspected bleed such as subdural hematoma or subarachnoid bleed. 2

Neurological Surgery Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for known or suspected brain tumor, mass or cancer.; There is a suspected or known brain tumor. 1


This is a request for a brain/head CT.; The study is requested for known or suspected brain tumor, mass or cancer.; There is not a suspected or known brain tumor.; The patient currently does not have cancer.; This is not a evaluation for a bone tumor or abnormality of the skull.; mri imaging demonstrates righ sided increased lateral ventricle caliber with multiple septations noted and trapping of the right lateral ventricle, also has signigicant swelling around the fornix and lateral ventricle. patietn is also experencing memory l 1




This study is being ordered for a neurological disorder.; 8/1/15; There has been treatment or conservative therapy.; ESI INJECTIONS, PT, HOME EXERCISE, MEDICATIONS. HE IS POST OP WITH COMPLICATIONS; NUMBNESS IN HANDS, MIGRAINES, DIZZINESS, SEVERE NEUROPATHY TO FEET.; 1

Neurological Surgery Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Enter answer here - or Type In UnCerebral arterial aneurysm Persistent headaches Neck pain known If No Info Given. 1

Neurological Surgery Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the brain. 3

Neurological Surgery Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Enter answer here - or Type In UnCerebral arterial aneurysm Persistent headaches Neck pain known If No Info Given. 1

Neurological Surgery Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the Neck. 2

Neurological Surgery Approval 70544 Mr angiography head w/o dye


Neurological Surgery Approval 70544 Mr angiography head w/o dye This is a request for a Brain MRA.; There is not an immediate family history of aneurysm.; The patient has a known aneurysm. 1

Neurological Surgery Approval 70544 Mr angiography head w/o dye This study is being ordered for Congenital Anomaly.; ; There has been treatment or conservative therapy.; ; ; 1

Neurological Surgery Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 5

Neurological Surgery Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; 1




This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; There are NO recent neurological deficits on exam such as one sided weakness, speech impairments or vision defects.; There is a new and sudden onset of a headache less than 1 week not improved by medications.; It is not known if the headache is described as a “thunderclap” or the worst headache of the patient’s life.; 1




This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; Post op MRI surgery back in July 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; It is not known if a metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; This is for therapy planning. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient has a congenital abnormality.; The patient has not undergone treatment for a congenital abnormality (such as hydrocephalus or craniosynostosis).; There are recent neurological symptoms or deficits such as one-sided weakness, speech impairments, or vision defects. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient has a congenital abnormality.; The patient has undergone treatment for a congenital abnormality (such as hydrocephalus or craniosynostosis). 1








This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of tumor; A biopsy has not been completed to determine tumor tissue type.; There are not recent neurological symptoms such as one-sided weakness, speech impairments, or vision defects.; There is not a new and sudden onset of headache (less than 1 week) not improved by pain medications.; The tumor is not a pituitary tumor or pituitary adenoma.; 1




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of tumor; It is not known if a biopsy has been completed to determine tumor tissue type.; There are not recent neurological symptoms such as one-sided weakness, speech impairments, or vision defects.; There is not a new and sudden onset of headache (less than 1 week) not improved by pain medications.; The tumor is a pituitary tumor or pituitary adenoma.; It is not known if there are physical findings or laboratory values indicating abnormal pituitary hormone levels.; There has been a previous Brain MRI completed.; The brain MRI was abnormal. 1

Neurological Surgery Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; This study is being ordered for a tumor. 2





Neurological Surgery Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This study is being ordered for a neurological disorder.; 05/11/2015; There has been treatment or conservative therapy.; surgery; worsening headaches, post op; unknown 1


This study is being ordered for a neurological disorder.; 08/24/2015; There has not been any treatment or conservative therapy.; Left arm weakness, losing strength and dropping items. Also stated at the time his left leg weak.; Patient complains of having "stroke-like" symptoms. 1

Neurological Surgery Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This study is being ordered for Congenital Anomaly.; ; There has been treatment or conservative therapy.; ; ; 1

Neurological Surgery Approval 71250 CT CHEST, THORAX


Neurological Surgery Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST 2

Neurological Surgery Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST

This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; Call does not know if there is a reason why the patient cannot have a Cervical Spine MRI.; needed to check cervical fusion. 1


This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is a reason why the patient cannot have a Cervical Spine MRI.; This study is being ordered due to chronic neck pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of Abnormal gait. 1


This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is a reason why the patient cannot have a Cervical Spine MRI.; This study is being ordered due to chronic neck pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of Lower extremity weakness. 1


This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is a reason why the patient cannot have a Cervical Spine MRI.; This study is being ordered due to follow-up surgery or fracture within the last 6 months.; "The patient has been seen by, or the ordering physician is, a neuro-specialist, orthopedist, or oncologist." 1


This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is a reason why the patient cannot have a Cervical Spine MRI.; This study is being ordered due to known tumor with or without metastasis.; "The patient is being seen by or is the ordering physician an oncologist, neurologist, neurosurgeon, or orthopedist."; This study is being ordered for follow-up.; The patient is undergoing active treatment for cancer. 1


This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is no reason why the patient cannot have a Cervical Spine MRI.; Pt had an MRI, DISH DESEASE ONLY FOUND ON A CT SCAN. 1

Neurological Surgery Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST This is a request for a Cervical Spine CT; This study is to be part of a Myelogram. 3

Neurological Surgery Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST This study is being ordered for a neurological disorder.; ; It is not known if there has been any treatment or conservative therapy.; ; 1


This study is being ordered for a neurological disorder.; 3/2015; There has been treatment or conservative therapy.; physical therapy, Epidural Steroid Injection; Leg weakness, Numbness; 1


This study is being ordered for a neurological disorder.; 8/1/15; There has been treatment or conservative therapy.; ESI INJECTIONS, PT, HOME EXERCISE, MEDICATIONS. HE IS POST OP WITH COMPLICATIONS; NUMBNESS IN HANDS, MIGRAINES, DIZZINESS, SEVERE NEUROPATHY TO FEET.; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 12/4/14; There has been treatment or conservative therapy.; Supervised physical therapy and hydrocodone; ; Cubital tunnel syndrome Degeneration of cervical intervertebral disc - Onset: 12/12/2014 Degeneration of lumbar intervertebral disc Chronic back pain Disorder of thoracic spine Muscle spasticity of spinal origin Neuralgia - Onset: 11/26/2014 Functi 1

Neurological Surgery Approval 72128 CT THORACIC SPINE, UPPER BACK NO CONTRAST

This is a request for a thoracic spine MRI.; There is a reason why the patient cannot undergo a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is not experiencing or presenting abnormal gait, lower extremity weakness, asymmetric reflexes, recent fracture, or radiculopathy.; The patient is experiencing sensory abnormalities such as numbness or tingling.; There has been a supervised trial of conservative management for at least 6 weeks. 1


This is a request for a thoracic spine MRI.; There is a reason why the patient cannot undergo a thoracic spine MRI.; The study is being ordered due to pre-operative evaluation.; There is a known condition of neurological deficits.; The patient is experiencing or presenting radiculopathy documented on EMG or nerve conduction study. 1


This is a request for a thoracic spine MRI.; There is no reason why the patient cannot undergo a thoracic spine MRI.; Patient has already had a MRI. For fusion surgery, need to see CT scan. 1



Neurological Surgery Approval 72128 CT THORACIC SPINE, UPPER BACK NO CONTRAST This study is being ordered for a neurological disorder.; ; It is not known if there has been any treatment or conservative therapy.; ; 1

Neurological Surgery Approval 72128 CT THORACIC SPINE, UPPER BACK NO CONTRAST This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1








This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; October 2014; There has been treatment or conservative therapy.; Physical Therapy Prescription Patient: William Perry Rutledge DOB: 05/07/1958 Date: 02/27/2015 Procedure: Diagnosis: 1. Lumb/lumbosac Disc Degen (722.52) 2. Lumbago (724.2) Treatment Location: Lumbar Spine Treatment: Plan: Ph; Patient is 5 months s/p T9 to L4 fusion with decompression at T12 and L1 for traumatic fracture with instability. He had a traumatic dural tear from posterior element fractures with nerve roots outside the thecal sac and adherent to surrounding tissues. T; Patient underwent a T10 to L3 posterior fusion with L1-T12 decompression and possible corpectomy on 01/19/15 @ St. Vincent Infirmary. 1

Neurological Surgery Approval 72131 CT LUMBAR SPINE, LOW BACK 1

Neurological Surgery Approval 72131 CT LUMBAR SPINE, LOW BACK







This is a request for a lumbar spine CT.; The patient does not have a history of severe low back trauma or lumbar injury.; This is not a preoperative or recent postoperative evaluation.; This study is to be part of a myelogram or discogram. 6

Neurological Surgery Approval 72131 CT LUMBAR SPINE, LOW BACK This is a request for a lumbar spine CT.; The patient has a history of severe low back trauma or lumbar injury. 8



Neurological Surgery Approval 72131 CT LUMBAR SPINE, LOW BACK This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1








This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; October 2014; There has been treatment or conservative therapy.; Physical Therapy Prescription Patient: William Perry Rutledge DOB: 05/07/1958 Date: 02/27/2015 Procedure: Diagnosis: 1. Lumb/lumbosac Disc Degen (722.52) 2. Lumbago (724.2) Treatment Location: Lumbar Spine Treatment: Plan: Ph; Patient is 5 months s/p T9 to L4 fusion with decompression at T12 and L1 for traumatic fracture with instability. He had a traumatic dural tear from posterior element fractures with nerve roots outside the thecal sac and adherent to surrounding tissues. T; Patient underwent a T10 to L3 posterior fusion with L1-T12 decompression and possible corpectomy on 01/19/15 @ St. Vincent Infirmary. 1

Neurological Surgery Approval 72131 CT LUMBAR SPINE, LOW BACK This study is being ordered for trauma or injury.; ; There has been treatment or conservative therapy.; ; ; 1

Neurological Surgery Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 11

Neurological Surgery Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST







This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks.; No, this patient did not have a recent course of supervised physical Therapy.; The patient has not failed a course of anti-inflammatory medication or steroids.; No, the patient did not have six weeks of Chiropractic care related to this episode.; 2 yr f/u 1




This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; bilateral weakness; severe neck pain, new numbness to left 3 fingers, pain radiating to left arm and upper back 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; It is not known if there has been a supervised trial of conservative management for at least six weeks.; It is not known if this patient had a recent course of supervised physical Therapy.; The patient has failed a course of anti-inflammatory medication or steroids. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; There has been a supervised trial of conservative management for at least 6 weeks.; It is not known if this patient had a recent course of supervised physical Therapy.; The patient has failed a course of anti-inflammatory medication or steroids. 1








This is a request for cervical spine MRI; Follow-up to Surgery or Fracture within the last 6 months; "The patient has been seen by, or the ordering physician is, a neuro-specialist, orthopedist, or oncologist." 4


This is a request for cervical spine MRI; Follow-up to Surgery or Fracture within the last 6 months; The patient has been seen by or is the ordering physician an oncologist, neurologist, neurosurgeon, or orthopedist. 1


This is a request for cervical spine MRI; Neurological deficits; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 1

Neurological Surgery Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Neurological deficits; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 12

Neurological Surgery Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Pre-Operative Evaluation; No, the last Cervical spine MRI was not performed within the past two weeks. 9


This is a request for cervical spine MRI; Suspected Tumor with or without Metastasis; It is not known if there is evidence or tumor or metastasis on bone scan or x-ray.; pt headaches worsening w/in last 2 wks, several blackouts since 1st of aug. has tunnel vision. lightheadedness and passes out. has confirmed chiari malformation. 1



Neurological Surgery Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This study is being ordered for a neurological disorder.; 05/11/2015; There has been treatment or conservative therapy.; surgery; worsening headaches, post op; unknown 1


This study is being ordered for a neurological disorder.; 08/24/2015; There has not been any treatment or conservative therapy.; Left arm weakness, losing strength and dropping items. Also stated at the time his left leg weak.; Patient complains of having "stroke-like" symptoms. 1


This study is being ordered for a neurological disorder.; 1/01/2012; There has been treatment or conservative therapy.; Physical therapy- worsened symptoms. Epidural steroid injections- minimal symptom relief. Muscle relaxer: Soma- minimal symptom relief. Narcotic: Norco- minimal symptom relief. Ibuprofen, ice- minimal symptom relief.; Myelopathy. Back pain with radiation to bilateral lower extremities. Pain is ache, burning, deep, and dull. Symptoms of numbness, limping, tenderness, tingling in legs, and weakness to bilateral upper and lower extremities. Cramping to bilateral feet. Dee; Patient with continued myelopathy affecting activities of daily living and safety. Unrelieved with conservative measures. Suspected stenosis in cervical and thoracic spine due to extremity weakness and numbness. 1


This study is being ordered for a neurological disorder.; 1997; There has been treatment or conservative therapy.; physical therapy, lyrica; right sided neck pain, pain in right anterior leg to the knee, numbness and tingling in right hip, restless legs and burning in her feet.; 1


This study is being ordered for a neurological disorder.; 2007; There has not been any treatment or conservative therapy.; The patient describes the pain as burning, piercing, sharp, shooting and stabbing.; patient was diagnosis w distal thoracic syringomyelia during evaluation of back pain. and per patient was also diagnosed with Arnold Chiari Malformation. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 8/14/2014; There has been treatment or conservative therapy.; oral medications, epidural steroid injections, pt, home exercises; chronic neck and back pain with lower extremity weakness; unknown 1


This study is being ordered for trauma or injury.; May 2014; There has been treatment or conservative therapy.; NSAIDs, Prednisone, other medications, home exercise program,; 10 month post op ACDF at C5 and C6 with ongoing severe mechanical pain with radiculopathy. MD suspect she may have adjacent level discopathy at C4, C5. she still seems to have some left C4 radiculopathy. Concerned about loosening of the ventral fusion p; Unknown. 1

Neurological Surgery Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST 4

Neurological Surgery Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; It is not known if the patient has any neurological deficits.; The patient is experiencing sensory abnormalities such as numbness or tingling.; There has been a supervised trial of conservative management for at least 6 weeks. 1


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of lower extremity weakness documented on physical exam.; Tried physical therapy 1






This study is being ordered for a neurological disorder.; 1/01/2012; There has been treatment or conservative therapy.; Physical therapy- worsened symptoms. Epidural steroid injections- minimal symptom relief. Muscle relaxer: Soma- minimal symptom relief. Narcotic: Norco- minimal symptom relief. Ibuprofen, ice- minimal symptom relief.; Myelopathy. Back pain with radiation to bilateral lower extremities. Pain is ache, burning, deep, and dull. Symptoms of numbness, limping, tenderness, tingling in legs, and weakness to bilateral upper and lower extremities. Cramping to bilateral feet. Dee; Patient with continued myelopathy affecting activities of daily living and safety. Unrelieved with conservative measures. Suspected stenosis in cervical and thoracic spine due to extremity weakness and numbness. 1


This study is being ordered for a neurological disorder.; 1997; There has been treatment or conservative therapy.; physical therapy, lyrica; right sided neck pain, pain in right anterior leg to the knee, numbness and tingling in right hip, restless legs and burning in her feet.; 1


This study is being ordered for a neurological disorder.; 2007; There has not been any treatment or conservative therapy.; The patient describes the pain as burning, piercing, sharp, shooting and stabbing.; patient was diagnosis w distal thoracic syringomyelia during evaluation of back pain. and per patient was also diagnosed with Arnold Chiari Malformation. 1


This study is being ordered for a neurological disorder.; 2014; There has been treatment or conservative therapy.; Medrol dose pak; mid to low back pain radiating in to lower extremities with pain and numbness; we have treat his neck now trying to find what is causing these problems 1


This study is being ordered for a neurological disorder.; June 2014; There has been treatment or conservative therapy.; ESI, NSAIDS, PT; mid and low back pain with leg pain; 1



Neurological Surgery Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST This study is being ordered for trauma or injury.; ; It is not known if there has been any treatment or conservative therapy.; ; 1

Neurological Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 12

Neurological Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST

The study requested is a Lumbar Spine MRI.; It is unknown if the patient has acute or chronic back pain.; This procedure is being requested for Follow-up to surgery or fracture within the last 6 months; The patient been seen by or the ordering physician is a neuro-specialist, orthopedist, or oncologist. 1

Neurological Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; It is unknown if the patient has acute or chronic back pain.; This procedure is being requested for Neurologic deficits 2


The study requested is a Lumbar Spine MRI.; Known Tumor with or without metastasis; The patient has been seen by or is the ordering physician an oncologist, neurologist, neurosurgeon, or orthopedist.; It is not known if the study is for follow up or staging.; The patient is presenting new symptoms. 1


The study requested is a Lumbar Spine MRI.; Neurological deficits; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does have new signs or symptoms of bladder or bowel dysfunction. 1

Neurological Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; Pre-Operative Evaluation; Surgery is not scheduled within the next 4 weeks.; 1


The study requested is a Lumbar Spine MRI.; Pre-Operative Evaluation; Surgery is scheduled within the next 4 weeks.; No, the last Lumbar spine MRI was not performed within the past two weeks. 1


The study requested is a Lumbar Spine MRI.; The patient does NOT have acute or chronic back pain.; This procedure is being requested for Follow-up to surgery or fracture within the last 6 months; The patient been seen by or the ordering physician is a neuro-specialist, orthopedist, or oncologist. 2

Neurological Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient does NOT have acute or chronic back pain.; This procedure is being requested for Neurologic deficits 1


The study requested is a Lumbar Spine MRI.; The patient does NOT have acute or chronic back pain.; This procedure is being requested for Pre-operative evaluation; The patient had a Lumbar Spine MRI performed within the past 2 weeks.; The patient is not experiencing new or changing symptoms.; will fax 1


The study requested is a Lumbar Spine MRI.; The patient does NOT have acute or chronic back pain.; This procedure is being requested for Pre-operative evaluation; The patient has not had a Lumbar Spine MRI performed within the past 2 weeks. 3



Neurological Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 5

Neurological Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 45

Neurological Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Patient is status post lumbar fusion 08/26/14.She was pushing a shopping cart and it hit a crack and caused it to flip over, she tried catching it and tensed up pulling her back. 1




This study is being ordered for a neurological disorder.; 02/2015; There has been treatment or conservative therapy.; PT, LESI's, NSAIDS; increased back and hip pain, worsening; 1


This study is being ordered for a neurological disorder.; 2014; There has been treatment or conservative therapy.; Medrol dose pak; mid to low back pain radiating in to lower extremities with pain and numbness; we have treat his neck now trying to find what is causing these problems 1


This study is being ordered for a neurological disorder.; June 2014; There has been treatment or conservative therapy.; ESI, NSAIDS, PT; mid and low back pain with leg pain; 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 8/14/2014; There has been treatment or conservative therapy.; oral medications, epidural steroid injections, pt, home exercises; chronic neck and back pain with lower extremity weakness; unknown 1

Neurological Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST This study is being ordered for trauma or injury.; ; It is not known if there has been any treatment or conservative therapy.; ; 1

Neurological Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST This study is being ordered for trauma or injury.; ; There has been treatment or conservative therapy.; ; ; 1

Neurological Surgery Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is not for any of the listed indications.; bilateral hip pain. 1

Neurological Surgery Approval 72196 MRI PELVIS

This is a request for a Pelvis MRI.; The request is not for any of the listed indications.; Ms Oglesby is a 64 year old that presents with low back and left hip pain. She has been having problems when her arms are extended and working on things and doing sweeping, mopping, walking. She has to take breaks and sit for a little and get some relief. 1

Neurological Surgery Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The study is being ordered for joint pain or suspicion of joint or bone infection.; The study is being ordered for tail bone pain or injury.; 1

Neurological Surgery Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT

This study is being ordered for Inflammatory/ Infectious Disease.; 9/8/15; There has been treatment or conservative therapy.; Colcrys 0.6 mg tablet Take 1 tablet(s) twice a day by oral route. 09/18/15 prescribed Debra Brent, APN doxycycline hyclate 100 mg capsule Take 1 capsule(s) twice a day by oral route. 09/10/15 entered Lucinda Graves hydrocodone 10 m; Severe and chronic pain, swelling, numbness; I have had a lengthy discussion with the patient and his mother today. My concern is that he has significantly elevated CRP , which is concerning for malignancy. His sedimentation rate is elevated as well as 69. Could this be a paraneoplastic syndrome ? C 1

Neurological Surgery Approval 73221 MRI JOINT OF UPPER EXTREMITY


Neurological Surgery Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This is a request for a lower extremity MRI.; This is not a pulsatile mass.; "There is no evidence of tumor or mass from a previous exam, plain film, ultrasound, or previous CT or MRI."; There is not a suspicion of an infection.; The patient is not taking antibiotics.; This is not a study for a fracture which does not show healing (non-union fracture).; This is a pre-operative study for planned surgery. 1

Neurological Surgery Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT

This is a requests for a hip MRI.; The request is for hip pain.; The hip pain is chronic.; The member has failed a 4 week course of conservative management in the past 3 months. 1


This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion. 1



Neurological Surgery Approval 74176 CT ABD & PELVIS W/O CONTRAST


Neurological Surgery Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; The study is requested for known or suspected brain tumor, mass or cancer.; There is a suspected or known brain tumor. 1

Neurological Surgery Disapproval 70544 Mr angiography head w/o dye Radiology Services Denied Not Medically Necessary


Neurological Surgery Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary


Neurological Surgery Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; 11/2014; There has been treatment or conservative therapy.; PT, prescription medication; severe headaches with neck and left arm pain, passing out with decreased memory loss; 1

Neurological Surgery Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2013; There has been treatment or conservative therapy.; nerve blocks, epidural steroid injections, gabapentin, zanaflex; pain in mid back and low back radiating around ribs and abdomen; 1

Neurological Surgery Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; It is not known if there has been a supervised trial of conservative management for at least six weeks.; It is not known if this patient had a recent course of supervised physical Therapy.; It is not known if the patient has failed a course of anti-inflammatory medication or steroids.; No, the patient did not have six weeks of Chiropractic care related to this episode.; patient has history of cervical spondylosis and had MRI done in March;however, patient had a rafting accident in July and now has worsening symptoms. 1




This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; Hand BILAT L worse than R; Looking for any nerve or spinal chord compression. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has not directed conservative treatment for the past 6 weeks.; Pt with neck pain since 1987 after being beaten up by another girl. Pt also has right hand pain and numbness for 1 year and says her pain is worse when driving or writing. Pt was referred to Dr Abuelem for neurosurgical evaluation 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has NOT had back pain for over 4 weeks.; 1




This study is being ordered for a neurological disorder.; 05/07/2014; There has been treatment or conservative therapy.; oral meds, pt x8 sessions, home exercises,; < Describe primary symptoms here - or Type In Unknown If No Info Given >; neck pain rt arm pain down to fingers, bilateral lower extremity pain 1


This study is being ordered for a neurological disorder.; 11/2014; There has been treatment or conservative therapy.; PT, prescription medication; severe headaches with neck and left arm pain, passing out with decreased memory loss; 1


This study is being ordered for a neurological disorder.; 2010; There has not been any treatment or conservative therapy.; Urinary and bowel incontinence, weakness in lower extremities bilaterally, numbness in bilateral feet, and right hand weakness.; None 1

Neurological Surgery Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for trauma or injury.; ; It is not known if there has been any treatment or conservative therapy.; ; 1

Neurological Surgery Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for a thoracic spine MRI.; The caller indicated the the study was not ordered for: Chronic Back pain, Trauma, Known or suspected tumor with or without metastasis, Follow up to or Pre-operative evalution, or Neurological deficits."; There are no documented clinical findings of immune system suppression.; The patient is not experiencing back pain associated with abdominal pain.; Pt with known chiari malformation being evaluated for syringomyelia 1


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of lower extremity weakness documented on physical exam.; Shanna is now 34. She resides in Heber Springs and Greers Ferry area. She is an administrative assistant for First Electric Cooperative. She is almost 2 years out from MIS transforaminal lumbar interbody fusion at L3-4 L4-5. She had done rather well follo 1





Neurological Surgery Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; He has numbness and tingling in his lower extremities. His pain starts midline and radiates to his bilateral hips. The pain radiates down his bilateral legs with the left being worse then the right. His legs will give out at times. His back pain is made w; He has seen the chiropractor in the past but stopped going because it was making his pain worse. He takes hydrocodone-acetaminophen 10-325 for mostly his back pain and it helps.He has done physical therapy for his lumbar pain and it did not help. 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has not seen the doctor more then once for these symptoms.; back back and neck pain 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has not directed conservative treatment for the past 6 weeks.; This is a complicated case. Patient has long standing low back pain and left leg pain with N/T. These symptoms started after a hysterectomy. I think the N/T in her left leg may be due to her incision and damage to the lateral femoral cutaneous nerve. She 1


The study requested is a Lumbar Spine MRI.; Neurological deficits; The patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has a new foot drop.; It is not known if the patient has new signs or symptoms of bladder or bowel dysfunction.; It is not known if there is x-ray evidence of a lumbar recent fracture.; There is weakness.; Chief Complaint: Lower back pain that radiates into his legs bilaterally, left worse than right. History of Present Illness This 58 year old male presents with lower back pain that radiates into the lateral aspect of his legs bilaterally, left wor; Patient reports LBP with pain to his hips and posterior legs with N/T. He has severe L4-5 spinal stenosis and an EMG consistent with radiculopathy at L4/5 and L5-S1. I explained to him that surgical decompression would likely give him relief of his leg pa 1


The study requested is a Lumbar Spine MRI.; Neurological deficits; The patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has a new foot drop.; It is not known if the patient has new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; It is not known if there is weakness or reflex abnormality.; Patient has low back pain radiating to her bilateral legs, worse on the right. Her Xrays show a grade I/II spondylolisthesis at L5/S1. We will start PT and obtain an MRI of her lumbar spine. We will give her tramadol and muscle relaxer to help with her pa 1


The study requested is a Lumbar Spine MRI.; Neurological deficits; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; PATIENT HAS WEAKNESS IN BILATERAL LEGS; DUE TO THE INCREASING PAIN WITH NUMBNESS AND WEAKNESS, POSSIBLE DISC BULGE. 1


The study requested is a Lumbar Spine MRI.; The patient does NOT have acute or chronic back pain.; This procedure is being requested for Pre-operative evaluation; The patient has not had a Lumbar Spine MRI performed within the past 2 weeks. 1

Neurological Surgery Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 4


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; pt with pain in neck, mid and lower back. pts mri T spine shows syringomyelia. need mri lumbar spine to see if syrinx is there also 1


This study is being ordered for a neurological disorder.; 05/07/2014; There has been treatment or conservative therapy.; oral meds, pt x8 sessions, home exercises,; < Describe primary symptoms here - or Type In Unknown If No Info Given >; neck pain rt arm pain down to fingers, bilateral lower extremity pain 1




This study is being ordered for trauma or injury.; May 2014; There has been treatment or conservative therapy.; NSAIDs, Prednisone, other medications, home exercise program,; 10 month post op ACDF at C5 and C6 with ongoing severe mechanical pain with radiculopathy. MD suspect she may have adjacent level discopathy at C4, C5. she still seems to have some left C4 radiculopathy. Concerned about loosening of the ventral fusion p; Unknown. 1

Neurological Surgery Disapproval 72196 MRI PELVIS Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; 02/2015; There has been treatment or conservative therapy.; PT, LESI's, NSAIDS; increased back and hip pain, worsening; 1

Neurological Surgery Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary

This study is being ordered for Inflammatory/ Infectious Disease.; 9/8/15; There has been treatment or conservative therapy.; Colcrys 0.6 mg tablet Take 1 tablet(s) twice a day by oral route. 09/18/15 prescribed Debra Brent, APN doxycycline hyclate 100 mg capsule Take 1 capsule(s) twice a day by oral route. 09/10/15 entered Lucinda Graves hydrocodone 10 m; Severe and chronic pain, swelling, numbness; I have had a lengthy discussion with the patient and his mother today. My concern is that he has significantly elevated CRP , which is concerning for malignancy. His sedimentation rate is elevated as well as 69. Could this be a paraneoplastic syndrome ? C 1

Neurological Surgery Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; unknown; It is not known if there has been any treatment or conservative therapy.; knee pain. numbness. in wheel chair; unknown 2

Neurological Surgery Disapproval 74150 CT ABDOMEN WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2013; There has been treatment or conservative therapy.; nerve blocks, epidural steroid injections, gabapentin, zanaflex; pain in mid back and low back radiating around ribs and abdomen; 1

Neurology Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; 1

Neurology Approval 70450 CT BRAIN, HEAD

This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for something other than trauma or injury, evaluation of known tumor, stroke or aneurysm, infection or inflammation, multiple sclerosis or seizures.; The patient has a sudden change in mental status.; since cardiac arrest patient is now experiencing memory loss, confusion, short tempered 1


This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for stroke or aneurysm.; This study is being ordered for a previous stroke or aneurysm.; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient has dizziness.; 1


This is a request for a brain/head CT.; The study is requested for headache.; There is headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; patient just having headaches 1



Neurology Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for Hydrocephalus or congenital abnormality. 1

Neurology Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for known or suspected brain tumor, mass or cancer.; There is a suspected or known brain tumor. 1

Neurology Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST 1

Neurology Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST This study is being ordered for a neurological disorder.; ; It is not known if there has been any treatment or conservative therapy.; ; 1

Neurology Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST

This study is being ordered for a neurological disorder.; 06/01/2015; There has not been any treatment or conservative therapy.; dizziness vision changes numbness; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; 09/12/2015; There has been treatment or conservative therapy.; medication; left arm numbness, speech slurring, syncope episode; history of stroke 1


This study is being ordered for a neurological disorder.; 8/2015; There has not been any treatment or conservative therapy.; right eye drooping, occasional headaches; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; CC: Neurological sxs of tingling. HPI: Ms Barbee is a 50 year old right handed woman was seen in neurology clinic for transient neurological symptoms. During one of her episode she had left sided facial numbness (forehead and chin, not neck). She ; There has been treatment or conservative therapy.; Since her last event, she has bitemporal headache, without changes in vision, sometimes its dull, sometimes its pulsating. She has along with it nausea, no vomiting, some photosensitivity and phonophobia. An MRI of brain and MRA were done. ; Current outpatient prescriptions:atorvastatin (LIPITOR) 40 MG tablet, Take 1 tablet (40 mg total) by mouth nightly at bedtime., Disp: 30 tablet, Rfl: 11; clopidogrel (PLAVIX) 75 mg tablet, Take 1 tablet (75 mg total) by mouth daily., Disp: 30 tablet, Rfl; 1


This study is being ordered for a neurological disorder.; HA BEGAN IN 2004 DOUBLE VISION STARTED TWO WEEKS AGO; There has not been any treatment or conservative therapy.; HA, double vision, dizziness; < Enter answer here - or Type In Unknown If No Info Given. > 1

Neurology Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the brain. 7Neurology Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST 2

Neurology Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST

This study is being ordered for a neurological disorder.; 06/01/2015; There has not been any treatment or conservative therapy.; dizziness vision changes numbness; < Enter answer here - or Type In Unknown If No Info Given. > 1






This study is being ordered for a neurological disorder.; CC: Neurological sxs of tingling. HPI: Ms Barbee is a 50 year old right handed woman was seen in neurology clinic for transient neurological symptoms. During one of her episode she had left sided facial numbness (forehead and chin, not neck). She ; There has been treatment or conservative therapy.; Since her last event, she has bitemporal headache, without changes in vision, sometimes its dull, sometimes its pulsating. She has along with it nausea, no vomiting, some photosensitivity and phonophobia. An MRI of brain and MRA were done. ; Current outpatient prescriptions:atorvastatin (LIPITOR) 40 MG tablet, Take 1 tablet (40 mg total) by mouth nightly at bedtime., Disp: 30 tablet, Rfl: 11; clopidogrel (PLAVIX) 75 mg tablet, Take 1 tablet (75 mg total) by mouth daily., Disp: 30 tablet, Rfl; 1



Neurology Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the Neck. 2

Neurology Approval 70540 MRI ORBIT/FACE/NECK W/O DYE

This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; 1

Neurology Approval 70544 Mr angiography head w/o dye 1

Neurology Approval 70544 Mr angiography head w/o dye This is a request for a Brain MRA.; There is an immediate family history of aneurysm. 4

Neurology Approval 70544 Mr angiography head w/o dye

This is a request for a Brain MRA.; There is not an immediate family history of aneurysm.; The patient does not have a known aneurysm.; The patient has had a recent MRI or CT for these symptoms.; There has been a stroke or TIA within the past 2 weeks. 1


This is a request for a Brain MRA.; There is not an immediate family history of aneurysm.; The patient does not have a known aneurysm.; The patient has had a recent MRI or CT for these symptoms.; There has not been a stroke or TIA within the past two weeks. 1


This is a request for a head and neck MR Angiogram.; There is not an immediate family history of aneurysm.; The patient does not have a known aneurysm.; The patient has had a recent MRI or CT for these symptoms.; There has not been a stroke or TIA within the past two weeks.; "There is a sudden onset of one-sided weakness, speech impairment, vision defects or severe dizziness." 1




This study is being ordered for a neurological disorder.; 08/2015; There has been treatment or conservative therapy.; Medications; Headaches, SP CT showing aneurysm.; Unknown 1


This study is being ordered for a neurological disorder.; 2013; There has been treatment or conservative therapy.; Meds; Weakness Dizziness; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; many years; There has been treatment or conservative therapy.; elavil; nausea dizziness sharp pain behind the right eye; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; It is not known if there has been any treatment or conservative therapy.; Headache; Headache 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; JUNE 2015; There has been treatment or conservative therapy.; PATIENT HAS BEEN ON SEVERAL DIFFERENT MEDICATIONS FOR MIGRAINES INCLUDING: AXERT, MIDRIN AND MAXALT.; MIGRAINES FOR 3 MONTHS WORSENING IN SEVERITY. ASSOCIATED WITH NAUSEA PHONOPHOBIA AND PHOTOPHOBIA. PT HAS A FAMILY HISTORY OF ANEURYSM.; WORST HEADACHE OF LIFE FOR 3 MONTHS FAMILY HISTORY OF ANEURYSM. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; last 5 months; There has been treatment or conservative therapy.; pain medication; double vision and headaches, vertigo, facial numbness including parts of the tongue. tingling in right hand and 3 fingers.; 1

Neurology Approval 70547 Mr angiography neck w/o dye

This is a request for a head and neck MR Angiogram.; There is not an immediate family history of aneurysm.; The patient does not have a known aneurysm.; The patient has had a recent MRI or CT for these symptoms.; There has not been a stroke or TIA within the past two weeks.; "There is a sudden onset of one-sided weakness, speech impairment, vision defects or severe dizziness." 1

Neurology Approval 70547 Mr angiography neck w/o dye This is a request for a Neck MR Angiography.; The patient has had a recent MRI or CT for these symptoms. 1

Neurology Approval 70547 Mr angiography neck w/o dye This is a request for a Neck MR Angiography.; The patient has not had a recent MRI or CT for these symptoms.; There has been a stroke or TIA within the past 2 weeks. 1


This is a request for a Neck MR Angiography.; The patient has not had a recent MRI or CT for these symptoms.; There has not been a stroke or TIA within the past two weeks.; "There is a sudden onset of one-sided weakness, speech impairment, vision defects or severe dizziness." 1



Neurology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 15

Neurology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST



This request is for a Brain MRI; Known or suspected multiple sclerosis (MS) best describes the reason that I have requested this test.; The patient has been diagnosed with known Multiple Sclerosis. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; It is not known if there are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Follow up. Had leukemia in childhood, has radiation-induced meningiomas, the last of which was operated on in the right posterior frontal region in the parasagittal convexity.She has other 2 spots, one in the suprasellar region and one in the right fronta 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; It is not known if there are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Nine month follow up of his Grade 2 oligodendroglioma. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; It is not known if there are recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; This is a yearly follow up. Patient has Hemangioma of intracranial structures. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Lori D Sisk is a 44 y.o. female with a history of episodic migraine that over the years has developed into chronic migraine now to her current preventative. She is overusing Excedrin every day and we talked about the triggers that might be allowing her to 1




This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Dianna Neely is a 59 y.o. female with episodic migraine that has gradually and progressed to chronic migraine. She also has menstrually related migraine We discussed in detail the pathophysiology of migraine and the importance of simultaneously using mult 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; migraines are getting worse 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; MRI of brain to rule out secondary etiologies as a cause for increased frequency and severity of headaches, patient has ahd daily headache x1 year. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; WILL FAX NOTES 2






This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; There are NO recent neurological deficits on exam such as one sided weakness, speech impairments or vision defects.; There is a new and sudden onset of a headache less than 1 week not improved by medications.; The headache is not described as a “thunderclap” or the worst headache of the patient’s life.; pt is also suffering from vertigo 1




This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient does not have a sudden severe, chronic or recurring or a thunderclap headache.; Pt having numbness in upper & lower extremities, blurred vision, need to R/O MS 1



Neurology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; eval for possible seizures, generalized jerking episodes followed by confusion 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; headaches with left arm and left leg weakness Dizziness Off balance 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; History of chronic daily headaches and numbness, headaches have been under poor control, new complaint of fainting. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; Pt is having headach's he is also having right-sided body pain. some degree of a little bit of discomfort, but then he will have flare ups. it kind of starts burning behind his right eye and he will have a deep bruning sensation, and then down into his 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a sudden and severe headache.; The patient had a recent onset (within the last 3 months) of neurologic symptoms.; The patient has one sided arm or leg weakness. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient has a sudden change in mental status.; The symptoms are reported as being moderate. the symptoms occur constantly and in the legs. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient has a sudden change in mental status.; UNKNOWN 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient has Bell's Palsy.; Left facial paralysis 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; It is unknown why this study is being ordered.; The patient has hearing loss.; The patient had an audiogram.; The results of the audiogram were abnormal. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; It is not known if the condition is associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; The results of the lab tests are unknown.; patient having tremors in hands on daily basis. 1






This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; The lab results were normal; 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; Difficulty swallowing and spells 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; During her pregnancy in 2011, she had pain on the last 3 bottom teeth (molar and premolar) on the right radiating to the gum line, sharp shooting like lightning, no facial pain. She had root canals in these 3 teeth which seemed to have relieved the pain. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; HISTORY OF PARESTHESIAS AND TINGLING OF THE LEFT UPPER AND LOWER EXTREMITY. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; Memory loss associated with speech problems. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; Patient has hyperreflexia at the ankle with clonus which could suggest primarily thoracic spinal cord initially. We have had an MRI of thoracic spine and an MRI of Cervical Spine done with negative results. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; Patient is experience numbness and Parasthesia over her entire body 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; It is not known if a metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; Patient with colloid cyst of the brain and pineal gland cyst. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; It is not known if a metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; When he was five he had a history of blood clot in his head. He is have stuttering problems for approximately 6 months. He has never stuttered before. He does not stutter when he talks on the phone or to his mother, but is is when it is with primarily wit 1




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing dizziness.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; 1








This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of Multiple Sclerosis; It is not known if the patient has undergone treatment for multiple sclerosis.; There are intermittent or new neurological symptoms or deficits such as one-sided weakness, speech impairments, or vision defects. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of Multiple Sclerosis; The patient has not undergone treatment for multiple sclerosis.; There are intermittent or new neurological symptoms or deficits such as one-sided weakness, speech impairments, or vision defects. 3




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of seizures; There has been a previous Brain MRI completed.; The brain MRI was abnormal. 5




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of stroke or aneurysm; There are not recent neurological symptoms such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; 782.0 1







Neurology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; This study is being ordered for and infection or inflammation. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; This study is being ordered for Multiple Sclerosis.; The patient has new symptoms.; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient does not have dizziness, one sided arm or leg weakness, the inability to speak, or vision changes.; Patient of 33 yo RH female with MS dx for MRI (brain and cervical) and CSF that is coming for her f/u. She came in with her husband. They stated increase level of anxiety with some personality changes, forgetfullness, and kind of panic attack epsiodes aro 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; This study is being ordered for Multiple Sclerosis.; This is a routine follow up.; This study is being ordered as a 12 month annual follow up. 2


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; This study is being ordered for seizures.; There has been a change in seizure pattern or a new seizure. 4


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; This study is being ordered for seizures.; There has NOT been a change in seizure pattern or a new seizure.; This is a new patient. 1




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; Multiple hemorrhagic brain lesions, needed to see post operative changes after surgery, decrease in proprioception and vison of right side, headache, weakness of left side 1



Neurology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; 1

Neurology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This study is being ordered for a neurological disorder.; ; It is not known if there has been any treatment or conservative therapy.; ; 1

Neurology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 2


This study is being ordered for a neurological disorder.; 02/2015; There has not been any treatment or conservative therapy.; patient is having numbness tingling from waist down complain of weakness, bladder discomfort and difficult walking and back pain.; unknnown 1


This study is being ordered for a neurological disorder.; 08/2015; There has been treatment or conservative therapy.; Medications; Headaches, SP CT showing aneurysm.; Unknown 1




This study is being ordered for a neurological disorder.; 09-21-2013; There has been treatment or conservative therapy.; Patient taking gabapentin and premarin; Dizziness and headaches, extremity in weakness, gait disturbance, memory impairment, numbness in extremity. Neck pain; The MD is concern about MS. 1


This study is being ordered for a neurological disorder.; 10/30/2014; There has been treatment or conservative therapy.; Tecfidera was begun in October and is well tolerated. She has not developed depression. The one case of PML with Tecfidera was discussed and symptoms of PML were discussed. The need for follow-up CBC with lymphocyte count, AST, L3, and surveillance MRIs; MRI of the brain and cervical spine with contrast - October; follow up for MS 1


This study is being ordered for a neurological disorder.; 2002; There has been treatment or conservative therapy.; medications; dizziness, extremity weakness, headaches, memory impairment, extremity numbness, tremors; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; 2005; There has been treatment or conservative therapy.; trials of medication and clinical testing; photophobia, tingling paresthesia of the face bilaterally,visual loss; throbbing pain from the bottom of her spine up towards her head 1




This study is being ordered for a neurological disorder.; 6 months ago; There has been treatment or conservative therapy.; hydrocodone, antibiotics for ears. No previous imaging studies; vertigo, headaches, fatibrial artery dissection; HX is not consistent with BPPV. 1


This study is being ordered for a neurological disorder.; Alayna is here today for a follow up on Multiple Sclerosis. She is on Copaxone 40 mgs TIW since mid March and she is tolerating it well. Today she reports that 3 wks ago,she developed pain in her left buttocks, "not in bone or muscle", that radiates into ; There has been treatment or conservative therapy.; Plan/Assessment: 1. Multiple Sclerosis, presumed exacerbation, on Copaxone 40 mgs TIW. Information given to pt on Aubagio. 2. Carbamezapine 200 mgs- start with a 1/2 tablet twice per day and go up by 1/2 tablet each day to a maximum of thee whole tabs t; Plan/Assessment: 1. Multiple Sclerosis, presumed exacerbation, on Copaxone 40 mgs TIW. Information given to pt on Aubagio. 2. Carbamezapine 200 mgs- start with a 1/2 tablet twice per day and go up by 1/2 tablet each day to a maximum of thee whole tabs t; 1


This study is being ordered for a neurological disorder.; Amber is here today for a follow up on her problems with MS. She is currently on Copaxone 40 mgs TIW and is tolerating it fairly well other than a few site injection reactions. She continues to have trouble with migraines, muscle spasms and neuropathic pa; There has been treatment or conservative therapy.; 1. Multiple Sclerosis- relapsing remitting, stable on Copaxone 40 mgs TIW. 2. Labs-CBC, CMP, TSH and Vitamin d level. 3. Neuropathic Pain-Gabapentin 300 mgs QD and may increase to TID if needed. 4. Muscle Spasms-info on stretching with MS given. Baclof; ; 1


This study is being ordered for a neurological disorder.; August 1, 2015; There has been treatment or conservative therapy.; NUVIGIL 150 MG; Pt has fatigue with a history of optic neuritis. He also has right sided arm radiculopathy. He has persistent pain in the right shoulder.; The doctor would like to rule out multiple sclerosis and cervical radiculopathy with his history of spinal surgery in the past. 1


This study is being ordered for a neurological disorder.; Davis is a 44-year-old seen in consultation to Dr. Smith regarding several symptoms that have been present for about 1 year. Mr. Davis is here with wife and they detail that he is having particular problems with headaches, leg weakness and pain, and thi; There has been treatment or conservative therapy.; tramadol 50 mg tablet take 1 tablet by oral route every 6 hours as needed 10/15/2014 09/10/2015 N hydrocodone 5 mg-acetaminophen 325 mg tablet take 1 tablet by oral route every 6 hours as needed for pain 10/15/2014 09/10/2015 N Lyrica 50 m; Constitutional Positive Fatigue, Weight loss. ENMT Positive Hearing loss. Eyes Positive Vision changes. Respiratory Positive Dyspnea. Cardio Positive Chest pain. GI Positive Abdominal pain. GI Negative Nausea. GU Negative Urinary in; Multiple largely neurologic symptoms of uncertain cause for 1 year - possible encephalopathy with or without cervical myelopathy, lumbar spinal stenosis, seizures. Differential includes MS, hepatitis C 1


This study is being ordered for a neurological disorder.; HA and neck pain is chronic, been going on for years.; There has been treatment or conservative therapy.; RX: Dilaudid and Ibuprofen; HA, neck pain, nausea, vomiting, dizziness, sensitivity to light, neck pain radiates to BILAT shoulders; Migraines twice a week, went to ER due to tingling in limbs 1




This study is being ordered for a neurological disorder.; July 2015; There has been treatment or conservative therapy.; medications have been prescribed; ; no decrease in symptoms with medication 1


This study is being ordered for a neurological disorder.; Past one and a half years.; There has been treatment or conservative therapy.; Medications; < Describe primary symptoms here - or Type In Unknown If No Info Given >; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; Unknown; There has been treatment or conservative therapy.; Medication; Back pain, weakness in leg, radiation pain in hip; Known MS, known history of degenerative disc disease 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; It is not known if there has been any treatment or conservative therapy.; Headache; Headache 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 06/08/2015; There has been treatment or conservative therapy.; medications- zolmitriptan sumatriptan; Increase in headaches, neck pain and occipital pain, memory impairment.. back pain joint pain joint swelling muscle weakness, neck pain and neck stiffness; This patient is here for follow up of a headache. Symptoms are aggravated by head position and neck issues... Symptoms have been treated and are worsening. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; JUNE 2015; There has been treatment or conservative therapy.; PATIENT HAS BEEN ON SEVERAL DIFFERENT MEDICATIONS FOR MIGRAINES INCLUDING: AXERT, MIDRIN AND MAXALT.; MIGRAINES FOR 3 MONTHS WORSENING IN SEVERITY. ASSOCIATED WITH NAUSEA PHONOPHOBIA AND PHOTOPHOBIA. PT HAS A FAMILY HISTORY OF ANEURYSM.; WORST HEADACHE OF LIFE FOR 3 MONTHS FAMILY HISTORY OF ANEURYSM. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; last 5 months; There has been treatment or conservative therapy.; pain medication; double vision and headaches, vertigo, facial numbness including parts of the tongue. tingling in right hand and 3 fingers.; 1


This study is being ordered for Vascular Disease.; 8/6/2015; There has been treatment or conservative therapy.; Patient had an MRI done; Memory loss Numbness back pain Weakness; Patient had a stroke 1

Neurology Approval 71250 CT CHEST, THORAX

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; Multiple hemorrhagic brain lesions, needed to see post operative changes after surgery, decrease in proprioception and vison of right side, headache, weakness of left side 1

Neurology Approval 71250 CT CHEST, THORAX


Neurology Approval 72131 CT LUMBAR SPINE, LOW BACK


Neurology Approval 72131 CT LUMBAR SPINE, LOW BACK This is a request for a lumbar spine CT.; The patient has a history of severe low back trauma or lumbar injury. 1

Neurology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 3

Neurology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST



This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is reflex abnormality.; Loss of his biceps reflex bilaterally, but riceps hyperreflexia, knee and ankle hyperreflexia. Plantar stimulation was withdrawal bilaterally.; He report tha he has had a lond standing problem with neck and back pain. He has been having an increased problem in his neck with his hands and arms going numb. He reprots that there are occasional times that he will turn his head to the right, and he ge 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is reflex abnormality.; Unable to lift hands above head, hands are swollen.; 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is x-ray evidence of a recent cervical spine fracture. 1






This is a request for cervical spine MRI; Known or Suspected Multiple Sclerosis, Infection or abscess; There is no laboratory or x-ray evidence of osteomyelitis.; There is not laboratory or x-ray evidence of meningitis.; There is not laboratory or x-ray evidence of an infected disc, septic arthritis, or "discitis".; There is not laboratory or x-ray evidence of a paraspinal abscess.; Patient of 33 yo RH female with MS dx for MRI (brain and cervical) and CSF that is coming for her f/u. She came in with her husband. They stated increase level of anxiety with some personality changes, forgetfullness, and kind of panic attack epsiodes aro 1


This is a request for cervical spine MRI; Known or Suspected Multiple Sclerosis, Infection or abscess; yes, there are documented clinical findings of Multiple sclerosis.; Yes, the patient have new or changing neurological signs or symptoms.; No, the patient is not experiencing or presenting new symptoms of upper extremity weakness?; No, the patient is not demonstrating unilateral muscle wasting.; No, the patient is not experiencing or presenting new symptoms of Bowel or bladder dysfunction.; Yes, the patient is experiencing new onset of parathesia diagnosed by a neurologist.; No, the patient is not experiencing or presenting x-ray evidence of a recent fracture.; having shortness of breath 1


This is a request for cervical spine MRI; Known or Suspected Multiple Sclerosis, Infection or abscess; yes, there are documented clinical findings of Multiple sclerosis.; Yes, the patient have new or changing neurological signs or symptoms.; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 1

Neurology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Neurological deficits; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 9

Neurology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; None of the above; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 1


This is a request for cervical spine MRI; Trauma or recent injury; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is reflex abnormality.; Patient has a trimmer (severe).; Unknown. 1


This is a request for cervical spine MRI; yes, there is a documented evidence of extremity weakness on physical examination.; Yes, the patient demonstrate neurological deficits.; Acute or Chronic neck and/or back pain 1

Neurology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; 1

Neurology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for a neurological disorder.; 06/19/2014; There has been treatment or conservative therapy.; COPAXONE BACLOFEN; WEAKNESS FATIGUE NUMBNESS OF RIGHT FACE TINGLING LEG SPASMS; MS WORSENING SYMPTOMS OF WEAKNESS AND TINGLING WITH SPASMS 1


This study is being ordered for a neurological disorder.; 09-21-2013; There has been treatment or conservative therapy.; Patient taking gabapentin and premarin; Dizziness and headaches, extremity in weakness, gait disturbance, memory impairment, numbness in extremity. Neck pain; The MD is concern about MS. 1


This study is being ordered for a neurological disorder.; 10 to 15 years ago; There has not been any treatment or conservative therapy.; paresthesias; The patient states that 10 to 15 years ago he developed the insidious onset of a sense that he had numbness and tingling in the right foot as if it felt swollen. He watched progression of the numbness and tingling into both feet radiating into both legs a 1


This study is being ordered for a neurological disorder.; 10/30/2014; There has been treatment or conservative therapy.; Tecfidera was begun in October and is well tolerated. She has not developed depression. The one case of PML with Tecfidera was discussed and symptoms of PML were discussed. The need for follow-up CBC with lymphocyte count, AST, L3, and surveillance MRIs; MRI of the brain and cervical spine with contrast - October; follow up for MS 1


This study is being ordered for a neurological disorder.; 2002; There has been treatment or conservative therapy.; medications; dizziness, extremity weakness, headaches, memory impairment, extremity numbness, tremors; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; 2004; There has been treatment or conservative therapy.; Tysabri; Numbness, weakness in lower extremities; gate disturbance; Worsening symptoms 1


This study is being ordered for a neurological disorder.; 2005; There has been treatment or conservative therapy.; trials of medication and clinical testing; photophobia, tingling paresthesia of the face bilaterally,visual loss; throbbing pain from the bottom of her spine up towards her head 1






This study is being ordered for a neurological disorder.; August 1, 2015; There has been treatment or conservative therapy.; NUVIGIL 150 MG; Pt has fatigue with a history of optic neuritis. He also has right sided arm radiculopathy. He has persistent pain in the right shoulder.; The doctor would like to rule out multiple sclerosis and cervical radiculopathy with his history of spinal surgery in the past. 1




This study is being ordered for a neurological disorder.; HA and neck pain is chronic, been going on for years.; There has been treatment or conservative therapy.; RX: Dilaudid and Ibuprofen; HA, neck pain, nausea, vomiting, dizziness, sensitivity to light, neck pain radiates to BILAT shoulders; Migraines twice a week, went to ER due to tingling in limbs 1


This study is being ordered for a neurological disorder.; July 2015; There has been treatment or conservative therapy.; medications have been prescribed; ; no decrease in symptoms with medication 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 06/08/2015; There has been treatment or conservative therapy.; medications- zolmitriptan sumatriptan; Increase in headaches, neck pain and occipital pain, memory impairment.. back pain joint pain joint swelling muscle weakness, neck pain and neck stiffness; This patient is here for follow up of a headache. Symptoms are aggravated by head position and neck issues... Symptoms have been treated and are worsening. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 07/07/2015 WEAKNESS,PARESTHESIA R/O MYELOPATHY; There has been treatment or conservative therapy.; Medication Cymbalta 60MG ibuprofen 200 mg capsule Percocet 7.5 mg-325 mg tablet,PT ALSO HAD EMG/NCV,DISCONTINUED LYRICA AND GABAPENTIN.; WEAKNESS,PARESTHESIA,DORSIFLEXORS SEVERLY WEAKENED NOT IMPROVING,SHE IS USING CRUTCHES; 1

Neurology Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST 1

Neurology Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST



This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of lower extremity weakness documented on physical exam.; The patient complains that she hurts around her neck, shoulders and pain around her back wear her bra strap would be that radiates around forward to under her rib cage. The patient noticed back in the summer when she was working with a personal trainer s 1


This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of lower extremity weakness documented on physical exam.; The upper back pain was first noticed 10 months ago and got worse overtime. He also c/o numbness and tingling in the hands, forearms and shoulders. He noticed to dropping things from the hands. has been to PT 1




This is a request for a thoracic spine MRI.; The study is being ordered due to Neurological deficits.; The patient is experiencing or presenting symptoms of bowel or bladder dysfunction. 1


This is a request for a thoracic spine MRI.; The study is being ordered due to Neurological deficits.; The patient is not experiencing or presenting symptoms of abnormal gait, lower extremity weakness, asymmetric reflexes, fracture, radiculopathy or bowel or bladder dysfunction.; The patient is experiencing sensory abnormalities such as numbness or tingling.; There has been a supervised trial of conservative management for at least 6 weeks. 2

Neurology Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; 1




This study is being ordered for a neurological disorder.; 06/19/2014; There has been treatment or conservative therapy.; COPAXONE BACLOFEN; WEAKNESS FATIGUE NUMBNESS OF RIGHT FACE TINGLING LEG SPASMS; MS WORSENING SYMPTOMS OF WEAKNESS AND TINGLING WITH SPASMS 1


This study is being ordered for a neurological disorder.; 10 to 15 years ago; There has not been any treatment or conservative therapy.; paresthesias; The patient states that 10 to 15 years ago he developed the insidious onset of a sense that he had numbness and tingling in the right foot as if it felt swollen. He watched progression of the numbness and tingling into both feet radiating into both legs a 1


This study is being ordered for a neurological disorder.; 2004; There has been treatment or conservative therapy.; Tysabri; Numbness, weakness in lower extremities; gate disturbance; Worsening symptoms 1


This study is being ordered for a neurological disorder.; 2013; There has been treatment or conservative therapy.; hydralazine 50 mg tablet take 1 tablet by oral route 3 times every day with food 05/05/2015 N spironolactone 50 mg tablet take 1 tablet by oral route every day 05/05/2015 N lisinopril 40 mg tablet take 1 tablet by oral route every day ; Examination is again notable for 4/5 proximal leg weakness with antalgic gait, difficulty on tandem gait, and quadriceps atrophy without fasciculations. Nasal speech. Reflexes are reduced. Sensation to light touch is intact VS noted. Afebrile Well gr; Lumbosacral plexus lesions (353.1). The cause of leg weakness is not certain. Further evaluation at UAMS is needed to try to sort this out. I thought the problem was a lumbosacral plexopathy; this is something difficult to diagnose and rare so we need a 1






This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 07/07/2015 WEAKNESS,PARESTHESIA R/O MYELOPATHY; There has been treatment or conservative therapy.; Medication Cymbalta 60MG ibuprofen 200 mg capsule Percocet 7.5 mg-325 mg tablet,PT ALSO HAD EMG/NCV,DISCONTINUED LYRICA AND GABAPENTIN.; WEAKNESS,PARESTHESIA,DORSIFLEXORS SEVERLY WEAKENED NOT IMPROVING,SHE IS USING CRUTCHES; 1

Neurology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST


Neurology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient does NOT have acute or chronic back pain.; This procedure is being requested for Neurologic deficits 2



Neurology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal nerve study involving the lumbar spine 1



Neurology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 12

Neurology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; 1




This study is being ordered for a neurological disorder.; 2013; There has been treatment or conservative therapy.; hydralazine 50 mg tablet take 1 tablet by oral route 3 times every day with food 05/05/2015 N spironolactone 50 mg tablet take 1 tablet by oral route every day 05/05/2015 N lisinopril 40 mg tablet take 1 tablet by oral route every day ; Examination is again notable for 4/5 proximal leg weakness with antalgic gait, difficulty on tandem gait, and quadriceps atrophy without fasciculations. Nasal speech. Reflexes are reduced. Sensation to light touch is intact VS noted. Afebrile Well gr; Lumbosacral plexus lesions (353.1). The cause of leg weakness is not certain. Further evaluation at UAMS is needed to try to sort this out. I thought the problem was a lumbosacral plexopathy; this is something difficult to diagnose and rare so we need a 1





Neurology Approval 72196 MRI PELVIS

This is a request for a Pelvis MRI.; The request is not for any of the listed indications.; low back pain radiating to left lower extremity. Mrs Hampton returns to the clinic for her routine visit after her SI injection and states her pain has been reduced.She continues to be sxs when she sits and her BLE at times feel numb. Her L buttock pain i 1

Neurology Approval 73221 MRI JOINT OF UPPER EXTREMITY


Neurology Approval 73221 MRI JOINT OF UPPER EXTREMITY

The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; rotator cuff syndrome; paresthesia 1

Neurology Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT


Neurology Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This study is being ordered for a neurological disorder.; This patient is a 37-year-old male that I initially evaluated when he presented to the office with profound spasticity and myelopathic findings. His symptoms began about a year ago. I initially evaluated him in November of last year. He was complaining; There has been treatment or conservative therapy.; Medication Name Sig Desc Start Date Stop Date Refilled baclofen 10 mg tablet take 1 tablet by oral route 3 times every day 01/05/2015 09/10/2015 amitriptyline 25 mg tablet take 1 tablet by oral route every day at bedtime 03/04/2015 09/10/20; Abnormality of gait (781.2). The patient has an unsteady, spastic gait. Initially it appeared that he had a fairly straightforward case of cervical myelopathy. He had significant cord compression from a very large protruding disk. He did not improve f; Further diagnostic evaluations ordered today include(s) MRI LOWER EXTREMITl W/wo Contrast, Right, thigh to be performed 10/6/15 and MRI PELVIS W/AND W/O CONTRAST, Right, hip to be performed 10/6/15. 1

Neurology Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT

This study is being ordered for a neurological disorder.; This patient is a 37-year-old male that I initially evaluated when he presented to the office with profound spasticity and myelopathic findings. His symptoms began about a year ago. I initially evaluated him in November of last year. He was complaining; There has been treatment or conservative therapy.; Medication Name Sig Desc Start Date Stop Date Refilled baclofen 10 mg tablet take 1 tablet by oral route 3 times every day 01/05/2015 09/10/2015 amitriptyline 25 mg tablet take 1 tablet by oral route every day at bedtime 03/04/2015 09/10/20; Abnormality of gait (781.2). The patient has an unsteady, spastic gait. Initially it appeared that he had a fairly straightforward case of cervical myelopathy. He had significant cord compression from a very large protruding disk. He did not improve f; Further diagnostic evaluations ordered today include(s) MRI LOWER EXTREMITl W/wo Contrast, Right, thigh to be performed 10/6/15 and MRI PELVIS W/AND W/O CONTRAST, Right, hip to be performed 10/6/15. 1

Neurology Approval 78608 BRAIN PET [POSITRON EMISSION TOMOGRAPHY] 1

Neurology Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary

This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for something other than trauma or injury, evaluation of known tumor, stroke or aneurysm, infection or inflammation, multiple sclerosis or seizures.; The patient has a sudden change in mental status.; Dizziness Tingling in left arm. 1

Neurology Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary

This is a request for a brain/head CT.; The study is NOT being requested for evaluation of a headache.; This study is being ordered for stroke or aneurysm.; This study is being ordered for screening for aneurysm or AVM.; DM- BS are doing good at home. BS 60-160. Last a1c was 9.6 3 months ago and we started metformin. On insulin also HTN- BP has been normal since starting Hydralazine. But has been having left arm tingling when he takes nifidepine in the morning. He had 1

Neurology Disapproval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for Vascular Disease.; ; There has been treatment or conservative therapy.; ; ; 1

Neurology Disapproval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for Vascular Disease.; ; There has been treatment or conservative therapy.; ; ; 1

Neurology Disapproval 70540 MRI ORBIT/FACE/NECK W/O DYE Radiology Services Denied Not Medically Necessary "This is a request for orbit,face, or neck soft tissue MRI.239.8"; The reason for the study is not for trauma, infection,cancer, mass, tumor, pre or post-operative evaluation; 1

Neurology Disapproval 70544 Mr angiography head w/o dye Radiology Services Denied Not Medically Necessary






Neurology Disapproval 70547 Mr angiography neck w/o dye Radiology Services Denied Not Medically Necessary


Neurology Disapproval 70547 Mr angiography neck w/o dye Radiology Services Denied Not Medically Necessary


Neurology Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary



This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a sudden and severe headache.; The patient had a recent onset (within the last 3 months) of neurologic symptoms.; The patient has dizziness.; PATIENT HAS A HISTORY OF VERTIGO INCREASING HEADACHES ASSOCIATED WITH POOR BALANCE. PT HAS A HX OF MIGRAINES WITH PHOTO AND PHONOPHOBIA. HEADACHES FREQUENCY AND SEVERITY ARE WORSENING. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; memory loss 1

Neurology Disapproval 72131 CT LUMBAR SPINE, LOW BACK Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; unknown; There has been treatment or conservative therapy.; physical therapy for 6 weeks, anti-inflammatory medications; complete back pain; unknown 1

Neurology Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is no weakness or reflex abnormality.; Clinical Information History / Dx: 729.5 Hand pain History / Dx: Pain in her hands. Positive numbness. Nerve conduction studies on her more affected hand were negative. She has not been able to get carpal tunnel braces yet as I recommended. Str 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is no weakness or reflex abnormality.; Patient has constant neck pain that shoots pain all over head and down both shoulders. Patient has had multiple episodes of blacking out with loss of memory. Arms, hands, and feet numb at all times. Patient has balance problems, walks "funny" at times. Ha 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; patient has numbness in the right side of the head and some neck and some feeling of weakness in the upper arms. Patient has a history of frozen arms; 1


This is a request for cervical spine MRI; Known or Suspected Multiple Sclerosis, Infection or abscess; yes, there are documented clinical findings of Multiple sclerosis.; Yes, the patient have new or changing neurological signs or symptoms.; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 1

Neurology Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for a neurological disorder.; 07/21/2015; There has been treatment or conservative therapy.; medication management; radiating low back and neck pain; 1


This study is being ordered for a neurological disorder.; 09/10/2014; There has been treatment or conservative therapy.; baclofen 10 mg tablet take 1 tablet by oral route 3 times every day amitriptyline 25 mg tablet take 1 tablet by oral route every day at bedtime Lyrica 75 mg capsule take 1 capsule by oral route 3 times every day tramadol 50 mg tablet 1 po q 6 hrs ; This patient is a 37-year-old male that I initially evaluated when he presented to the office with profound spasticity and myelopathic findings. His symptoms began about a year ago. I initially evaluated him in November of last year. He was complaining; The patient returns for evaluation. He is still having ambulating difficulties. He complains of discomfort in his right leg. The pain at times can be quite severe. The pain is daily. The pain causes him to bear less weight on this leg than on his lef 1


This study is being ordered for a neurological disorder.; many years; There has been treatment or conservative therapy.; elavil; nausea dizziness sharp pain behind the right eye; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Unknown; It is not known if there has been any treatment or conservative therapy.; Unknown; There has not been a reason or finding as to why patient has foot drop. 1

Neurology Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary



This study is being ordered for a neurological disorder.; 09/10/2014; There has been treatment or conservative therapy.; baclofen 10 mg tablet take 1 tablet by oral route 3 times every day amitriptyline 25 mg tablet take 1 tablet by oral route every day at bedtime Lyrica 75 mg capsule take 1 capsule by oral route 3 times every day tramadol 50 mg tablet 1 po q 6 hrs ; This patient is a 37-year-old male that I initially evaluated when he presented to the office with profound spasticity and myelopathic findings. His symptoms began about a year ago. I initially evaluated him in November of last year. He was complaining; The patient returns for evaluation. He is still having ambulating difficulties. He complains of discomfort in his right leg. The pain at times can be quite severe. The pain is daily. The pain causes him to bear less weight on this leg than on his lef 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; date unknown; There has been treatment or conservative therapy.; physical therapy and pt is take robaxin and ultram; Back pain inbetween his shoulder blades to the upper part of his lumbar spine. Primarliy midline pain. He has pain on either side of his spine as well in the paraspinal regions. He describes it as a constant burning pain as well as an occasional sharp sho; Thoracolumbar pain, presisten for several years byt worsening. The pateeint subjectiely has slight decreased sensation in the lower extremities with occasional paresthesias although I cannot detect any definited focal finding on examination today. Because 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Unknown; It is not known if there has been any treatment or conservative therapy.; Unknown; There has not been a reason or finding as to why patient has foot drop. 1

Neurology Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary



The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is no weakness or reflex abnormality.; Pain radiating down legs hx Arnold chiari malformation R/O spinal stenosis hx of wolff Parkinson white 1

Neurology Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 1


This study is being ordered for a neurological disorder.; 07/21/2015; There has been treatment or conservative therapy.; medication management; radiating low back and neck pain; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; date unknown; There has been treatment or conservative therapy.; physical therapy and pt is take robaxin and ultram; Back pain inbetween his shoulder blades to the upper part of his lumbar spine. Primarliy midline pain. He has pain on either side of his spine as well in the paraspinal regions. He describes it as a constant burning pain as well as an occasional sharp sho; Thoracolumbar pain, presisten for several years byt worsening. The pateeint subjectiely has slight decreased sensation in the lower extremities with occasional paresthesias although I cannot detect any definited focal finding on examination today. Because 1

Neurology Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary This study is being ordered for a neurological disorder.; ; There has been treatment or conservative therapy.; ; ; 2

OB/Gynecology Approval 70450 CT BRAIN, HEAD


OB/Gynecology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 2

OB/Gynecology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of tumor; A biopsy has not been completed to determine tumor tissue type.; There are not recent neurological symptoms such as one-sided weakness, speech impairments, or vision defects.; There is not a new and sudden onset of headache (less than 1 week) not improved by pain medications.; The tumor is a pituitary tumor or pituitary adenoma.; There are physical findings or laboratory values indicating abnormal pituitary hormone levels. 1

OB/Gynecology Approval 71250 CT CHEST, THORAX 3

OB/Gynecology Approval 71250 CT CHEST, THORAX

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; Assesment for chemo therapy to see if treatment needs to be continued or changed. 1

OB/Gynecology Approval 71250 CT CHEST, THORAX

This study is being ordered for Inflammatory/ Infectious Disease.; 08/15/2015; There has been treatment or conservative therapy.; This testing, chest xray was abnormal; abdominal pain with bloating and cramping decreased appetite, nausea, constipation r/o bowel blockage; unknown 1

OB/Gynecology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 2OB/Gynecology Approval 72192 CT PELVIS WITHOUT CONTRAST 3OB/Gynecology Approval 72196 MRI PELVIS 5

OB/Gynecology Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is for evaluation of the pelvis prior to surgery or laparoscopy. 3

OB/Gynecology Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is for suspicion of tumor, mass, neoplasm, or metastatic disease? 2

OB/Gynecology Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is not for any of the listed indications.; pt had pelvis surgery, patient has constant pain since 1

OB/Gynecology Approval 72196 MRI PELVIS

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/04/2015; There has not been any treatment or conservative therapy.; LWR ABD Pain in the groin area L-side.; MDO to R/O Hernia or Mass. 1

OB/Gynecology Approval 74150 CT ABDOMEN WITHOUT CONTRAST 1OB/Gynecology Approval 74176 CT ABD & PELVIS W/O CONTRAST 19

OB/Gynecology Approval 74176 CT ABD & PELVIS W/O CONTRAST






OB/Gynecology Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Other; There are clinical findings or indications of Hematuria. 2


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; pain x 1 yr 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; ureteral/vaginal fistula 1






This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; It is not known if a pelvic exam was performed.; US WAS 9/21 ABNORMAL 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; Assesment for chemo therapy to see if treatment needs to be continued or changed. 1


This study is being ordered for Inflammatory/ Infectious Disease.; 08/15/2015; There has been treatment or conservative therapy.; This testing, chest xray was abnormal; abdominal pain with bloating and cramping decreased appetite, nausea, constipation r/o bowel blockage; unknown 1

OB/Gynecology Approval 74181 MRI ABDOMEN 1

OB/Gynecology Approval 74181 MRI ABDOMEN

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/04/2015; There has not been any treatment or conservative therapy.; LWR ABD Pain in the groin area L-side.; MDO to R/O Hernia or Mass. 1

OB/Gynecology Approval 77058 MRI breast,without and/or with contrast material(s);unilateral 6

OB/Gynecology Approval 77058 MRI breast,without and/or with contrast material(s);unilateral

This is a request for Breast MRI.; This study is being ordered as a screening examination for known family history of breast cancer.; There is a pattern of breast cancer history in at least two first-degree relatives (parent, sister, brother, or children). 1


This is a request for Breast MRI.; This study is being ordered for something other than known breast cancer, known breast lesions, screening for known family history, screening following genetric testing or a suspected implant rupture.; Breast cancer screening member can't have skin compressed to do mammogram 1


Yes, the results of this MRI (size and shape of tumor) affect the patient's further management.; Yes, this is a confirmed breast cancer.; No, this is not an individual who has known breast cancer in the contralateral (other) breast.; This study is being ordered for a known history of breast cancer.; This is a request for Breast MRI. 1

OB/Gynecology Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY 1

OB/Gynecology Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for Cervical Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made). 1

OB/Gynecology Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; It is not known if the patient has had back pain for over 4 weeks.; Sciatica, low back pain that readiates down left leg. Xray of the Lumbar Apine on 09/03/15 showss Degenerative changes. 1

OB/Gynecology Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; low abdominal pain 1

Obstetrics & Gynecology Approval 77058 MRI breast,without and/or with contrast material(s);unilateral 2

Occupational Medicine Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2013; There has been treatment or conservative therapy.; Physical Therapy, Electro Stimulation Therapy and chiropractic adjustments w/ no improvements; Head ache, decreased range of motion and tingling; < Enter answer here - or Type In Unknown If No Info Given. > 1

Occupational Medicine Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2013; There has been treatment or conservative therapy.; Physical Therapy, Electro Stimulation Therapy and chiropractic adjustments w/ no improvements; Head ache, decreased range of motion and tingling; < Enter answer here - or Type In Unknown If No Info Given. > 1

Oncology Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for known tumor. 1

Oncology Approval 71250 CT CHEST, THORAX

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; 6/18/2015 1




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; restaging to check the status of tumor 1

Oncology Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Follow up treatment for cancer; Imaging studies have been performed on the member in the past 3 months.; 6/18/2015 1

Oncology Approval 74176 CT ABD & PELVIS W/O CONTRAST


Oncology Approval 74176 CT ABD & PELVIS W/O CONTRAST

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; restaging to check the status of tumor 1

Oncology Approval 77058 MRI breast,without and/or with contrast material(s);unilateral

This is a request for Breast MRI.; This study is being ordered for known breast lesions.; It is unknown if there are benign lesions in the breast associated with an increased cancer risk.; No, this is not an individual who has known breast cancer in the contralateral (other) breast.; No, this is not a confirmed breast cancer.; No, this patient does not have axillary node adenocarcinoma.; Yes, there are anatomic factors (deformity or extreme density) that make a simple mammogram impossible. 1

Oncology Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; To eval for endometrial CA. 1

Ophthalmology Approval 70450 CT BRAIN, HEAD 2Ophthalmology Approval 70480 CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC. 7Ophthalmology Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST 2Ophthalmology Approval 70540 MRI ORBIT/FACE/NECK W/O DYE 5

Ophthalmology Approval 70540 MRI ORBIT/FACE/NECK W/O DYE

This is a request for an Orbit MRI.; There is not a history of orbit or face trauma or injury.; There is not a suspicion of an infection or abscess.; This examination is NOT being requested to evaluate lymphadenopathy or mass.; There is not a suspicion of a bone infection (osteomyelitis).; There is NOT a suspicion of an orbit or face neoplasm, tumor, or metastasis.; 1


This study is being ordered for a neurological disorder.; sept 7th 2015; There has not been any treatment or conservative therapy.; blurred vision; double vision; dose imaging; vision shakes; present for the last 5 days; r/o tumors, stroke; 1


This study is being ordered for Inflammatory/ Infectious Disease.; 8/31/15; There has not been any treatment or conservative therapy.; Headache behind eyes and frontal lobe swelling of the optic nerve; < Enter answer here - or Type In Unknown If No Info Given. > 1

Ophthalmology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 3

Ophthalmology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST



This study is being ordered for a neurological disorder.; sept 7th 2015; There has not been any treatment or conservative therapy.; blurred vision; double vision; dose imaging; vision shakes; present for the last 5 days; r/o tumors, stroke; 1


This study is being ordered for Inflammatory/ Infectious Disease.; 8/31/15; There has not been any treatment or conservative therapy.; Headache behind eyes and frontal lobe swelling of the optic nerve; < Enter answer here - or Type In Unknown If No Info Given. > 1

Oral/Maxillofacial Approval 70336 MRI TEMPROMANDIBULAR JOINT,TMJ,JAW JOINT This is a request for a temporomandibular joint MRI. 1Orthopedics Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 1

Orthopedics Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST


Orthopedics Approval 71250 CT CHEST, THORAX


Orthopedics Approval 71250 CT CHEST, THORAX


Orthopedics Approval 71550 MRI CHEST This is a request for a chest MRI.; This study is being ordered for follow-up to trauma.; "The ordering physician is a surgeon, pulmonologist, or cardiologist." 1

Orthopedics Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST

This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is a reason why the patient cannot have a Cervical Spine MRI.; This study is being ordered due to pre-operative evaluation.; There is a known condition of neurological deficits.; The patient is experiencing or presenting symptoms of abnormal gait. 1

Orthopedics Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST This is a request for a Cervical Spine CT; This study is to be part of a Myelogram. 5


This study is being ordered for a neurological disorder.; 2/14/15; There has been treatment or conservative therapy.; PT for 3 months. medications.; severe right arm pain with numbness and tingling. right hand weakness.; R/O disc herniation and fracture 1


This study is being ordered for a neurological disorder.; 2001; There has been treatment or conservative therapy.; Patient saw a chiropractor and stated therapy did not help alleviate pain symptoms.; Constant numbness in right arm and hand with occasional tingling. Patient reports episodes of vertigo.; Evaluating cause of cervical spine pain and constant numbness in right arm into the hand. Patient notes constant numbness or tingling in his right hand worsened with rotation of his neck or raising his arms above his head. Describes pain in center of his 1

Orthopedics Approval 72128 CT THORACIC SPINE, UPPER BACK NO CONTRAST

This is a request for a thoracic spine MRI.; There is a reason why the patient cannot undergo a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting abnormal gait. 1

Orthopedics Approval 72131 CT LUMBAR SPINE, LOW BACK 1

Orthopedics Approval 72131 CT LUMBAR SPINE, LOW BACK



This is a request for a lumbar spine CT.; The patient does not have a history of severe low back trauma or lumbar injury.; This is not a preoperative or recent postoperative evaluation.; This study is not part of a myelogram or discogram.; The patient is not experiencing symptoms of radiculopathy for six weeks or more.; There is no neurologic symptoms of bowel or urinary bladder dysfunction. 1


This is a request for a lumbar spine CT.; The patient does not have a history of severe low back trauma or lumbar injury.; This is not a preoperative or recent postoperative evaluation.; This study is to be part of a myelogram or discogram. 1

Orthopedics Approval 72131 CT LUMBAR SPINE, LOW BACK This is a request for a lumbar spine CT.; The patient has a history of severe low back trauma or lumbar injury. 3


This study is being ordered for a neurological disorder.; 2001; There has been treatment or conservative therapy.; Patient saw a chiropractor and stated therapy did not help alleviate pain symptoms.; Constant numbness in right arm and hand with occasional tingling. Patient reports episodes of vertigo.; Evaluating cause of cervical spine pain and constant numbness in right arm into the hand. Patient notes constant numbness or tingling in his right hand worsened with rotation of his neck or raising his arms above his head. Describes pain in center of his 1

Orthopedics Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 6

Orthopedics Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST





This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; It is not known if there has been a supervised trial of conservative management for at least six weeks.; Yes, this patient had a recent course of supervised physical Therapy. 1






This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; Cervical pain that radiates into the shoulders with tingling and numbness (B) upper extremities. Decreased ROM in cervical spine and increased pain upper extremities.; Unknown 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has not seen the doctor more then once for these symptoms.; He is also having neck pain that radiates into the posterior shoulder and proximal upper arm bilaterally. He does not have significant radicular pain beyond the upper arm region. He continues to have symptoms of numbness, tingling, pain in his bilateral 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 4


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; There has been a supervised trial of conservative management for at least 6 weeks.; It is not known if this patient had a recent course of supervised physical Therapy.; The patient has failed a course of anti-inflammatory medication or steroids. 1










This is a request for cervical spine MRI; Neurological deficits; No, the patient is not experiencing or presenting new symptoms of upper extremity weakness?; No, the patient is not demonstrating unilateral muscle wasting.; No, the patient is not experiencing or presenting new symptoms of Bowel or bladder dysfunction.; No, the patient is not experiencing new onset of parathesia diagnosed by a neurologist; Yes, the patient is experiencing or presenting x-ray evidence of a recent fracture. 1


This is a request for cervical spine MRI; Neurological deficits; No, the patient is not experiencing or presenting new symptoms of upper extremity weakness?; No, the patient is not demonstrating unilateral muscle wasting.; No, the patient is not experiencing or presenting new symptoms of Bowel or bladder dysfunction.; Yes, the patient is experiencing new onset of parathesia diagnosed by a neurologist.; No, the patient is not experiencing or presenting x-ray evidence of a recent fracture.; <Enter Additional Clinical Information> 1

Orthopedics Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Neurological deficits; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 18

Orthopedics Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; None of the above; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 1

Orthopedics Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Pre-Operative Evaluation; No, the last Cervical spine MRI was not performed within the past two weeks. 1






This study is being ordered for a neurological disorder.; 2/14/15; There has been treatment or conservative therapy.; PT for 3 months. medications.; severe right arm pain with numbness and tingling. right hand weakness.; R/O disc herniation and fracture 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 08/17/2015; There has been treatment or conservative therapy.; PT, Anti Inflammatories; Numbness and tingling, cervical radiculopathy, weakness.; Headaches from neck pain 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; This is a 64-year-old female who presents with mid back and neck pain. Pain is chronic, since approximately 2012. Pain is burning in nature. She has pain in the mid thoracic region as well as her cervical spine. Neck pain radiates across the shoulde; There has been treatment or conservative therapy.; She had chiropractic treatment, for about a year which didn't help much. She tried TENS and traction without much relief. She is using an inversion table which helps some. She can't taken NSAIDS per cardiologist, she is on Coumadin for atrial fib.; Pain is burning in nature. She has pain in the mid thoracic region as well as her cervical spine. Neck pain radiates across the shoulders into the upper arm region to the elbow. She has intermittent numbness and tingling in her fingers. Pain progesses; AP and lateral x-ray of the thoracic spine ordered, obtained, and interpreted today reveals slight thoracolumbar curvature. Diffuse degenerative changes. AP and lateral x-ray of the cervical spine ordered, obtained, and interpreted today reveals 1

Orthopedics Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST 1

Orthopedics Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST



This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of lower extremity weakness documented on physical exam.; <Enter Additional Clinical Information> 1




This is a request for a thoracic spine MRI.; The study is being ordered due to Neurological deficits.; The patient is not experiencing or presenting symptoms of abnormal gait, lower extremity weakness, asymmetric reflexes, fracture, radiculopathy or bowel or bladder dysfunction.; Caller does not know whether the patient is experiencing sensory abnormalities such as numbness or tingling.; Motorcycle accident flipped & landed on shoulder. 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; This is a 64-year-old female who presents with mid back and neck pain. Pain is chronic, since approximately 2012. Pain is burning in nature. She has pain in the mid thoracic region as well as her cervical spine. Neck pain radiates across the shoulde; There has been treatment or conservative therapy.; She had chiropractic treatment, for about a year which didn't help much. She tried TENS and traction without much relief. She is using an inversion table which helps some. She can't taken NSAIDS per cardiologist, she is on Coumadin for atrial fib.; Pain is burning in nature. She has pain in the mid thoracic region as well as her cervical spine. Neck pain radiates across the shoulders into the upper arm region to the elbow. She has intermittent numbness and tingling in her fingers. Pain progesses; AP and lateral x-ray of the thoracic spine ordered, obtained, and interpreted today reveals slight thoracolumbar curvature. Diffuse degenerative changes. AP and lateral x-ray of the cervical spine ordered, obtained, and interpreted today reveals 1

Orthopedics Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 9

Orthopedics Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does have a new foot drop. 2


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is no weakness or reflex abnormality.; This is a pleasant 51-year-old African American female who presents with low back pain status post physical therapy. She has had back pain that has waxed and waned. On 5/1/15, she developed severe back pain with right leg pain and weakness. She has bee 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has not seen the doctor more then once for these symptoms.; This is a 38-year-old female who presents with neck, thoracolumbar/ low back pain. She was referred by Gretchen Keyse APN. Back is more bothersome, we are focusing on her back. Pain is chronic, since 2010 and getting worse. She reports that she was 1




The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; The home treatment did include exercise, prescription medication and follow-up office visits.; Home trx since 06/15/2015 pain worsening; Increased lordosis 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has not directed a home exercise program for at least 6 weeks.; None 1

Orthopedics Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; It is unknown if the patient has acute or chronic back pain.; This procedure is being requested for Neurologic deficits 1


The study requested is a Lumbar Spine MRI.; Neurological deficits; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is no weakness or reflex abnormality.; This 61 year old male presents for Spinal Stenosis. History of Present Illness: 1. Spinal Stenosis Location of pain is in the bilateral lumbar area, bilateral gluteal area and left leg. Location of weakness/numbness is in the bilateral lumbar area 1



Orthopedics Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal nerve study involving the lumbar spine 2

Orthopedics Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 10



Orthopedics Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 23


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; patient came in with complaints of right hip, leg and back pain. She is taking Mobic 15mg daily and has had no improvement with daily modifications. 1


The study requested is a Lumbar Spine MRI.; Trauma or recent injury; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is no weakness or reflex abnormality.; pt is having severe back pain with numbness in the right lower extremity. 1




This study is being ordered for a neurological disorder.; 7/23/15; There has been treatment or conservative therapy.; PT for 6 weeks, medications. injections; low back pain, numbness and tingling down both legs, right leg weakness. hip pain; R/O disc herniation and radiculopathy 1


This study is being ordered for a neurological disorder.; Unknown; There has been treatment or conservative therapy.; Previously treated with physical therapy and stated it didn't help.; Patient states she has numbness bilaterally in both hands and the hands feel like 'dead weight', pain from right hip that radiates down to right toes, lower lumbar pain that radiates bilaterally down legs. Complains of tenderness in lower lumbar with palp; To rule out abnormalities in the cervical and lumbar spine regions. 1


This study is being ordered for Inflammatory/ Infectious Disease.; 8/12/15; There has been treatment or conservative therapy.; 08/01/2015; pain in the lower back, hip and radiating pain down the legs; the pt has lateral recess stenosis,right L4-5 and right L5 radiculopathy including foot drop 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 01-05-2015; There has been treatment or conservative therapy.; NSAIDS, Steroid Injections, Ultrasound guided steroid injections, narcotics and 6 weeks of outpatient physical therapy.; Low back pain with radiculopathy and right hip pain with limited range of motion and inability to bear weight, sit and lay. Also pt. is unable to raise her leg.; Her gait is somewhat antalgic. She has decreased sensation upper thigh. No focal motor or neurologic changes otherwise noted right iliotibial band is markedly tender and a positive Ober sign. There is tenderness in the right groin as well. Knee motion is 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 08/17/2015; There has been treatment or conservative therapy.; PT, Anti Inflammatories; Numbness and tingling, cervical radiculopathy, weakness.; Headaches from neck pain 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 3 months ago; There has been treatment or conservative therapy.; pt has had surgery and physical therapy pt has also had a injection; pt has tenderness in her low back, right upper extremity in her low back; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for trauma or injury.; 2012; It is not known if there has been any treatment or conservative therapy.; pain that is constant and sharp; to evaluate the reason for the pain to see if it is caused by the pts scoliosis 1

Orthopedics Approval 72192 CT PELVIS WITHOUT CONTRAST 1

Orthopedics Approval 72192 CT PELVIS WITHOUT CONTRAST

This is a request for a Pelvis CT.; This study is being ordered as a follow-up to trauma.; "The ordering physician is not a gastroenterologist, urologist, gynecologist, or surgeon or PCP ordering on behalf of a specialist who has seen the patient."; There is NO laboratory or physical evidence of a pelvic bleed.; There are no physical or abnormal blood work consistent with peritonitis or pelvic abscess.; There is physical or radiological evidence of a pelvic fracture.; pelvic fx can't see extent in back 1


This is a request for a Pelvis CT.; This study is being ordered as pre-operative evaluation.; "The ordering physician is NOT an oncologist, urologist, gynecologist, gastroenterologist or surgeon or PCP ordering on behalf of a specialist who has seen the patient."; There is not a known tumor.; There is NO known pelvic infection.; 1


This is a request for a Pelvis CT.; This study is being ordered because of a suspicious mass/ tumor.; There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor.; "The patient has had a pelvic ultrasound, barium, CT, or MR study."; abnormal MRI showed mass 1

Orthopedics Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is for pelvic trauma or injury. 3

Orthopedics Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is for suspicion of tumor, mass, neoplasm, or metastatic disease? 1

Orthopedics Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is not for any of the listed indications.; PELVIS X-RAY DONE SHOWS SEVERE DYSPLASTIC CHANGES IN THE HIP... 1

Orthopedics Approval 72196 MRI PELVIS

This is a request for a Pelvis MRI.; The study is being ordered for joint pain or suspicion of joint or bone infection.; The study is being ordered for something other than arthritis, slipped femoral capital epiphysis, bilateral hip avascular necrosis, osteomylitis or tail bone pain or injury.; Enthesopathy of the hip region, bilateral hip pain, unresolved several years 1

Orthopedics Approval 73200 CT ARM OR UPPER EXTREMITY 4

Orthopedics Approval 73200 CT ARM OR UPPER EXTREMITY This is a request for an upper extremity, shoulder, scapula, elbow, hand, or wrist joint CT.; There is a history of upper extremity joint or long bone trauma or injury. 13

Orthopedics Approval 73200 CT ARM OR UPPER EXTREMITY

This is a request for an upper extremity, shoulder, scapula, elbow, hand, or wrist joint CT.; There is not a history of upper extremity joint or long bone trauma or injury.; This is a preoperative or recent postoperative evaluation. 4

Orthopedics Approval 73200 CT ARM OR UPPER EXTREMITY

This is a request for an upper extremity, shoulder, scapula, elbow, hand, or wrist joint CT.; There is not a history of upper extremity joint or long bone trauma or injury.; This is not a preoperative or recent postoperative evaluation.; There is not suspicion of upper extremity neoplasm or tumor or metastasis.; There is not suspicion of upper extremity bone or joint infection.; The ordering physician is an orthopedist or rheumatologist. 1

Orthopedics Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT 3

Orthopedics Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT The request is for an upper extremity non-joint MRI.; This is a preoperative or recent postoperative evaluation. 6

Orthopedics Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT

The request is for an upper extremity non-joint MRI.; This is not a preoperative or recent postoperative evaluation.; There is not suspicion of upper extremity neoplasm or tumor or metastasis.; There is no suspicion of upper extremity bone or soft tissue infection.; The ordering physician is an orthopedist. 3




This study is being ordered for trauma or injury.; 08/29/15; It is not known if there has been any treatment or conservative therapy.; Swelling of right forearm and right upper arm. Fluctuation noted upon exam .; Palpable fluctuant areas noted on exam. 2

Orthopedics Approval 73221 MRI JOINT OF UPPER EXTREMITY 26

Orthopedics Approval 73221 MRI JOINT OF UPPER EXTREMITY

The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; < Enter answer here - or Type In Unknown If No Info Given. > 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; evaluate for rotator cuff tear. shoulder weakness osteophytes 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; patient fell 8-23-15 landed on her shoulder. Has decreased ROM , severe pain. 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Right Shoulder ExaminationBrief Exam Skin: There are no abrasions, contusions, or erythema. Gait: Inspection: There is no deformity, swelling, ecchymosis or atrophy present. Palpation: Moderate subacromial crepitus. Moderate subacromial tenderness. 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Right Shoulder ExaminationBrief Exam Skin: There are no abrasions, contusions, or erythema. Gait: Inspection: There is no deformity, swelling, ecchymosis or atrophy present. Palpation: Moderate tenderness over the midshaft clavicle and supraclavicu 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; Rotator cuff tear, acute injury from a fall two weeks ago, on tramadol 1


The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; thoracic outlet syndrome 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; It is not known if the patient has completed and failed a course of conservative treatment.; . Patient is having ongoing pain for approximately 6 months. He fell back in July onto the shoulder and it seemed to get worse. He has not had any injections. He is not taking anti-inflammatories. He reports weakness and pain when lifting out to the 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; It is not known if the patient has completed and failed a course of conservative treatment.; Left shoulder pain & decreased ROM. Physician suspects rotator cuff tear 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; It is not known if the patient has completed and failed a course of conservative treatment.; left shoulder pain after he felt and heard a pop while shooting his bow. 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; It is not known if the patient has completed and failed a course of conservative treatment.; Left shoulder pain aggravated with lifting and reaching, with night pain. 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; It is not known if the patient has completed and failed a course of conservative treatment.; MRI Right shoulder. Right shoulder pain secondary to AC arthrosis; probable rotator cuff tear; rupture of long head of the bicep. Pt states he has a long history of right shoulder pain. Pt has a bulge at the base of his bisep. Atrophy, tenderness, externa 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; It is not known if the patient has completed and failed a course of conservative treatment.; Pain and severely limited ROM for 2 months. 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; It is not known if the patient has completed and failed a course of conservative treatment.; Patient has a new injury, has persistently positive impingement sign left shoulder and a new MRI is being ordered to check for a possible rotator cuff tear. 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has completed and failed a course of conservative treatment of at least 4 weeks.; The ordering physician is an orthopedist. 126




The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; < Enter answer here - or Type In Unknown If No Info Given. > 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; R/O ROTATOR CUFF TEAR PAIN DURING PHYSICAL ACTIVITIES PAIN WHEN SLEEPING 1


The requested study is a Shoulder MRI.; Study being ordered due to trauma within past 72 hours.; The patient has had recent plain films of the shoulder.; The plain films were normal.; It is not known if the patient is experiencing joint locking or instability.; The patient has a documented limited range of motion on physical examination. 1




The requested study is a Shoulder MRI.; Study being ordered due to trauma within past 72 hours.; The patient has had recent plain films of the shoulder.; The plain films were not normal. 2

Orthopedics Approval 73221 MRI JOINT OF UPPER EXTREMITY The requested study is a Shoulder MRI.; Study being ordered for post-operative evaluation.; The ordering physician is an orthopedist. 3


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; "This study is not being ordered prior to a planned or scheduled open surgery (joint replacement, etc.)."; He had an a.c. joint reconstruction and getting a lot of heterotopic bone. He has had previous surgery to remove some of this. He said over the last few years again having more pain especially with overhead activities and reaching across his body. A.C. 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; "This study is not being ordered prior to a planned or scheduled open surgery (joint replacement, etc.)."; The pain is worse with lifting pulling and stretching and better with rest. He points anteriorly as the area that is most painful. Regional numbness and tingling is noted. He also has pain at night. He states he has not had any history of dislocation. 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; : Kathleen Guin is a 62 years old Female from Elizabeth, AR. Patient fell in February and then again more recently. She is having worsening pain and inability to raise the arm. She is right-hand dominant. She has not had any injections or MRIs. Sh 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; Dislocation right shoulder recent origin with significant pain. There is a history of chronic subluxation. Particularly I want to see what her anterior glenoid looks like. 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; Pt is a 27 years old right hand dominant Female with RIGHT shoulder pain for 3 days. His began after she was lifting her son over her head and felt a pop in her shoulder. This was on August 29. Sharp, stabbing pain is intermittent and moderate in sever 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; RIGHT shoulder impingement/bursitis/tendonitis and questionable rotator cuff tear. 4 views of the right shoulder show mild a.c. joint arthritis and a type I acromion. The pain is worse with overhead activity and moving it and better with rest. She comp 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; To recent contusion right shoulder with evidence of grade 1 before meals strain. Furthermore at this time the patient exhibits findings of biceps tendinosis and a possible rotator cuff tear. . Patient notes that she is continuing to have anterior right 1

Orthopedics Approval 73221 MRI JOINT OF UPPER EXTREMITY The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; 5


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; < Enter answer here - or Type In Unknown If No Info Given. > 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; Continued right shoulder pain after conservative treatment. 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; LEFT shoulder impingement/bursitis/tendonitis and questionable rotator cuff tear. 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; Painful, limited ROM, right rotator cuff tear. 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; PATIENT FELL 3 YEARS AGO IN AN ACCIDENT ON THE GOLF COURSE AND HAS HAD PAIN SINCE THEN. SHE HAS PAIN RAISING AND REACHING BACK BEHIND. HAS HAD IBUPROFEN, HAS PAIN WITH SWINGING A GOLF CLUB, SO SHE HAS LIMITED ROM. TAKING MOBIC AND ASPRIN. 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; PATIENT HAS PAIN WITH HAWKINS AND NEER AND QUITE A BIT OF CREPITUS WITH HAWKINS. HER ROTATOR CUFF STRENGHT IS GOOD, BUT CAUSES PAIN WITH RESISTED SUPRASPINATUS TESTING. SHE IS TENDER OVER THE BICEP GROOVE. XR S HOWS A TYPE III ACROMION AND MILD DEGENERATI 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; patient has possible labral injury after throwing a softball hard resulting in immediate pain for the last 8 weeks. 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; Possible Labrum tear after injury 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is being ordered prior to arthroscopic surgery.; Sharp stabbing pain and problems with the shoulder think he may have some loose bodies in the shoulder versus chronic damage his rotator cuff. 1


The requested study is a Shoulder MRI.; Study being ordered for pre-operative evaluation; This study is not being ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; For views left shoulder show some mild a.c. joint arthritis and a type III acromion. LEFT shoulder impingement/bursitis/tendonitis and questionable rotator cuff tear 1

Orthopedics Approval 73221 MRI JOINT OF UPPER EXTREMITY The requested study is a Shoulder MRI.; Study is being ordered for known/suspected joint infection.; The plain films were not normal. 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is described as chronic; It is not known if the physician has directed conservative treatment for the past 6 weeks.; 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is described as chronic; It is not known if the physician has directed conservative treatment for the past 6 weeks.; Chronic bursitis of the right shoulder. I suspect this patient may have had at least a partial if not full-thickness rotator cuff tear. X-rays 4 views of the right shoulder show rather impressive acromioclavicular arthritis with a large subacromial spur 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; It is not known if the patient has completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient received oral analgesics.; It is not known if the patient has completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; The home treatment did include exercise, prescription medication and follow-up office visits.; home treatment. Patient has not improved with conservative care.; 1




The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient received oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; The home treatment did include exercise, prescription medication and follow-up office visits.; ; 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient recevied joint injection(s). 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is described as chronic; The physician has not directed conservative treatment for the past 6 weeks.; Pt has dealt with this pain for years, ready to get some answers. Pt seen in our clinic first time on 9/8/15. Pt is scheduled for shoulder surgery therefore request is for pre-op planning. Pt unable to perform normal daily routine activities, unable to ra 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from a recent injury.; There is a suspicion of tendon, ligament, rotator cuff injury or labral tear.; It is not know if surgery or arthrscopy is scheduled in the next 4 weeks.; Recurrent instability and dislocations. 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from a recent injury.; There is a suspicion of tendon, ligament, rotator cuff injury or labral tear.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; 2


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from a recent injury.; There is a suspicion of tendon, ligament, rotator cuff injury or labral tear.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; Injury due to fall 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from a recent injury.; There is a suspicion of tendon, ligament, rotator cuff injury or labral tear.; Surgery or arthrscopy is scheduled in the next 4 weeks. 1


The requested study is a Shoulder MRI.; This study being ordered for suspected aseptic necrosis.; The patient has had recent plain films of the shoulder.; The plain films were normal.; The ordering physician is an orthopedist or infectious disease specialist. 1


This is a request for an elbow MRI; The study is requested for evaluation of elbow pain.; The pain is described as chronic; The member has failed a 4 week course of conservative management in the past 3 months. 2




This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There has has been a history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has been treated with and failed a course of four weeks of supervised physical therapy. 4


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There has has been a history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint. 1


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does have an abnormal plain film study of the joint.; The patient has been treated with and failed a course of four weeks of supervised physical therapy. 4


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has been treated with and failed a course of four weeks of supervised physical therapy.; The patient does not have a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is being ordered by the operating surgeon for pre-operative planning. 1


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint. 7


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient does not have a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is being ordered by the operating surgeon for pre-operative planning. 1


This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is being ordered by the operating surgeon for pre-operative planning. 3




This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does have an abnormal plain film study of the joint.; The patient has been treated with and failed a course of four weeks of supervised physical therapy. 1


This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient does not have a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks. 1


This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has been treated with and failed a course of four weeks of supervised physical therapy.; The patient does not have a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks. 1


This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion. 1


This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient does not have a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is being ordered by the operating surgeon for pre-operative planning. 1


This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient does not have a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has not been treated with anti-inflammatory medication in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1


This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is being ordered by the operating surgeon for pre-operative planning. 1


This request is for a wrist MRI.; This study is requested for evalutation of wrist pain.; The pain is from a recent injury.; There is a suspicion of tendon or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; Julie Raney is a 29 y.o. female who presents for evaluation of left wrist pain. Onset was sudden, related to a fall from standing. Mechanism of injury: fall. Focused exam of left upper extremity demonstrates that she is neurovascularly intact distally. Lo 1


This request is for a wrist MRI.; This study is requested for evalutation of wrist pain.; The pain is from an old injury.; The member has failed a 4 week course of conservative management in the past 3 months. 1


This request is for a wrist MRI.; This study is requested for evalutation of wrist pain.; The pain is from an old injury.; The member has not failed a 4 week course of conservative management in the past 3 months.; < Enter answer here - or Type In Unknown If No Info Given. > 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 5/2015; There has been treatment or conservative therapy.; Physical therapy, anti-inflammatory medications, activity modification and rest.; Lateral shoulder pain down to elbow, night pain and pain with overhead activity.; 2


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 6-25-15; There has been treatment or conservative therapy.; Physical Therapy only completed 2 weeks because he could not complete due to the pain.; ; He has failed physical therapy. We will order an MRI scan of both the right and left shoulder. 2


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; several years; There has been treatment or conservative therapy.; Physical therapy, non steroidal, anti inflammatory narcotics, injections; pain, but with all therapy needs a to r/o bilateral cuff tears; xrays where normalhad an mri left and right shoulder shows arthritis and tindenitis 4

Orthopedics Approval 73221 MRI JOINT OF UPPER EXTREMITY This study is being ordered for trauma or injury.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for trauma or injury.; 4 years ago; There has been treatment or conservative therapy.; physical therapy steroid injection; pain severe On evaluation of his bilateral upper extremities, he doe not have any gross deformities, atrophies, or scars to his shoulders. His range of motion is symmetric with 180 degrees of forward elevation, 110 degrees of abduction, 50 degrees of; On examination, he does have bilateral impingement with possible rotator cuff pathology. He has received steroid injections in the past which have not given him any significant relief. Therefore, he would like to proceed with bilateral MRIs. That wa 2


This study is being ordered for trauma or injury.; DOI on or about 7/20/15; There has been treatment or conservative therapy.; NSAIDS, rest, activity modification; reduced ROM, tenderness, weakness, effusion, pain; xrays non-diagnostic. Pt not improving with time, rest, NSAIDS. 2

Orthopedics Approval 73700 CT LEG OR LOWER EXTREMITY 5

Orthopedics Approval 73700 CT LEG OR LOWER EXTREMITY



This is a request for a foot CT.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint. 1


This is a request for a foot CT.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion. 1


This is a request for a hip CT.; This study is not being ordered in conjunction with a pelvic CT.; There is not a suspected infection of the hip.; There is not a suspicion of AVN.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; The patient has a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the hip other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has been treated with and failed a course of supervised physical therapy. 1

Orthopedics Approval 73700 CT LEG OR LOWER EXTREMITY This is a request for a Lower Extremity CT.; This is a preoperative or recent postoperative evaluation. 6


This is a request for a Lower Extremity CT.; This is not a preoperative or recent postoperative evaluation.; There is no suspicion of a lower extremity neoplasm, tumor or metastasis.; There is no suspicion of lower extremity bone or joint infection.; There is not a history of lower extremity joint or long bone trauma or injury. 4


This is a request for a Lower Extremity CT.; This is not a preoperative or recent postoperative evaluation.; There is suspicion of a lower extremity neoplasm, tumor or metastasis. 1




This is a request for an ankle CT.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is a suspected tarsal coalition.; There is a history of new onset of severe pain in the ankle within the last two weeks.; The patient has a documented limitation of their range of motion.; The patient had an abnormal plain film study of the ankle other than arthritis. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2/11/2014; There has been treatment or conservative therapy.; ANTI INFLAMMATORY MOBIC, MEDROL DOSE PACK, SINVIS, CELEBREX, PHYSICAL THERAPY; PAIN; PRE OPERATIVE PLANNING 2


This study is being ordered for trauma or injury.; 07/10/2015; There has been treatment or conservative therapy.; Brace, medication; Pain and swelling; Right foot and ankle swells 3


This study is being ordered for trauma or injury.; 7/28/2015; There has been treatment or conservative therapy.; Medications were given as well as PT and anti inflammatory medications.; Back and hip pain as well as leg an knee pain; < Enter answer here - or Type In Unknown If No Info Given. > 2

Orthopedics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT 37

Orthopedics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT The ordering physician is an orthopedist.; Suspected meniscus, tendon, or ligament injury; This is a request for a Knee MRI. 1

Orthopedics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT





This is a request for a foot MRI.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion. 1




This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is a suspected tarsal coalition.; There is not a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion. 1




This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint.; This is not for pre-operative planning. 1


This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has been treated with and failed a course of supervised physical therapy. 1


This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint.; This is not for pre-operative planning. 1


This is a request for a foot MRI.; The study is being ordered for suspected fracture.; They did not have 2 normal xrays at least 3 weeks apart that did not show a fracture.; The patient has not had a recent bone scan.; 1

Orthopedics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is an orthopedist.; Instability 7

Orthopedics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is an orthopedist.; Limited range of motion 2

Orthopedics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is an orthopedist.; Locking 12


This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is an orthopedist.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were normal. 16


This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is an orthopedist.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were not normal. 3


This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is an orthopedist.; Pain greater than 3 days; The patient had recent plain films of the knee.; The results of the plain films is not known.; It is not known if patient has completed and failed a course of conservative treatment.; the patient is also having locking up and popping pain. The patient stats the knee is going out from under her when walking. Pain in knee and it is always weak and sore. 1

Orthopedics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is an orthopedist.; Swelling greater than 3 days 3

Orthopedics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Post-operative Evaluation; The ordering physician is an orthopedist. 1


This is a request for a Knee MRI.; Pre-operative Evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; "This study is being ordered prior to a planned or scheduled open surgery (joint replacement, etc.)."; The ordering physician is an orthopedist.; Limited range of motion 1


This is a request for a Knee MRI.; Pre-operative Evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; "This study is being ordered prior to a planned or scheduled open surgery (joint replacement, etc.)."; The ordering physician is an orthopedist.; Locking 1


This is a request for a Knee MRI.; Pre-operative Evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; "This study is being ordered prior to a planned or scheduled open surgery (joint replacement, etc.)."; The ordering physician is an orthopedist.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were not normal. 1


This is a request for a Knee MRI.; Pre-operative Evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; The ordering physician is an orthopedist.; Instability 3


This is a request for a Knee MRI.; Pre-operative Evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; The ordering physician is an orthopedist.; Limited range of motion 2


This is a request for a Knee MRI.; Pre-operative Evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; The ordering physician is an orthopedist.; Pain greater than 3 days; The patient has not had recent plain films of the knee.; It is not known if patient has completed and failed a course of conservative treatment.; Ted Weichselbaum is a 58 years old male from Mountain Home, AR. This man is seen today for evaluation of right knee pain. He also is been having some left knee pain. However this is more of a chronic problem for him. The right knee pain started appro 1


This is a request for a Knee MRI.; Pre-operative Evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; The ordering physician is an orthopedist.; Pain greater than 3 days; The patient has not had recent plain films of the knee.; Yes, patient has completed and failed a course of conservative treatment.; Physician directed course of non-steroidal anti-inflammatory medications 1


This is a request for a Knee MRI.; Pre-operative Evaluation; It is not known if the study is ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; The ordering physician is an orthopedist.; Swelling greater than 3 days 1


This is a request for a Knee MRI.; Pre-operative Evaluation; This study is being ordered prior to arthroscopic surgery.; The ordering physician is an orthopedist.; Limited range of motion 1

Orthopedics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Pre-operative Evaluation; This study is being ordered prior to arthroscopic surgery.; The ordering physician is an orthopedist.; Locking 1


This is a request for a Knee MRI.; Pre-operative Evaluation; This study is not being ordered prior to arthroscopic surgery.; "This study is being ordered prior to a planned or scheduled open surgery (joint replacement, etc.)."; The ordering physician is an orthopedist.; Limited range of motion 1


This is a request for a Knee MRI.; Pre-operative Evaluation; This study is not being ordered prior to arthroscopic surgery.; "This study is being ordered prior to a planned or scheduled open surgery (joint replacement, etc.)."; The ordering physician is an orthopedist.; Pain greater than 3 days; The patient had recent plain films of the knee.; The plain films were not normal. 2


This is a request for a Knee MRI.; Pre-operative Evaluation; This study is not being ordered prior to arthroscopic surgery.; It is not known if the study is for pre-operative planning.; The ordering physician is an orthopedist.; Swelling greater than 3 days 1

Orthopedics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is an orthopedist. 216


This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; No, there is no known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Instability 1






This is a request for a Knee MRI.; Suspicious Mass or Suspected Tumor/ Metastasis; The patient has not had recent plain films of the knee.; The patient has not had a recent bone scan.; No, the patient did not have a recent ultrasound of the knee.; There are no physical findings (palpabel mass) of a suspicious mass or known primary site of cancer.; Sharp pain started 3 months ago.Stairs and Weight Barring makes it worse. 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; It is not known if the patient has completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient recevied joint injection(s). 1




This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a known mass.; The diagnosis of Mass, Tumor, or Cancer has been established.; The study is requested for follow-up.; The study is not requested to detect residual cancer after a course of treatment has been completed?; The patient is presenting with unresolved or new symptoms 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a known mass.; The diagnosis of Mass, Tumor, or Cancer has been established.; The study is requested for staging. 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; It is not know if surgery or arthrscopy is scheduled in the next 4 weeks.; 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; 2


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; Pre op evaluation. 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; Suspected ligament injury 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; worried patient has a meniscal tear due to recent injury. 1




This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from an old injury.; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from an old injury.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient recevied joint injection(s). 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from an old injury.; The physician has not directed conservative treatment for the past 6 weeks.; Pt tried PT. Pt was told that she needed surgery, but never had it done. Pt can not control the knee itself. 1


This is a request for a Knee MRI.; There is no supsected meniscus,pre-op or post-op evaluation,non-acute Chronic Pain,supsected tumor or Aseptic Necrosis; It is not known if the ordering physician is an orthopedist.; There is no symptom of locking,Instability, Swelling,Redness,Limited range of motion or pain.; It is not known if patient had recent plain films of the knee.; 1


This is a request for a Knee MRI.; There is no supsected meniscus,pre-op or post-op evaluation,non-acute Chronic Pain,supsected tumor or Aseptic Necrosis; The ordering physician is an orthopedist.; Instability 2


This is a request for a Knee MRI.; There is no supsected meniscus,pre-op or post-op evaluation,non-acute Chronic Pain,supsected tumor or Aseptic Necrosis; The ordering physician is an orthopedist.; Limited range of motion 1


This is a request for a lower extremity MRI.; There is a pulsaitile mass.; "There is evidence of tumor or mass from a previous exam, plain film, ultrasound, or previous CT or MRI."; There is not a suspicion of an infection.; The patient is not taking antibiotics.; This is not a study for a fracture which does not show healing (non-union fracture).; This is not a pre-operative study for planned surgery. 1




This is a request for a lower extremity MRI.; This is not a pulsatile mass.; "There is no evidence of tumor or mass from a previous exam, plain film, ultrasound, or previous CT or MRI."; There is not a suspicion of an infection.; The patient is not taking antibiotics.; This is a study for a fracture which does not show healing (non-union fracture).; This is a pre-operative study for planned surgery. 1








This is a request for an Ankle MRI.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is a suspected tarsal coalition. 3




This is a request for an Ankle MRI.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the ankle within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the ankle other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has been treated with and failed a course of supervised physical therapy. 1


This is a request for an Ankle MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is a suspected tarsal coalition.; There is a history of new onset of severe pain in the ankle within the last two weeks. 2


This is a request for an Ankle MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the ankle within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the ankle other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint. 1




This is a request for an Ankle MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the ankle within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient had an abnormal plain film study of the ankle other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1


This is a request for an Ankle MRI.; The study is requested for a reason other that ankle pain.; The study is for post operative evaluation.; There are physical or plain film findings of delayed or failed healing. 1


This is a request for an Ankle MRI.; The study is requested for ankle pain.; It is not known if there is a suspicion of tendon or ligament injury.; There is a suspicion of fracture not adequately determined by x-ray. 1


This is a request for an Ankle MRI.; The study is requested for ankle pain.; There is a suspicion of tendon or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; tendinitis and possible lateral ankle instability.wn If No Info Given. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; Bone mets seen on previous CT 2


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; SOFT TISSUE MASSES WITHIN THE ANTERIOR PORTION OF THE KNEE BILATERALLY IN THE INFRAPATELLAR REGION, THESE ARE FIRM AND MOBILE, WITH A SLIGHTLY NODULAR FEEL 2




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2013; There has been treatment or conservative therapy.; had steroid injections/ anti inflammatory meds (off and on); bilat knee pain/ having mechanical catching in the knee; joint tenderness on physical exam, has positive mcmurray's bilat / xrays showed mild to moderate osteoarthritis in both knees has possible mensiscal pathology In both knees 2

Orthopedics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This study is being ordered for trauma or injury.; ; There has been treatment or conservative therapy.; ; ; 2


This study is being ordered for trauma or injury.; 09/15/2015; There has been treatment or conservative therapy.; Short leg walking boot, oral NSAIDs, activity modification (rest, ice, and alternating with heat). All with no improvement. X-ray performed on 09/17/2015 that was negative.; Pain and swelling to right foot and ankle, unable to bear weight, pain on plantar fascia plate, decreased sensation in plantar surface of foot and dorsal lateral foot compared to the left side.; R/o plantar fascia tear. 1


This study is being ordered for trauma or injury.; 7/25/15; There has been treatment or conservative therapy.; unknown; knee and ankle pain; < Enter answer here - or Type In Unknown If No Info Given. > 2


This study is being ordered for trauma or injury.; July 2015; There has been treatment or conservative therapy.; Naproxen, steroid injections, rest and icing; swelling and pain with ambulation; The left and right knee both have good range of motion with extension. However, they do have pain with flexion and cannot flex past 90 degrees. She has severe retropatellar crepitus. No instability with varus or valgus strain. Most of her tenderness t 2

Orthopedics Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT 2

Orthopedics Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT

The patient had an abnormal plain film study of the hip other than arthritis.; The patient has a documented limitation of their range of motion.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; There is not a suspicion of AVN.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; This study is not being ordered in conjunction with a pelvic MRI.; This is a requests for a hip MRI. 1


This is a requests for a hip MRI.; The request is for hip pain.; The hip pain is chronic.; The member has failed a 4 week course of conservative management in the past 3 months. 1


This is a requests for a hip MRI.; This study is being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion.; The patient had an abnormal plain film study of the hip other than arthritis.; The patient has used a cane or crutches for greater than four weeks. 2






This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is receiving long-term steriod therapy (Prednisone or Cortisone). 1


This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion. 7


This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is a suspicion of AVN.; The patient is receiving long-term steriod therapy (Prednisone or Cortisone). 3


This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient does not have a documented limitation of their range of motion.; The patient had an abnormal plain film study of the hip other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has been treated with and failed a course of supervised physical therapy. 2




This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the hip other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; There is not a mass near the hip.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint.; This is for pre-operative planning. 1


This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the hip other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; There is not a mass near the hip.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint.; This is not for pre-operative planning. 2




This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the hip other than arthritis.; The patient has used a cane or crutches for greater than four weeks. 8




This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion. 1


This study is being ordered for a neurological disorder.; 7/23/15; There has been treatment or conservative therapy.; PT for 6 weeks, medications. injections; low back pain, numbness and tingling down both legs, right leg weakness. hip pain; R/O disc herniation and radiculopathy 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 01-05-2015; There has been treatment or conservative therapy.; NSAIDS, Steroid Injections, Ultrasound guided steroid injections, narcotics and 6 weeks of outpatient physical therapy.; Low back pain with radiculopathy and right hip pain with limited range of motion and inability to bear weight, sit and lay. Also pt. is unable to raise her leg.; Her gait is somewhat antalgic. She has decreased sensation upper thigh. No focal motor or neurologic changes otherwise noted right iliotibial band is markedly tender and a positive Ober sign. There is tenderness in the right groin as well. Knee motion is 1

Orthopedics Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Lesion 11th Rib. Sharp pain that goes down legs. Lower back pain which is constant. Physical Therapy has been done as well as Tramadol taken. 1

Orthopedics Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Requested for evaluation of tumor; A biopsy has not been completed to determine tumor tissue type.; There are not recent neurological symptoms such as one-sided weakness, speech impairments, or vision defects.; There is not a new and sudden onset of headache (less than 1 week) not improved by pain medications.; The tumor is not a pituitary tumor or pituitary adenoma.; superficial palpable mass just superior to the ear on lateral side of head times 2 months due to patient being still within child bearing years physician would prefer to evaluate with MRI instead of CT 1

Orthopedics Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 3/2015; There has been treatment or conservative therapy.; Injections Nsaid's; Pain with reaching above head Cervical pain Shoulder pain; < Enter answer here - or Type In Unknown If No Info Given. > 1

Orthopedics Disapproval 71550 MRI CHEST Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; 01/18/2014; There has been treatment or conservative therapy.; 3 months of PT, trigger point injections, Mobic 15mg; neck pain, shoulder pain, chest pain, numbness and tingling down arms, bilateral hand weakness and headaches; trying to R/O disc herniation for the neck, looking at lymphadenopathy 1

Orthopedics Disapproval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST Radiology Services Denied Not Medically Necessary This is a request for a Cervical Spine CT; This study is to be part of a Myelogram. 1

Orthopedics Disapproval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 3/2015; There has been treatment or conservative therapy.; Injections Nsaid's; Pain with reaching above head Cervical pain Shoulder pain; < Enter answer here - or Type In Unknown If No Info Given. > 1

Orthopedics Disapproval 72128 CT THORACIC SPINE, UPPER BACK NO CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; Chronic Pain, severe pain starting in 12/2010; There has been treatment or conservative therapy.; Physical Therapy, Steroid injections, Oral steroids, NSAID treatment, Chropractic Care; 58-year-old female with chronic progressive history of thoracolumbar pain that is now radiating into both legs mostly on the right and L5 distribution. The pain is severe. Her main complaint of pain is at the thoracolumbar junction on the right side aro; 1

Orthopedics Disapproval 72131 CT LUMBAR SPINE, LOW BACK Radiology Services Denied Not Medically Necessary


Orthopedics Disapproval 72131 CT LUMBAR SPINE, LOW BACK Radiology Services Denied Not Medically Necessary This is a request for a lumbar spine CT.; The patient has a history of severe low back trauma or lumbar injury. 1

Orthopedics Disapproval 72131 CT LUMBAR SPINE, LOW BACK Radiology Services Denied Not Medically Necessary

This study is being ordered for a neurological disorder.; Chronic Pain, severe pain starting in 12/2010; There has been treatment or conservative therapy.; Physical Therapy, Steroid injections, Oral steroids, NSAID treatment, Chropractic Care; 58-year-old female with chronic progressive history of thoracolumbar pain that is now radiating into both legs mostly on the right and L5 distribution. The pain is severe. Her main complaint of pain is at the thoracolumbar junction on the right side aro; 1

Orthopedics Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient demonstrate neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks.; No, this patient did not have a recent course of supervised physical Therapy.; It is not known if the patient has failed a course of anti-inflammatory medication or steroids.; It is not known if the patient had six weeks of Chiropractic care related to this episode.; There is a right-sided thoracolumbar scoliosis. There is narrowing of L2-L3 L3-L4 and L5-S1 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has NOT had back pain for over 4 weeks.; : 2 views of the cervical spine shows calcification of the thyroid. Spurring is noted anteriorly as well as posteriorly in the lower cervical levels cervical spondylosis and DJD 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is no weakness or reflex abnormality.; Review of Systems from 4-17-15 is positive for numbness in the hands and anxiety 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is no weakness or reflex abnormality.; to evaluate for the cause of and numbness in the left side. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is reflex abnormality.; abduction is 3\5 on right 3\5 on left external rotation at 0. decrease sensation of radial bone and index finger; < Enter answer here - or Type In Unknown If No Info Given. > 1




This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; INTERMITTENT NUMBNESS IN FOOT, PAIN AND LIMITED RANGE OF MOTION; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; right upper extremity weakness, compared to contralateral side; very abnormal plain file x-ray, with degeneration. symptoms of neck pain with rue radiculopathy. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; It is not known was medications were used in treatment.; It is not known if the patient has completed 6 weeks or more of Chiropractic care.; The physician has not directed a home exercise program for at least 6 weeks.; Pt was referred by PCP to orthopedic specialist. Pt has numbness and tingling. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; The home treatment did include exercise, prescription medication and follow-up office visits.; May 8 2015 Start date , Last visit July 10 no improvement; popping in shoulder 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has not directed a home exercise program for at least 6 weeks.; None 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; Yes, the patient demonstrate neurological deficits.; No, there is not a documented evidence of extremity weakness on physical examination.; No, there is no evidence of recent development of unilateral muscle wasting.; There has not been a supervised trial of conservative management for at least 6 weeks.; Maloxican and Medrol dose pack, Rarm pain, R arm and hand numbness and tingling. Possible servical radiclopathy 1




This is a request for cervical spine MRI; None of the above; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has NOT had back pain for over 4 weeks.; 1


This is a request for cervical spine MRI; None of the above; No, the patient is not experiencing or presenting new symptoms of upper extremity weakness?; No, the patient is not demonstrating unilateral muscle wasting.; No, the patient is not experiencing or presenting new symptoms of Bowel or bladder dysfunction.; No, the patient is not experiencing new onset of parathesia diagnosed by a neurologist; No, the patient is not experiencing or presenting x-ray evidence of a recent fracture.; 2

Orthopedics Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This is a request for cervical spine MRI; Trauma or recent injury; It is not known if the patient have new or changing neurological signs or symptoms.; 1




This study is being ordered for a neurological disorder.; 2013; There has been treatment or conservative therapy.; steriod injs - 3 rounds of PT - muscle relaxers - meloxicam; L shoulder pain - cervical pain - difficulty sleeping; has done 1 year of conservative treatments with no relief. 1


This study is being ordered for a neurological disorder.; 6/16/2015; There has been treatment or conservative therapy.; CHIROPRATIC MANIPULATION; 40-year-old gentleman that approximately 2-1/2 months ago he was walking off a wheelchair ramp and slipped and fell and landed on his low back. He went to a chiropractor for an adjustment, but he states that it made his pain worse. He complains of sever; 1. His physical exam findings with his upper motor neuron reflexes were discussed with the patient. Given that he has had a recent fall and he has sustained bilateral clonus with worsening midthoracic pain, I have recommended he undergo an MRI of his tho 1


This study is being ordered for a neurological disorder.; unknown; There has been treatment or conservative therapy.; medication, therapy; patient having back and neck pain, tingling, numbness; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; Unknown; There has been treatment or conservative therapy.; Physical Therapy and three Epidural Steroid Injections.; Gradual onset of symptoms over 20 years with worsening symptoms over last 2 years. Patient fell through a ladder on 2007, hit left leg, and has residual numbness through now. Symptoms worsen with prolonged periods of sitting or standing. Patient completed; Unknown 1


This study is being ordered for a neurological disorder.; Unknown; There has been treatment or conservative therapy.; Previously treated with physical therapy and stated it didn't help.; Patient states she has numbness bilaterally in both hands and the hands feel like 'dead weight', pain from right hip that radiates down to right toes, lower lumbar pain that radiates bilaterally down legs. Complains of tenderness in lower lumbar with palp; To rule out abnormalities in the cervical and lumbar spine regions. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 10 years ago; There has been treatment or conservative therapy.; steroids,physical therapy; right leg numbness, increased pain with prolonged walking,sitting, or standing, been to pain clinic had injections and physical therapy and still in pain; xrays showing mild c5 to 6 disc degeneration and slight kyphosis at c4 and 5 .chronic pain for 10yrs 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1-2015; There has been treatment or conservative therapy.; medication; pain neck and back; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 3 months ago; There has been treatment or conservative therapy.; pt has had surgery and physical therapy pt has also had a injection; pt has tenderness in her low back, right upper extremity in her low back; < Enter answer here - or Type In Unknown If No Info Given. > 1

Orthopedics Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does not have any neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; The patient has failed a course of anti-inflammatory medication or steroids.; It is not known how many follow-up thoracic spine MRIs the patient has had.; 1


This study is being ordered for a neurological disorder.; 58-year-old female with chronic progressive history of thoracolumbar pain that is now radiating into both legs mostly on the right and L5 distribution. The pain is severe. Her main complaint of pain is at the thoracolumbar junction on the right side aro; There has been treatment or conservative therapy.; NSaid therapy, Oral and epidural steroid therapy, Home exercise program, Physical therapy; 58-year-old female with chronic progressive history of thoracolumbar pain that is now radiating into both legs mostly on the right and L5 distribution. The pain is severe. Her main complaint of pain is at the thoracolumbar junction on the right side aro; 1


This study is being ordered for a neurological disorder.; 6/16/2015; There has been treatment or conservative therapy.; CHIROPRATIC MANIPULATION; 40-year-old gentleman that approximately 2-1/2 months ago he was walking off a wheelchair ramp and slipped and fell and landed on his low back. He went to a chiropractor for an adjustment, but he states that it made his pain worse. He complains of sever; 1. His physical exam findings with his upper motor neuron reflexes were discussed with the patient. Given that he has had a recent fall and he has sustained bilateral clonus with worsening midthoracic pain, I have recommended he undergo an MRI of his tho 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 10 years ago; There has been treatment or conservative therapy.; steroids,physical therapy; right leg numbness, increased pain with prolonged walking,sitting, or standing, been to pain clinic had injections and physical therapy and still in pain; xrays showing mild c5 to 6 disc degeneration and slight kyphosis at c4 and 5 .chronic pain for 10yrs 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2008; There has been treatment or conservative therapy.; Ibuprofen, Home exercises; back pain Left arm and leg pain; Enter answer here - or Type In Unkn Arkansas Specialty Orthopaedics, 600 South McKinley, Little Rock, AR 72205 __________________________________________________________________________________ PATIENT: Marsha Hippler MED REC NUM: 000000009518 1


This study is being ordered for trauma or injury.; 2012; It is not known if there has been any treatment or conservative therapy.; pain that is constant and sharp; to evaluate the reason for the pain to see if it is caused by the pts scoliosis 1

Orthopedics Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; It is not known if the physician has directed conservative treatment for the past 6 weeks.; Patient complains of lower lumbar pain. States onset of pain followed surgical procedure patient had in August, 2015. States doing multiple lifting and carrying activities over summer. Denies any specific injury. X-ray of lumbar and thoracic spine on 08/3 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; It is not known if the physician has directed conservative treatment for the past 6 weeks.; Patient complains of pain across her lower lumbar into both hips that radiates down both legs into her feet. Describes the pain as beginning with numbness that is followed by pins and needles with moderated burning sensations in both feet, and the pain is 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; It is not known if the patient has completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; It is not known if the patient has completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; The home treatment did include exercise, prescription medication and follow-up office visits.; ; 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; It is not known if there is weakness or reflex abnormality.; the pt has degenerative disc disease and thoracic scoliosis, she is having numbness and tingling in the left side. 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is no weakness or reflex abnormality.; no weakness verbalized by the patient. severe pain when in sitting position. has tried rest and ICE Has been on muslce reaxers and anti-inflammatories not helping with the back pain. 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is no weakness or reflex abnormality.; She is 5'3" and weighs 185 pounds. Mood, orientation, affect, and appearance are appropriate. She is heavy and moves slowly. She has a slight asymmetry and seems to have a slightly shorter left leg. She walks with a mildly waddling gait. She has tend 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; ; 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; Leg weakness; Herniation and l45 1




The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; in may was running track, heard a snap in his back. Can't run without pain. Was put on some meds back in May. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Patient complaining of lumbosacral spine pain without radiation into either lower extremity. Recent bone scan is normal. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Patient Has had 4 weeks of Therapy and it has helped some but has not eliminated the pain. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Patient has had other testing and now the Dr is wanting to see if the pain is coming from the Lspine 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; patient is having low back pain with numbness at times down both legs. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Patient with chronic back pain and weakness in both legs for over a year. 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Pt is a 64 years old Male with LEFT hip pain since June of this year. He had a fall and that is when this began. He describes pain as sharp, achy pain is intermittent and 9/10 severity. Pain is worse with stretching and pulling and standing and better 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Suspected spondylolytic spondylolisthesis.Range of motion of lumbar spine is grossly limited. Patient has tried Percogesic and ibuprofen with no relief of symptoms. 1


This study is being ordered for a neurological disorder.; 58-year-old female with chronic progressive history of thoracolumbar pain that is now radiating into both legs mostly on the right and L5 distribution. The pain is severe. Her main complaint of pain is at the thoracolumbar junction on the right side aro; There has been treatment or conservative therapy.; NSaid therapy, Oral and epidural steroid therapy, Home exercise program, Physical therapy; 58-year-old female with chronic progressive history of thoracolumbar pain that is now radiating into both legs mostly on the right and L5 distribution. The pain is severe. Her main complaint of pain is at the thoracolumbar junction on the right side aro; 1


This study is being ordered for a neurological disorder.; unknown; There has been treatment or conservative therapy.; medication, therapy; patient having back and neck pain, tingling, numbness; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for a neurological disorder.; Unknown; There has been treatment or conservative therapy.; Physical Therapy and three Epidural Steroid Injections.; Gradual onset of symptoms over 20 years with worsening symptoms over last 2 years. Patient fell through a ladder on 2007, hit left leg, and has residual numbness through now. Symptoms worsen with prolonged periods of sitting or standing. Patient completed; Unknown 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 1-2015; There has been treatment or conservative therapy.; medication; pain neck and back; < Enter answer here - or Type In Unknown If No Info Given. > 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2008; There has been treatment or conservative therapy.; Ibuprofen, Home exercises; back pain Left arm and leg pain; Enter answer here - or Type In Unkn Arkansas Specialty Orthopaedics, 600 South McKinley, Little Rock, AR 72205 __________________________________________________________________________________ PATIENT: Marsha Hippler MED REC NUM: 000000009518 1

Orthopedics Disapproval 72196 MRI PELVIS Radiology Services Denied Not Medically Necessary

This study is being ordered for Inflammatory/ Infectious Disease.; 8/12/15; There has been treatment or conservative therapy.; 08/01/2015; pain in the lower back, hip and radiating pain down the legs; the pt has lateral recess stenosis,right L4-5 and right L5 radiculopathy including foot drop 1

Orthopedics Disapproval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT Radiology Services Denied Not Medically Necessary

This study is being ordered for Congenital Anomaly.; 11/2014; There has been treatment or conservative therapy.; hand therapy.; severe pain in wrist, arm, and fingers, as well as, numbness.; < Enter answer here - or Type In Unknown If No Info Given. > 2

Orthopedics Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary

This is a request for an elbow MRI; The study is requested for evaluation of elbow pain.; The pain is not from a recent injury, old injury, chronic pain or a mass.; hand numbness and right thumb locking 1




This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint. 1




This study is being ordered for a neurological disorder.; 2013; There has been treatment or conservative therapy.; steriod injs - 3 rounds of PT - muscle relaxers - meloxicam; L shoulder pain - cervical pain - difficulty sleeping; has done 1 year of conservative treatments with no relief. 1

Orthopedics Disapproval 73225 MRA, MRI ANGIOGRAPHY UPPER EXTREMITY WITH/WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for trauma or injury.; ; There has been treatment or conservative therapy.; ; ; 1

Orthopedics Disapproval 73700 CT LEG OR LOWER EXTREMITY Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; 07/10/2015; There has been treatment or conservative therapy.; Brace, medication; Pain and swelling; Right foot and ankle swells 1

Orthopedics Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary This is a request for a foot MRI.; The study is being ordered forfoot pain.; The study is being ordered for acute pain.; questionable posterior tibial tendon tear. . 1

Orthopedics Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is an orthopedist. 1

Orthopedics Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary

This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; It is not known if the patient has completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient received oral analgesics.; It is not known if the patient has completed 6 weeks or more of Chiropractic care.; It is not known if the physician has directed a home exercise program for at least 6 weeks.; 1




This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is described as chronic; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient recevied medication other than joint injections(s) or oral analgesics.; ibuprofen and ultram; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has not directed a home exercise program for at least 6 weeks.; needing to rule out a meniscus tear 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is described as chronic; The physician has not directed conservative treatment for the past 6 weeks.; medial joint line tenderness; modified daily activities; nsaids not working; possible medial meniscus tear 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is described as chronic; The physician has not directed conservative treatment for the past 6 weeks.; ongoing knee pain worried she has a meniscal tear joint line tenderness 1


This is a request for a Knee MRI.; The study is requested for knee pain.; The pain is from a recent injury.; There is a suspicion of a meniscus, tendon, or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; 1






This is a request for an Ankle MRI.; The study is requested for ankle pain.; There is a suspicion of tendon or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; MRI is being ordered for suspected tendon and ligament injury. 1


This study is being ordered for trauma or injury.; 09/15/2015; There has been treatment or conservative therapy.; Short leg walking boot, oral NSAIDs, activity modification (rest, ice, and alternating with heat). All with no improvement. X-ray performed on 09/17/2015 that was negative.; Pain and swelling to right foot and ankle, unable to bear weight, pain on plantar fascia plate, decreased sensation in plantar surface of foot and dorsal lateral foot compared to the left side.; R/o plantar fascia tear. 1

Orthopedics Disapproval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT Radiology Services Denied Not Medically Necessary

This is a requests for a hip MRI.; This study is not being ordered in conjunction with a pelvic MRI.; "There is no a history (within the last six months) of significant trauma, dislocation, or injury to the hip."; There is not a suspicion of AVN.; The patient is not receiving long-term steriod therapy (Prednisone or Cortisone).; The patient has a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the hip other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; There is not a mass near the hip.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint.; This is for pre-operative planning. 1

Osteopath Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; Intercoastal neuralgia, "pinching" pain. Worse with bending to right side. 1

Other Approval 70336 MRI TEMPROMANDIBULAR JOINT,TMJ,JAW JOINT This is a request for a temporomandibular joint MRI. 1

Other Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST


Other Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST


Other Approval 71250 CT CHEST, THORAX


Other Approval 71250 CT CHEST, THORAX


Other Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST






Other Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST


Other Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 2

Other Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST This study is being ordered for trauma or injury.; ; There has been treatment or conservative therapy.; ; ; 1

Other Approval 72191 CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST This is a request for a pelvis CT angiography. 1

Other Approval 72196 MRI PELVIS This study is being ordered for trauma or injury.; ; There has been treatment or conservative therapy.; ; ; 1

Other Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is not an orthopedist.; Swelling greater than 3 days 1

Other Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is not an orthopedist.; It is not known if there is a known trauma involving the knee.; Yes, the member experience a painful popping, snapping, or giving away of the knee.; Limited range of motion 1

Other Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; There is a known or a strong suspicion of kidney or ureteral stones. 1

Other Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This study is being ordered for trauma or injury.; 9/18/2015; There has not been any treatment or conservative therapy.; Lower neck and head pain.; None 1

Other Disapproval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST Radiology Services Denied Not Medically Necessary This study is being ordered for trauma or injury.; 9/18/2015; There has not been any treatment or conservative therapy.; Lower neck and head pain.; None 1

Other Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient demonstrate neurological deficits.; It is not known if there has been a supervised trial of conservative management for at least six weeks.; It is not known if this patient had a recent course of supervised physical Therapy.; It is not known if the patient has failed a course of anti-inflammatory medication or steroids.; It is not known if the patient had six weeks of Chiropractic care related to this episode.; MDO bypassed the clinical questions. 1

Other Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has not seen the doctor more then once for these symptoms.; Patient was given an anti-inflamatory to see if that would help also. 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; It is not known if the physician has directed conservative treatment for the past 6 weeks.; Patient's mid to lower back has continued to get worse. 1


The study requested is a Lumbar Spine MRI.; None of the above; It is not known if the patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has had back pain for over 4 weeks.; MDO bypassed the clinical questions. 1

Other Disapproval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT Radiology Services Denied Not Medically Necessary


Other Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; It is unknown if the patient had an Amylase or Lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were abnormal.; The urinalysis was positive for ketones.; Patient has stomach cancer and is just making sure it not matassis size. 1

Otolaryngology Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for known or suspected brain tumor, mass or cancer.; There is a suspected or known brain tumor. 1

Otolaryngology Approval 70480 CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC. 6

Otolaryngology Approval 70480 CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC.

"This request is for orbit,sella, int. auditory canal,temporal bone, mastoid, CT.239.8"; "There is not suspicion of bone infection, cholesteoma, or inflammatory disease.ostct"; "There is not a history of serious head or skull, trauma or injury.ostct"; "There is not suspicion of neoplasm, or metastasis.ostct"; This is not a preoperative or recent postoperative evaluation.; "There is not suspicion of acoustic neuroma, pituitary or other tumor. ostct" 1

Otolaryngology Approval 70480 CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC. "This request is for orbit,sella, int. auditory canal,temporal bone, mastoid, CT.239.8"; "There is suspicion of bone infection, cholesteoma, or inflammatory disease.ostct" 17

Otolaryngology Approval 70480 CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC.

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/18/2015; There has been treatment or conservative therapy.; Pt with one week c/o ear pain, swelling and trismus, no improvement with abxs and drops. She has had a lot of ear infections and otitis externa in the past.; c/o ear pain, swelling and trismus, no improvement with abxs and drops. Severe ear pain, ear swelling, facial swelling; No additional 1

Otolaryngology Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST 28

Otolaryngology Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST



This is a request for a Sinus CT.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as Chronic Rhinosinusitis (episode is greater than 12 weeks); This study is being ordered for sinusitis. 1

Otolaryngology Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST This is a request for a Sinus CT.; This study is being ordered for a known or suspected tumor. 8

Otolaryngology Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST This is a request for a Sinus CT.; This study is being ordered for follow-up to trauma. 1

Otolaryngology Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST This is a request for a Sinus CT.; This study is being ordered for post-operative evaluation. 1

Otolaryngology Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST This is a request for a Sinus CT.; This study is being ordered for pre-operative evaluation. 11


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; It is unknown if the patient is immune-compromised.; The patient's current rhinosinusitis symptoms are described as Chronic Rhinosinusitis (episode is greater than 12 weeks) 7


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; It is unknown if the patient is immune-compromised.; The patient's current rhinosinusitis symptoms are described as Chronic Rhinosinusitis (episode is greater than 12 weeks); < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; It is unknown if the patient is immune-compromised.; The patient's current rhinosinusitis symptoms are described as Recurrent Acute Rhinosinusitis (4 or more acute episodes per year); 1

Otolaryngology Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is immune-compromised. 3


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is immune-compromised.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as (sudden onset of 2 or more symptoms of nasal discharge, blockage or congestion, facial pain, pressure and reduction or loss of sense of smell, which are less than 12 wks in duration); It has been 14 or more days since onset AND the patient failed a course of antibiotic treatment; 9/2/15 She complains of constant right sided nasal congestion. She has fairly severe allergies. She is not undergoing immunotherapy. She is currently using nasal steroids. She had a short course of antibiotics that were not effective. nasal mucosa is dry. 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as (sudden onset of 2 or more symptoms of nasal discharge, blockage or congestion, facial pain, pressure and reduction or loss of sense of smell, which are less than 12 wks in duration); It has been 14 or more days since onset AND the patient failed a course of antibiotic treatment; She says she gets sinus headaches and pain, especially over the left forehead. She will get symptoms of feeling like she has got fullness and drainage in her throat, then she gets a little bit nauseous, and almost always then has a headache right over the 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as (sudden onset of 2 or more symptoms of nasal discharge, blockage or congestion, facial pain, pressure and reduction or loss of sense of smell, which are less than 12 wks in duration); It has been less than 14 days since onset; she is currently on anti biotics, started sept 9, ct is scheduled after antibiotics are to be done. 1




This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as Chronic Rhinosinusitis (episode is greater than 12 weeks); 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as Chronic Rhinosinusitis (episode is greater than 12 weeks); Deviated septum , Hypertrophy . Has left middle medial polyps 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as Chronic Rhinosinusitis (episode is greater than 12 weeks); Frontal headaches, uses FLONASE and AUGMENTIN, and OMNISEF, Tubes in ears, 1



Otolaryngology Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST This is a request for a Sinus CT.; This study is not being ordered for trauma, tumor, sinusitis, osteomyelitis, pre operative or a post operative evaluation.; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/18/2015; There has been treatment or conservative therapy.; Pt with one week c/o ear pain, swelling and trismus, no improvement with abxs and drops. She has had a lot of ear infections and otitis externa in the past.; c/o ear pain, swelling and trismus, no improvement with abxs and drops. Severe ear pain, ear swelling, facial swelling; No additional 1

Otolaryngology Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST 11

Otolaryngology Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST This is a request for neck soft tissue CT.; The patient has a known tumor or metastasis in the neck.; The study is being ordered for Initial Staging. 2

Otolaryngology Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST This is a request for neck soft tissue CT.; The patient has a neck lump or mass.; There is NOT a palpable neck mass or lump.; pharyngeal mass on endoscopy 1

Otolaryngology Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST This is a request for neck soft tissue CT.; There has been recent trauma or other injury to the neck. 1

Otolaryngology Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST



This is a request for neck soft tissue CT.; There has not been recent trauma or other injury to the neck.; There is no suspicion of or known tumor, metastasis, lymphadenopathy, or mass.; There is not a suspicion of an infection or abscess.; This is being ordered by an ENT specialist. 3




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; ORDERING CT NECK WITH CONTRAST CT CHEST WITH CONTRAST heavy smoker, family history of head and neck cancer. MRI a couple of months ago showed a 5 cm cystic right neck mass. She has had some odynophagia. She does drink alcohol. There is some right ot 1

Otolaryngology Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Unknow; It is not known if there has been any treatment or conservative therapy.; Unknown; Unknown 1

Otolaryngology Approval 70496 CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST This study is being ordered for Vascular Disease.; 2 years; There has not been any treatment or conservative therapy.; ; 1

Otolaryngology Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Unknow; It is not known if there has been any treatment or conservative therapy.; Unknown; Unknown 1

Otolaryngology Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST This study is being ordered for Vascular Disease.; 2 years; There has not been any treatment or conservative therapy.; ; 1

Otolaryngology Approval 70540 MRI ORBIT/FACE/NECK W/O DYE 1

Otolaryngology Approval 70544 Mr angiography head w/o dye This study is being ordered for Vascular Disease.; ; There has not been any treatment or conservative therapy.; ; 1

Otolaryngology Approval 70544 Mr angiography head w/o dye

This study is being ordered for Vascular Disease.; Left Pulsatile Tinnitus - Discussed that this is likely a result of increased venous pressure and is not an ear problem. Recommend MRI to workup pulsatile tinnitus. I do not recommend an Audiogram at this time as pt denies any hearing loss and it is not a; There has not been any treatment or conservative therapy.; pulsatile tinnitus greater in left ear than right; Pt states she also has pulsatile ringing in her ears (worse in left, especially when she leans or turns to the side), that started about a year ago which was about the same as when the cough started. Pt states she thinks her hearing is fine, but has notic 1

Otolaryngology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 4

Otolaryngology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This is a request for an Internal Auditory Canal MRI.; There is a suspected Acoustic Neuroma or tumor of the inner or middle ear. 12

Otolaryngology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This is a request for an Internal Auditory Canal MRI.; There is not a suspected Acoustic Neuroma or tumor of the inner or middle ear.; There is not a suspected cholesteatoma of the ear.; The patient has not had a recent brain CT or MRI within the last 90 days.; There are neurologic symptoms or deficits such as one-sided weakness, speech impairments, vision defects or sudden onset of severe dizziness. 1








This request is for a Brain MRI; The study is being requested for evaluation of a headache.; This headache is not described as sudden, severe or chronic recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; It is not known if there is a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Pt with 3 week c/o temporal and frontal headaches, stopped up ears, and a several year h/o unsteadinessn If No Info Given. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing dizziness.; It is not known if the condition is associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; patient is having 389.6 tinnitus, dizziness last 10 to 15mins. decreased hearing, patient has tried mediations with no success. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing dizziness.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; The lab results were normal; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing dizziness.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing dizziness.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; It is not known if a metabolic work-up done including urinalysis, electrolytes, and complete blood count with results completed.; Tinnitus, earaches. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing hearing loss.; The patient did not have a normal audiogram. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing vertigo; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; Hx of recurrent eye pain, periorbital discomfort, dysequilibrium, vertigo, hearing loss. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing vertigo; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; R/O Vertigo 1






This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; This study is being ordered for trauma or injury.; The patient had a recent onset (within the last 4 weeks) of neurologic symptoms.; The patient does not have dizziness, one sided arm or leg weakness, the inability to speak, or vision changes.; < Enter answer here - or Type In Unknown If No Info Given. > 1

Otolaryngology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This study is being ordered for Vascular Disease.; ; There has not been any treatment or conservative therapy.; ; 1


This study is being ordered for Vascular Disease.; Left Pulsatile Tinnitus - Discussed that this is likely a result of increased venous pressure and is not an ear problem. Recommend MRI to workup pulsatile tinnitus. I do not recommend an Audiogram at this time as pt denies any hearing loss and it is not a; There has not been any treatment or conservative therapy.; pulsatile tinnitus greater in left ear than right; Pt states she also has pulsatile ringing in her ears (worse in left, especially when she leans or turns to the side), that started about a year ago which was about the same as when the cough started. Pt states she thinks her hearing is fine, but has notic 1

Otolaryngology Approval 71250 CT CHEST, THORAX 3

Otolaryngology Approval 71250 CT CHEST, THORAX

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; ORDERING CT NECK WITH CONTRAST CT CHEST WITH CONTRAST heavy smoker, family history of head and neck cancer. MRI a couple of months ago showed a 5 cm cystic right neck mass. She has had some odynophagia. She does drink alcohol. There is some right ot 1

Otolaryngology Approval 71250 CT CHEST, THORAX


Otolaryngology Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT

The request is for an upper extremity non-joint MRI.; This is not a preoperative or recent postoperative evaluation.; There is suspicion of upper extremity neoplasm or tumor or metastasis. 1

Otolaryngology Approval 73725 MRA, MRI ANGIOGRAPHY LOWER EXTREMITY WITH/WITHOUT CONTRAST 2

Otolaryngology Approval 74176 CT ABD & PELVIS W/O CONTRAST


Otolaryngology Approval 78813 PET IMAGING WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being requested for Head/Neck Cancer.; The patient does NOT have Thyroid or Brain cancer.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; This would be the first PET Scan performed on this patient for this cancer. 1

Otolaryngology Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY 2

Otolaryngology Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being requested for Head/Neck Cancer.; The patient does NOT have Thyroid or Brain cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This would be the first PET Scan performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Head/Neck Cancer.; The patient does NOT have Thyroid or Brain cancer.; This study is being ordered for subsequent treatment.; The patient is experiencing new signs or symptoms indicating a reoccurrence of cancer.; 2 PET Scans have already been performed on this patient for this cancer. 1


This is a request for a Tumor Imaging PET Scan; This study is being requested for Melanoma.; This study is being ordered to establish a cancer diagnosis.; This is NOT for evaluation of regional lymph nodes.; This would be the first PET Scan performed on this patient for this cancer. 1

Otolaryngology Disapproval 70480 CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC. Radiology Services Denied Not Medically Necessary

"This request is for orbit,sella, int. auditory canal,temporal bone, mastoid, CT.239.8"; "There is not suspicion of bone infection, cholesteoma, or inflammatory disease.ostct"; "There is not a history of serious head or skull, trauma or injury.ostct"; "There is not suspicion of neoplasm, or metastasis.ostct"; This is not a preoperative or recent postoperative evaluation.; "There is not suspicion of acoustic neuroma, pituitary or other tumor. ostct" 1

Otolaryngology Disapproval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as (sudden onset of 2 or more symptoms of nasal discharge, blockage or congestion, facial pain, pressure and reduction or loss of sense of smell, which are less than 12 wks in duration); It has been 14 or more days since onset; r/o polyposis. The septum deviates to the right. Examination of the left side revealed a clear middle meatus and sphenoethmoid recess. There was no mucopurulence or polyps. Examination of the right side revealed a clear middle meatus and sphenoethmoid re 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as Chronic Rhinosinusitis (episode is greater than 12 weeks); < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is NOT immune-compromised.; The patient's current rhinosinusitis symptoms are described as Chronic Rhinosinusitis (episode is greater than 12 weeks); 3 episodes of sinusitis in the past year and has had clear persistent drainage and left nasal congestion. She was treated with Augmentin and Bactrim and steroid IM. She has not been using antihistamines or steroid nasal spray. 1

Otolaryngology Disapproval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary Yes, this is a request for CT Angiography of the Neck. 1

Otolaryngology Disapproval 70540 MRI ORBIT/FACE/NECK W/O DYE Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 3/2/2015; There has been treatment or conservative therapy.; medications; hearing loss, nasal polyps, sinus infection, no improvement with medications; < Enter answer here - or Type In Unknown If No Info Given. > 1

Otolaryngology Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 3/2/2015; There has been treatment or conservative therapy.; medications; hearing loss, nasal polyps, sinus infection, no improvement with medications; < Enter answer here - or Type In Unknown If No Info Given. > 1

Otolaryngology Disapproval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/08/2015 Ms. Lowery is a 52 y.o. female referred in consultation for evaluation of migraine headache pain and in the left area of the auriculotemporal nerve and V3 that first started 8 years ago. When the pain first started it was on the right face then; There has not been any treatment or conservative therapy.; history migraine headache pain improved after nerve block and Botox injection. She now is having left arm and shoulder pain .; history migraine headache pain improved after nerve block and Botox injection. She now is having left arm and shoulder pain . 1

Otolaryngology Disapproval 72128 CT THORACIC SPINE, UPPER BACK NO CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/08/2015 Ms. Lowery is a 52 y.o. female referred in consultation for evaluation of migraine headache pain and in the left area of the auriculotemporal nerve and V3 that first started 8 years ago. When the pain first started it was on the right face then; There has not been any treatment or conservative therapy.; history migraine headache pain improved after nerve block and Botox injection. She now is having left arm and shoulder pain .; history migraine headache pain improved after nerve block and Botox injection. She now is having left arm and shoulder pain . 1

Pediatrics Approval 70450 CT BRAIN, HEAD 3

Pediatrics Approval 70450 CT BRAIN, HEAD


Pediatrics Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for Hydrocephalus or congenital abnormality. 1

Pediatrics Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for known or suspected brain tumor, mass or cancer.; There is a suspected or known brain tumor. 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/01/15; There has not been any treatment or conservative therapy.; headaches and vomiting; < Enter answer here - or Type In Unknown If No Info Given. > 1

Pediatrics Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST "This request is for face, jaw, mandible CT.239.8"; "There is a history of serious facial bone or skull, trauma or injury.fct" 1

Pediatrics Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 09/01/15; There has not been any treatment or conservative therapy.; headaches and vomiting; < Enter answer here - or Type In Unknown If No Info Given. > 1

Pediatrics Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST


Pediatrics Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 6

Pediatrics Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This request is for a Brain MRI; It is unknown if the study is being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing dizziness.; The condition is associated with headache, blurred or double vision or a change in sensation noted on exam. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; It is not known if the headache is presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Ordered for Headaches . Pt had a CT due to injury in Feb. 2014 CT was abnormal. 1


This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as chronic or recurring.; The headache is not presenting with a sudden change in severity, associated with exertion, or a mental status change.; There are not recent neurological symptoms or deficits such as one sided weakness, speech impairments, or vision defects.; There is not a family history (parent, sibling or child of the patient) of AVM (arteriovenous malformation).; Patient has a week long headache without relief, sensitivity to light and sound, plus nausea and vomiting. 1




This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The headache is described as sudden and severe.; There are NO recent neurological deficits on exam such as one sided weakness, speech impairments or vision defects.; There is a new and sudden onset of a headache less than 1 week not improved by medications.; It is not known if the headache is described as a “thunderclap” or the worst headache of the patient’s life.; The headaches are waking the PT up out of her sleep. The headaches are worse when siting up or exercise. 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; macrocephaly; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo. 1




This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient does NOT have dizziness, fatigue or malaise, Bell's Palsy, a congenital abnormality, loss of smell, hearing loss or vertigo.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; Brother Neuro impairment- R/O abnormailities 1


This request is for a Brain MRI; The study is NOT being requested for evaluation of a headache.; Not requested for evaluation of trauma/injury, tumor, stroke/aneurysm, infection/inflammation,multiple sclerosis, or seizures; The patient is experiencing dizziness.; The condition is not associated with headache, blurred or double vision or a change in sensation noted on exam.; A metabolic work-up done including urinalysis, electrolytes, and complete blood count with results was not completed.; ct was performed and recommended mri. Showed shortening of the corpus callosum. 1






This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; CONTINUED FOLLOW UP IN MEMBER WITH HISTORY OF NONGERMINOMATOUS GERM CELL TUMOR OF THE CENTRAL NERVOUS SYSTEM. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; headaches started 9/23/2015 vomiting dec 2014 on and off; There has not been any treatment or conservative therapy.; vomiting leg weakness and pain and headaches dragged her foot while walking and occasionally trips on her foot early morning; left leg weaker then the right , wont be weight on her left leg while walking up the stairs , 1

Pediatrics Approval 71250 CT CHEST, THORAX 1

Pediatrics Approval 71250 CT CHEST, THORAX


Pediatrics Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST






Pediatrics Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This is a request for a thoracic spine MRI.; The study is being ordered due to known or suspected infection or abscess.; "The caller indicated that there is not x-ray or laboratory evidence of: Osteomyelitis, Meningitis, Septic Arthritis or discitis, or a paraspinal abscess."; None 1

Pediatrics Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST


Pediatrics Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST





This study is being ordered for trauma or injury.; 01-2015; There has been treatment or conservative therapy.; chiropractor; difficulty walking, sitting, lumbar pain, buttock and muscle spasms, sciatic pain down left side; < Enter answer here - or Type In Unknown If No Info Given. > 1

Pediatrics Approval 72192 CT PELVIS WITHOUT CONTRAST


Pediatrics Approval 72196 MRI PELVIS 1

Pediatrics Approval 72196 MRI PELVIS

This study is being ordered for trauma or injury.; 01-2015; There has been treatment or conservative therapy.; chiropractor; difficulty walking, sitting, lumbar pain, buttock and muscle spasms, sciatic pain down left side; < Enter answer here - or Type In Unknown If No Info Given. > 1

Pediatrics Approval 73221 MRI JOINT OF UPPER EXTREMITY

This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has not experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1

Pediatrics Approval 73700 CT LEG OR LOWER EXTREMITY

This is a request for a foot CT.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion.; The patient has an abnormal plain film study of the foot other than arthritis. 1

Pediatrics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT



This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint. 1

Pediatrics Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is an orthopedist. 1







Pediatrics Approval 74150 CT ABDOMEN WITHOUT CONTRAST This is a request for an Abdomen CT.; This study is being ordered for a kidney/ureteral stone.; There is a known or a strong suspicion of kidney or ureteral stones. 1

Pediatrics Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered for an infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease.; It is not known if the patient has been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis. 1

Pediatrics Approval 74150 CT ABDOMEN WITHOUT CONTRAST


Pediatrics Approval 74176 CT ABD & PELVIS W/O CONTRAST 2

Pediatrics Approval 74176 CT ABD & PELVIS W/O CONTRAST



This is a request for an abdomen-pelvis CT combination.; Infection such as pancreatitis, appendicitis, abscess, colitis and inflammatory bowel disease; No, the patient has not been seen by a specialist or are the studies being requested on behalf of a specialist for an infection.; There are NO abnormal lab results or physical findings on exam such as rebound or guarding that are consistent with peritonitis, abscess, pancreatitis or appendicitis.; This study is being ordered for another reason besides Crohn's disease, Abscess, Ulcerative Colitis, Acute Non-ulcerative Colitis, Diverticulitis, or Inflammatory bowel disease.; There are no findings that confirm hepatitis C.; 1




This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Diarrhea nausea and vomiting 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; The patient was born with Hirschsprung disease and had surgery to fix it at 3 days of age. The patient's abdominal x-ray as follows: There is a large amount of stool distally in the rectum and colon and there is gaseous distention of the colon up to 11 1


This is a request for an abdomen-pelvis CT combination.; Trauma; This request is for follow up to abdominal and/or pelvic trauma ordered by a specialist or PCP on behalf of a specialist who has seen the patient. 1

Pediatrics Approval 74181 MRI ABDOMEN 1

Pediatrics Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY

This study is being ordered for a metastatic disease.; There are 4 exams are being ordered.; Mbr 17 y/o cycle 2 of chemo therapy. Needs PET Scan to begin cycle 2 COPDACE. 1

Pediatrics Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary


Pediatrics Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; unknown; There has been treatment or conservative therapy.; medications; patient having headaches, that are daily; < Enter answer here - or Type In Unknown If No Info Given. > 1

Pediatrics Disapproval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; unknown; There has been treatment or conservative therapy.; medications; patient having headaches, that are daily; < Enter answer here - or Type In Unknown If No Info Given. > 1

Pediatrics Disapproval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST Radiology Services Denied Not Medically Necessary


Pediatrics Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary


Pediatrics Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; headaches started 9/23/2015 vomiting dec 2014 on and off; There has not been any treatment or conservative therapy.; vomiting leg weakness and pain and headaches dragged her foot while walking and occasionally trips on her foot early morning; left leg weaker then the right , wont be weight on her left leg while walking up the stairs , 1

Pediatrics Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary

The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; c/o hurting L shoulder in gymnastics at age 9-10 but does not recall the specific injury and was never evaluated for that ,but has had trouble with pain off and on in the same area ever since(5yrs). she never told her mom about the chronic pain until rece 1

Pediatrics Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary


Physical Medicine Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This is a request for a thoracic spine MRI.; The study is being ordered due to chronic back pain or suspected degenerative disease.; The patient does have neurological deficits.; The patient is experiencing or presenting symptoms of lower extremity weakness documented on physical exam.; unknown 1

Physical Medicine Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST


Plastic Surgery Approval 70480 CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC. "This request is for orbit,sella, int. auditory canal,temporal bone, mastoid, CT.239.8"; "There is suspicion of bone infection, cholesteoma, or inflammatory disease.ostct" 1

Plastic Surgery Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the Neck. 1

Plastic Surgery Approval 73221 MRI JOINT OF UPPER EXTREMITY

This request is for a wrist MRI.; This study is requested for evalutation of wrist pain.; The pain is from a recent injury.; There is a suspicion of tendon or ligament injury.; It is not know if surgery or arthrscopy is scheduled in the next 4 weeks.; none given 1

Plastic Surgery Disapproval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST Radiology Services Denied Not Medically Necessary


Plastic Surgery Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary


Podiatry Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST


Podiatry Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 1

Podiatry Approval 73700 CT LEG OR LOWER EXTREMITY


Podiatry Approval 73700 CT LEG OR LOWER EXTREMITY

This is a request for an ankle CT.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the ankle within the last two weeks.; The patient has a documented limitation of their range of motion. 1

Podiatry Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT 3

Podiatry Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

"There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient has an abnormal plain film study of the foot other than arthritis.; BILAT heel pain, hx of inject and PT w/o relief, ice and stretching, anti inflammatories, had tried shoes and shoe gear,; This is a request for bilateral foot MRI. 1






This is a request for a foot MRI.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint. 1




This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has been treated with and failed a course of supervised physical therapy. 1


This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has not been treated with anti-inflammatory medications in conjunction with this complaint.; This is for pre-operative planning. 1


This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has not been treated with anti-inflammatory medications in conjunction with this complaint.; This is not for pre-operative planning. 1




This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient has an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has not been treated with anti-inflammatory medications in conjunction with this complaint.; This is for pre-operative planning. 1


This is a request for a foot MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient has an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has not been treated with anti-inflammatory medications in conjunction with this complaint.; This is not for pre-operative planning. 1


This is a request for a foot MRI.; The study is being oordered for infection.; There are physical exam findings, laboratory results, other imaging including bone scan or plain film confirming infection, inflammation and or aseptic necrosis.; Surgery or other intervention is planned in the next 4 weeks. 1


This is a request for a foot MRI.; The study is being ordered forfoot pain.; The study is being ordered to rule out tarsal coalition.; The patient has had foot pain for over 4 weeks.; The patient has been treated with a walking cast for at least 6 weeks. 1








This is a request for an Ankle MRI.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the ankle within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the ankle other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint. 1


This is a request for an Ankle MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is a suspected tarsal coalition.; There is a history of new onset of severe pain in the ankle within the last two weeks. 2




This is a request for an Ankle MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the ankle within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the ankle other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has been treated with and failed a course of supervised physical therapy.; The patient has not been treated with anti-inflammatory medications in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1


This is a request for an Ankle MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the ankle within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the ankle other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has been treated with anti-inflammatory medications in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1


This is a request for an Ankle MRI.; The study is requested for ankle pain.; There is a suspicion of tendon or ligament injury.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; rule out ligament tear 1


This is a request for bilateral foot MRI.; BILAT heel pain, hx of inject and PT w/o relief, ice and stretching, anti inflammatories, had tried shoes and shoe gear,; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient has an abnormal plain film study of the foot other than arthritis. 1

Podiatry Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; It is not known if there is weakness or reflex abnormality.; Pt. having warm, shooting pains from back down the sides of the legs. 1

Podiatry Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary

This is a request for an Ankle MRI.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the ankle within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the ankle other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has been treated with and failed a course of supervised physical therapy. 1


This is a request for bilateral foot MRI.; Having pain in both feet.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion. 2


This is a request for bilateral foot MRI.; The patient is a diabetic & has a ulcer on right foot & he step on his left foot & toe broke; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has used a cane or crutches for greater than four weeks. 2


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 3 years ago; There has been treatment or conservative therapy.; Steriod injections, anti-inflammatories; Pain, decreased ROM, swelling; 2

Psychiatry Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; Concussion 1

Psychiatry Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; none 1

Pulmonary Medicine Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST This is a request for a Sinus CT.; This study is being ordered for sinusitis.; The patient is immune-compromised. 1

Pulmonary Medicine Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST


Pulmonary Medicine Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST


Pulmonary Medicine Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST


Pulmonary Medicine Approval 71250 CT CHEST, THORAX 27

Pulmonary Medicine Approval 71250 CT CHEST, THORAX

A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for hemoptysis.; The patient did NOT have a Chest x-ray in the past 2 weeks.; hemoptysis 1




A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Bilateral lung nodules. Will repeat CT chest in June. Overdue for repeat CT. 1

Pulmonary Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Lung nodule 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Patient has asbestosis exposure, also has shortness of breath, and a cough. 1

Pulmonary Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; pleural effusion 1

Pulmonary Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; PT HAD A POSITIVE TB SKIN TEST. 1


A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Reactive aiwwa disease, mild intermittent, uncomplicated. 1

Pulmonary Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; unknown 2




A Chest/Thorax CT is being ordered.; This study is being ordered for known or suspected inflammatory disease or pneumonia.; There is radiologic evidence of non-resolving pneumonia for 6 weeks after antibiotic treatment was prescribed. 1

Pulmonary Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for known tumor. 17

Pulmonary Medicine Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for suspected pulmonary Embolus. 2




A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; 3 MONTH FOLLOW UP 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; 6mo follow up of lung nodule 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; Chest x-ray dated 08/03/2015 Findings: No osseous abnormality is seen. There is an opacity in the right lung apex beneath the right first rib. The heart, mediastinum, hila, and pulmonary vessels appear normal. No pneumothorax is identified. No free 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; dyspnea, 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; Given the 7.3 mm in size of this nodule and I think it is too small for PET resolution. A solitary pulmonary lung nodule risk calculator calculates has a malignancy risk of less than 1%. Will repeat a CT scan in 6 months to ensure stability and a year 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; had ct 3 months ago and cxr showing 5mm nodule and lung mass 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; hasn't been checked on in 2 years 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; Incidental finding of pulmonary nodule on CT scan of the Abdomen L Lower Lobe 7mm - 6 month follow up of nodule. 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; lung nodule. several pulmonary nodules. 1

Pulmonary Medicine Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Yes, this is a request for a Chest CT Angiography.; This study is requested to evaluate suspected pulmonary embolus. 3

Pulmonary Medicine Approval 74176 CT ABD & PELVIS W/O CONTRAST 1

Pulmonary Medicine Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; There is a known or a strong suspicion of kidney or ureteral stones. 1

Pulmonary Medicine Approval 78813 PET IMAGING WHOLE BODY 1

Pulmonary Medicine Approval 78813 PET IMAGING WHOLE BODY This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered to establish a cancer diagnosis. 2

Pulmonary Medicine Approval 78813 PET IMAGING WHOLE BODY

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Was found on preop visit for umbilical Hernia 8-27-2015; There has not been any treatment or conservative therapy.; exercise intolerance; dyspnea with exertion with a little chest tightness but not often.. decreased breath sounds and diminished air movement.; 1

Pulmonary Medicine Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY 1

Pulmonary Medicine Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for an other solid tumor.; This study is being ordered to establish a cancer diagnosis.; The suspicion of cancer is based on an imaging study.; This would be the first PET Scan performed on this patient for this cancer. 2





Pulmonary Medicine Approval S8032 Low-dose Computed Tomography For Lung Cancer Screening

This request is for a Low Dose CT for Lung Cancer Screening (S8032); This patient has NOT had a Low Dose CT for Lung Cancer Screening (S8032) in the past 11 months.; The patient is between 55 and 80 years old.; This patient is a smoker or has a history of smoking.; The patient has a 30 pack per year history of smoking.; The patient quit smoking in the past 15 years.; The patient does NOT have signs or symptoms of Lung Cancer. 1

Pulmonary Medicine Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary



A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Ms. Cooper is a 50 year old white female who has had a progressive cough over the last 4-5 years. It tends to become worse after 5 pm or later. She has to get out of bed at times because the cough is so bad that it wakes her husband. She has even slept in 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Was found on preop visit for umbilical Hernia 8-27-2015; There has not been any treatment or conservative therapy.; exercise intolerance; dyspnea with exertion with a little chest tightness but not often.. decreased breath sounds and diminished air movement.; 1

Radiation Oncology Approval 70450 CT BRAIN, HEAD 2Radiation Oncology Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST 3Radiation Oncology Approval 70540 MRI ORBIT/FACE/NECK W/O DYE 1Radiation Oncology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 1

Radiation Oncology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST


Radiation Oncology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST

This study is being ordered for a metastatic disease.; There are 5 or more exams are being ordered.; patient had PET scan on 08/13/2015 that showed possible METS to the bone. Follow up to check the advancement of the disease 1

Radiation Oncology Approval 71250 CT CHEST, THORAX 2

Radiation Oncology Approval 71250 CT CHEST, THORAX

A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Physical Exam There is no supraclavicular or axillary lymphadenopathy on the right. The right breast reveals minimal hyperpigmentation. There is no desquamation. There is no subcutaneous fibrosis. I reviewed her CT scan of the chest from September 4 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; restaging for Colon cancer 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; MDO is wanting to see if cancer has spread 1

Radiation Oncology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST

This is a request for cervical spine MRI; Known Tumor with or without metastasis; "The patient is being seen by or is the ordering physician an oncologist, neurologist, neurosurgeon, or orthopedist."; This study is being ordered for follow-up.; The patient is presenting new symptoms. 1

Radiation Oncology Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT 1Radiation Oncology Approval 74150 CT ABDOMEN WITHOUT CONTRAST 1Radiation Oncology Approval 74176 CT ABD & PELVIS W/O CONTRAST 2

Radiation Oncology Approval 74176 CT ABD & PELVIS W/O CONTRAST

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; restaging for Colon cancer 1

Radiation Oncology Approval 74176 CT ABD & PELVIS W/O CONTRAST

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; MDO is wanting to see if cancer has spread 1

Radiation Oncology Approval 77058 MRI breast,without and/or with contrast material(s);unilateral


Radiation Oncology Approval 78813 PET IMAGING WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being requested for Head/Neck Cancer.; The patient does NOT have Thyroid or Brain cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; This would be the first PET Scan performed on this patient for this cancer. 1

Radiation Oncology Approval 78813 PET IMAGING WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being requested for Lung Cancer.; This study is being ordered for initial treatment (after a diagnosis of Cancer has been made).; 3 PET Scans have already been performed on this patient for this cancer. 1

Radiation Oncology Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY 2

Radiation Oncology Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being requested for Head/Neck Cancer.; The patient does NOT have Thyroid or Brain cancer.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 1 PET Scans has already been performed on this patient for this cancer. 1

Radiation Oncology Disapproval 70540 MRI ORBIT/FACE/NECK W/O DYE Radiology Services Denied Not Medically Necessary


Radiation Oncology Disapproval 71550 MRI CHEST Radiology Services Denied Not Medically Necessary


Radiation Oncology Disapproval 72196 MRI PELVIS Radiology Services Denied Not Medically Necessary


Radiation Oncology Disapproval 74181 MRI ABDOMEN Radiology Services Denied Not Medically Necessary


Radiology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 1Radiology Approval 72196 MRI PELVIS 1Radiology Approval 74150 CT ABDOMEN WITHOUT CONTRAST 1Radiology Approval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST 1Radiology Approval 74176 CT ABD & PELVIS W/O CONTRAST 1

Radiology Approval 74176 CT ABD & PELVIS W/O CONTRAST

This is a request for an abdomen-pelvis CT combination.; Known Tumor, Cancer, Mass, or R/O metastases; It is not known if this is a request for follow up of a known tumor or cancer involving both the abdomen and pelvis or if this patient is undergoing active treatment.; It is not known if this is a request for initial staging of a known tumor other than prostate.; Caller does not know if there is a known prostate cancer with a PSA greater than 10.; It is not known if there is a palpable or observed abdominal mass.; It is not known if there is an abdominal and pelvic or retroperitoneal mass that has been confirmed by previous imaging other than a CT.; It is not known if there are new signs or symptoms including hematuria, presenting with known cancer or tumor.; Mass found on right kidney 1

Radiology Approval 74181 MRI ABDOMEN

This request is for an Abdomen MRI.; This study is being ordered for Known Tumor.; "The ordering physician is an oncologist, urologist, gastroenterologist, or surgeon."; This study is being ordered for follow-up.; The patient is not undergoing active treatment for cancer.; The patient is not presenting new symptoms.; The patient has had 3 or fewer follow-up abdomen MRIs.; 60 y/o WM with hx of Hepatocellular carcinoma in setting of Cirrhosis 2/2 Hep C with multiple liver lesions (atleast 4 measurable with largest one being 5.3cm). Was not a candidate for resection or transplant and thus registered on E1208 IRB 112317 study 1

Radiology Approval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING 1

Rehabilitations Approval 72131 CT LUMBAR SPINE, LOW BACK


Rehabilitations Approval 72131 CT LUMBAR SPINE, LOW BACK This is a request for a lumbar spine CT.; The patient has a history of severe low back trauma or lumbar injury. 1

Rehabilitations Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST

This study is being ordered for trauma or injury.; before 11/07/2015; There has been treatment or conservative therapy.; OTC meds, NSAIDS, cold/heat therapy; The patient describes the pattern of pain as constant with intermittent flare ups. Describes the quality of increased pain as aching, burning, and sharp.; To determine source of increased pain 1

Rehabilitations Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST




Rehabilitations Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 2


This study is being ordered for trauma or injury.; before 11/07/2015; There has been treatment or conservative therapy.; OTC meds, NSAIDS, cold/heat therapy; The patient describes the pattern of pain as constant with intermittent flare ups. Describes the quality of increased pain as aching, burning, and sharp.; To determine source of increased pain 1

Rehabilitations Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; Before 10/15/2014; There has been treatment or conservative therapy.; Medication and heat/ice therapy; The patient presents for follow up for chronic pain management due to neck and complete back pain that radiates into bilateral upper and lower extremities. The patient describes the pattern of pain as constant with intermittent flare ups. Describes the ; Unknown 1

Rehabilitations Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; More than one year; There has been treatment or conservative therapy.; Physical therapy, water therapy, yoga, OTC, NSAID's, massage; Neck pain, lower and mid back pain. Aching, throbbing, tender, pins and needles. Pain radiates to lower extremeties.; Increased Pain that is barely controlled by medication or therapy. 1

Rehabilitations Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has completed 6 weeks of physical therapy? 1


This study is being ordered for trauma or injury.; Before 10/15/2014; There has been treatment or conservative therapy.; Medication and heat/ice therapy; The patient presents for follow up for chronic pain management due to neck and complete back pain that radiates into bilateral upper and lower extremities. The patient describes the pattern of pain as constant with intermittent flare ups. Describes the ; Unknown 1


This study is being ordered for trauma or injury.; More than one year; There has been treatment or conservative therapy.; Physical therapy, water therapy, yoga, OTC, NSAID's, massage; Neck pain, lower and mid back pain. Aching, throbbing, tender, pins and needles. Pain radiates to lower extremeties.; Increased Pain that is barely controlled by medication or therapy. 1

Rheumatology Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; Acute and severe episode of double vision. 1

Rheumatology Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST


Rheumatology Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST


Rheumatology Approval 71250 CT CHEST, THORAX 2

Rheumatology Approval 71250 CT CHEST, THORAX


Rheumatology Approval 71250 CT CHEST, THORAX

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; fever 103, elevated CRP, night sweats, plural effusion. 1

Rheumatology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST 3

Rheumatology Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST






Rheumatology Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST 2Rheumatology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 4

Rheumatology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST


Rheumatology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 2

Rheumatology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 1

Rheumatology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Muscular skeletal pain 1

Rheumatology Approval 72196 MRI PELVIS 1Rheumatology Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is for pelvic trauma or injury. 1

Rheumatology Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is not for any of the listed indications.; 1Rheumatology Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT 3

Rheumatology Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT

The request is for an upper extremity non-joint MRI.; This is not a preoperative or recent postoperative evaluation.; There is not suspicion of upper extremity neoplasm or tumor or metastasis.; There is no suspicion of upper extremity bone or soft tissue infection.; The ordering physician is an orthopedist. 1


The request is for an upper extremity non-joint MRI.; This is not a preoperative or recent postoperative evaluation.; There is not suspicion of upper extremity neoplasm or tumor or metastasis.; There is no suspicion of upper extremity bone or soft tissue infection.; The ordering physician is not an orthopedist.; There is not a history of upper extremity trauma or injury. 2


The request is for an upper extremity non-joint MRI.; This is not a preoperative or recent postoperative evaluation.; There is not suspicion of upper extremity neoplasm or tumor or metastasis.; There is suspicion of upper extremity bone or soft tissue infection. 1

Rheumatology Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT This study is being ordered for Inflammatory/ Infectious Disease.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for Inflammatory/ Infectious Disease.; 07/22/2015; There has been treatment or conservative therapy.; Physician supervised home exercise since 8/21/15 and anti-inflammatories; Primary osteo arthritis bilateral hands, lump on left finger, ganglion of the wrist, synovitis and tenosynovitis.; Pt has hx of inflammatory arthritis and poly-arthralgia. 1


This study is being ordered for Inflammatory/ Infectious Disease.; 5/27/15; There has been treatment or conservative therapy.; Medications Print Name Date Source atenolol 07/15/15 entered Shannon Boone Plaquenil 07/15/15 entered Shannon Boone Plaquenil 200 mg tablet Take 1 tablet twice daily 08/27/15 renewed Debra Brent, APN ; Chronic Pain; This is a pleasant Caucasian man comes in today for follow-up. He has advancing seronegative rheumatoid arthritis. He has history of hepatitis C status post treatment as well as history of renal cell CA status post left nephrectomy. He has been on IV O 1


This study is being ordered for Inflammatory/ Infectious Disease.; ABOUT 1 YEAR AGO; There has been treatment or conservative therapy.; MEDICATIONS, HEAT AND ICE; HAND SWELLING AND PAIN, TENDERNESS TO PALPATIONS; UNKNOWN 1

Rheumatology Approval 73221 MRI JOINT OF UPPER EXTREMITY 3

Rheumatology Approval 73221 MRI JOINT OF UPPER EXTREMITY

The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; It is not known if the patient has completed and failed a course of conservative treatment.; At his initial visit with Dr. Chi on 9/10/15 he was given Solu-Medrol 125 mg IV. He states that steroids caused significant rage and anger. Later that evening he states that he lost his balance when ambulating and fell injuring his right shoulder. He w 1






This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient does not have a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks. 1


This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient does not have a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1

Rheumatology Approval 73221 MRI JOINT OF UPPER EXTREMITY This study is being ordered for Inflammatory/ Infectious Disease.; ; There has been treatment or conservative therapy.; ; ; 1


This study is being ordered for Inflammatory/ Infectious Disease.; 5/27/15; There has been treatment or conservative therapy.; Medications Print Name Date Source atenolol 07/15/15 entered Shannon Boone Plaquenil 07/15/15 entered Shannon Boone Plaquenil 200 mg tablet Take 1 tablet twice daily 08/27/15 renewed Debra Brent, APN ; Chronic Pain; This is a pleasant Caucasian man comes in today for follow-up. He has advancing seronegative rheumatoid arthritis. He has history of hepatitis C status post treatment as well as history of renal cell CA status post left nephrectomy. He has been on IV O 1


This study is being ordered for Inflammatory/ Infectious Disease.; ABOUT 1 YEAR AGO; There has been treatment or conservative therapy.; MEDICATIONS, HEAT AND ICE; HAND SWELLING AND PAIN, TENDERNESS TO PALPATIONS; UNKNOWN 1

Rheumatology Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT 4

Rheumatology Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is not an orthopedist.; Swelling greater than 3 days 1

Rheumatology Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This is a request for a Knee MRI.; There is no supsected meniscus,pre-op or post-op evaluation,non-acute Chronic Pain,supsected tumor or Aseptic Necrosis; The ordering physician is not an orthopedist.; Instability 1

Rheumatology Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; Unknown; There has been treatment or conservative therapy.; medications; Walks with forearm crutches, has muscle pains and weakness; Unknown 2

Rheumatology Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT


Rheumatology Approval 74176 CT ABD & PELVIS W/O CONTRAST 1

Rheumatology Approval 74176 CT ABD & PELVIS W/O CONTRAST

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; fever 103, elevated CRP, night sweats, plural effusion. 1

Rheumatology Approval 74181 MRI ABDOMEN 1Rheumatology Approval 77058 MRI breast,without and/or with contrast material(s);unilateral 1

Rheumatology Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; 1

Rheumatology Disapproval 72131 CT LUMBAR SPINE, LOW BACK Radiology Services Denied Not Medically Necessary 1

Rheumatology Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; It is not known if the patient does have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; It is not known if the patient has completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; It is not known if the patient has completed 6 weeks or more of Chiropractic care.; It is not known if the physician has directed a home exercise program for at least 6 weeks.; 1

Rheumatology Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary


Rheumatology Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary


Rheumatology Disapproval 72196 MRI PELVIS Radiology Services Denied Not Medically Necessary This is a request for a Pelvis MRI.; The request is not for any of the listed indications.; LBP 1

Rheumatology Disapproval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT Radiology Services Denied Not Medically Necessary

There is not a history of upper extremity trauma or injury.; The ordering physician is not an orthopedist.; There is no suspicion of upper extremity bone or soft tissue infection.; There is not suspicion of upper extremity neoplasm or tumor or metastasis.; This is not a preoperative or recent postoperative evaluation.; The request is for an upper extremity non-joint MRI. 1

Rheumatology Disapproval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT Radiology Services Denied Not Medically Necessary This study is being ordered for Inflammatory/ Infectious Disease.; ; It is not known if there has been any treatment or conservative therapy.; ; 1


This study is being ordered for Inflammatory/ Infectious Disease.; 8/28/15; There has been treatment or conservative therapy.; baclofen Benicar Cymbalta gabapentin Lasix prednisone Ultram Vitamin; muscle aches, muscle weakness, arthralgias/joint pain, and swelling in the extremities, and numbness; I had the pleasuring of seeing Mrs. Elaine Townsley. She is very pleasant 62-year-old white female. She presents with a friend. She tells me that for at least two years, she has had abnormal skin lesions, bullous type lesions on her legs. She describes tw 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 7/13/15; There has been treatment or conservative therapy.; diclofenac sodium 75 mg tablet,delayed release Take 1 tablet(s) twice a day by oral route. 07/13/15 prescribed Jasen Chi, MD gabapentin 100 mg capsule Take 1 capsule(s) twice a day by oral route.; Elizabeth complaints of bilateral wrist pain and stiffness in her hands. She's had these symptoms for many years. She also complains of hip pain. There is faint narrowing in both of her knees. Remainder of her plain films are normal. Lungs send her f; Today I'm seeing Mrs. Martin for the first time. She is a very pleasant 35-year-old female who comes on consultation by Dr. Michael Beard. She states for years she has had stiffness in her hands with difficulty forming a complete grip. Many years she work 1

Rheumatology Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary

The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from a recent injury.; There is a suspicion of tendon, ligament, rotator cuff injury or labral tear.; Surgery or arthrscopy is not scheduled in the next 4 weeks.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for an upper extremity joint MRI.; The patient does not have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient has a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has been treated with anti-inflammatory medication in conjunction with this complaint.; This study is not being ordered by an operating surgeon for pre-operative planning. 1

Rheumatology Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary This study is being ordered for Inflammatory/ Infectious Disease.; ; It is not known if there has been any treatment or conservative therapy.; ; 1


This study is being ordered for Inflammatory/ Infectious Disease.; 07/22/2015; There has been treatment or conservative therapy.; Physician supervised home exercise since 8/21/15 and anti-inflammatories; Primary osteo arthritis bilateral hands, lump on left finger, ganglion of the wrist, synovitis and tenosynovitis.; Pt has hx of inflammatory arthritis and poly-arthralgia. 1


This study is being ordered for Inflammatory/ Infectious Disease.; 8/28/15; There has been treatment or conservative therapy.; baclofen Benicar Cymbalta gabapentin Lasix prednisone Ultram Vitamin; muscle aches, muscle weakness, arthralgias/joint pain, and swelling in the extremities, and numbness; I had the pleasuring of seeing Mrs. Elaine Townsley. She is very pleasant 62-year-old white female. She presents with a friend. She tells me that for at least two years, she has had abnormal skin lesions, bullous type lesions on her legs. She describes tw 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 7/13/15; There has been treatment or conservative therapy.; diclofenac sodium 75 mg tablet,delayed release Take 1 tablet(s) twice a day by oral route. 07/13/15 prescribed Jasen Chi, MD gabapentin 100 mg capsule Take 1 capsule(s) twice a day by oral route.; Elizabeth complaints of bilateral wrist pain and stiffness in her hands. She's had these symptoms for many years. She also complains of hip pain. There is faint narrowing in both of her knees. Remainder of her plain films are normal. Lungs send her f; Today I'm seeing Mrs. Martin for the first time. She is a very pleasant 35-year-old female who comes on consultation by Dr. Michael Beard. She states for years she has had stiffness in her hands with difficulty forming a complete grip. Many years she work 1

Rheumatology Disapproval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT Radiology Services Denied Not Medically Necessary


Sports Medicine Approval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST

This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is a reason why the patient cannot have a Cervical Spine MRI.; This study is being ordered due to chronic neck pain or suspected degenerative disease.; The patient does not have any neurological deficits.; There has been a supervised trial of conservative management for at least 6 weeks. 1

Sports Medicine Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST


Sports Medicine Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST


Surgery Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST This is a request for neck soft tissue CT.; The patient has a suspicious infection or abscess.; Surgery is NOT scheduled within the next 30 days.; 1

Surgery Approval 70547 Mr angiography neck w/o dye 2Surgery Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 1

Surgery Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST


Surgery Approval 71250 CT CHEST, THORAX 7

Surgery Approval 71250 CT CHEST, THORAX


Surgery Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; Grips on hands 3 out of 5.; Worsening 1

Surgery Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST

This is a request for cervical spine MRI; Trauma or recent injury; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is x-ray evidence of a recent cervical spine fracture. 1

Surgery Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

There are no documented clinical findings of immune system suppression.; The patient is experiencing back pain associated with abdominal pain.; The caller indicated the the study was not ordered for: Chronic Back pain, Trauma, Known or suspected tumor with or without metastasis, Follow up to or Pre-operative evalution, or Neurological deficits."; This is a request for a thoracic spine MRI. 1

Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 5

Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST


Surgery Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST


Surgery Approval 72192 CT PELVIS WITHOUT CONTRAST 3

Surgery Approval 72192 CT PELVIS WITHOUT CONTRAST

This is a request for a Pelvis CT.; This study is being ordered due to known or suspected infection.; "The ordering physician is a surgeon, gynecologist, urologist, gastroenterologist, or infectious disease specialist or PCP ordering on behalf of a specialist who has seen the patient."; < Enter answer here - or Type In Unknown If No Info Given. > 1

Surgery Approval 72196 MRI PELVIS 3

Surgery Approval 72196 MRI PELVIS

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 9-23-15; There has not been any treatment or conservative therapy.; abdominal pain, nausea vomiting ,tenderness to right lower quadrant with rebound tenderness; pregnant so she cant have ct done 1

Surgery Approval 72196 MRI PELVIS

This study is being ordered for trauma or injury.; 1/29/15; There has been treatment or conservative therapy.; Gabapentin; continued pain and 5cm nodule over left hip.; 23 y.o. Female s/p blunt trauma with left hip nodule that is likely lipoma vs neuroma 1

Surgery Approval 73200 CT ARM OR UPPER EXTREMITY This is a request for an upper extremity, shoulder, scapula, elbow, hand, or wrist joint CT.; There is a history of upper extremity joint or long bone trauma or injury. 4

Surgery Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT 1

Surgery Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT The request is for an upper extremity non-joint MRI.; This is a preoperative or recent postoperative evaluation. 3

Surgery Approval 73221 MRI JOINT OF UPPER EXTREMITY



This is a request for an upper extremity joint MRI.; The patient does have documented weakness or partial loss of feeling in the upper extremity.; There is no history of significant trauma, dislocation or injury to the joint within the past 6 weeks.; The patient does not have an abnormal plain film study of the joint.; The patient has not been treated with and failed a course of four weeks of supervised physical therapy.; The patient does not have a documented limitation of their range of motion.; The patient has experienced pain for greater than six weeks.; The patient has not been treated with anti-inflammatory medication in conjunction with this complaint.; This study is being ordered by the operating surgeon for pre-operative planning. 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; year ago; There has been treatment or conservative therapy.; injections and therapy; pain, numbness; < Enter answer here - or Type In Unknown If No Info Given. > 2

Surgery Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT 4

Surgery Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT


Surgery Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is an orthopedist. 1

Surgery Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT


Surgery Approval 74150 CT ABDOMEN WITHOUT CONTRAST 1

Surgery Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered as a pre-op or post op evaluation.; The requested study is for post-operative evaluation.; The requested study is a first follow up study for a post operatove complication. 1

Surgery Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered as a pre-op or post op evaluation.; The requested study is for pre-operative evaluation.; The study is requested by a surgeon, specialist or PCP on behalf of a specialist who has seen the patient. 1

Surgery Approval 74176 CT ABD & PELVIS W/O CONTRAST 54

Surgery Approval 74176 CT ABD & PELVIS W/O CONTRAST







This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; hernia large woman. 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Previous CT in January small hernia was found in the upper gastric 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; pt is having mid abdominal pain; possible mass; 1






This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; It is not known if the pain is acute or chronic.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; ABDOMINAL PAIN AND A CHANGE IN BOWEL HABBITS 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; It is not known if the pain is acute or chronic.; This is the first visit for this complaint.; It is unknown if the patient had an Amylase or Lipase lab test.; A urinalysis has not been completed.; Inguinal hernia is the reason she was referred over. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; .CT scan and pelvic ultrasound obtained at that time showed bilateral cystic structures in the pelvis (ovarian vs inclusion cyst), and she was referred back to UAMS. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; abdominal pain, tender to palpation possible hernia 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; Patient has a incisional hernia 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; It is unknown if the patient had an Amylase or Lipase lab test.; It is not known if a urinalysis has been completed.; chronic but worsening. referred to surgeon by ob/gyn. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has not been completed.; evaluate for a hernia 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient had an amylase lab test.; The results of the lab test were normal.; A urinalysis has not been completed.; patient has had multi extensive abdominal surgeries. she was seen in the clinic on 9/23/15 with severe abdominal pain labs are normal. Trying to confirm Incisional hernia present and possibly incarcerated 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is infection.; The patient has a fever and elevated white blood cell count or abnormal amylase/lipase. 1

Surgery Approval 74181 MRI ABDOMEN 5

Surgery Approval 74181 MRI ABDOMEN

This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; Patient had questions about a spot on his liver. I suggested that he discuss this with his family physician or could consider getting another opinion from a general surgeon.. 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; The patient had previous abnormal imaging including a CT, MRI or Ultrasound.; A liver abnormality was found on a previous CT, MRI or Ultrasound.; There is NO suspicion of metastasis.; none 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 9-23-15; There has not been any treatment or conservative therapy.; abdominal pain, nausea vomiting ,tenderness to right lower quadrant with rebound tenderness; pregnant so she cant have ct done 1


This study is being ordered for trauma or injury.; 1/29/15; There has been treatment or conservative therapy.; Gabapentin; continued pain and 5cm nodule over left hip.; 23 y.o. Female s/p blunt trauma with left hip nodule that is likely lipoma vs neuroma 1

Surgery Approval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING 1Surgery Approval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING Yes, this is a request for CT Angiography of the abdominal arteries. 1Surgery Approval 77058 MRI breast,without and/or with contrast material(s);unilateral 4

Surgery Approval 77058 MRI breast,without and/or with contrast material(s);unilateral This is a request for Breast MRI.; This study is being ordered for known breast lesions.; There are benign lesions in the breast associated with an increased cancer risk. 1

Surgery Approval 78813 PET IMAGING WHOLE BODY 1Surgery Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY 3

Surgery Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY

This is a request for a Tumor Imaging PET Scan; This study is being requested for Soft Tissue Sarcoma, Pancreatic or Testicular Cancer.; This study is being ordered to establish a cancer diagnosis.; The suspicion of cancer is based on an imaging study.; This would be the first PET Scan performed on this patient for this cancer. 1

Surgery Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is no weakness or reflex abnormality.; arthritis 1

Surgery Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; There has not been any treatment or conservative therapy.; Pain; < Enter answer here - or Type In Unknown If No Info Given. > 1

Surgery Disapproval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; < Enter date of initial onset here - or Type In Unknown If No Info Given >; There has not been any treatment or conservative therapy.; Pain; < Enter answer here - or Type In Unknown If No Info Given. > 2

Surgery Disapproval 74150 CT ABDOMEN WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; ABDOMINAL PAIN 1

Surgery Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary


Surgery Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are no new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; There is not a suspicion of an adrenal mass.; This is not a request to confirm a suspicious renal mass suggested by physical exam, lab studies, IVP or ultrasound.; Abdominal pain budge on abdomen wall, R/O hernia. 1

Surgical Oncology Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Pt has nodule 1

Surgical Oncology Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; This study is being ordered for suspected pulmonary Embolus. 1

Surgical Oncology Approval 71250 CT CHEST, THORAX

A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; 1


A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; 6 mo fu for suspicious masses detected on previous CT 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; alkali is elevated, ASP elevated 1

Surgical Oncology Approval 74176 CT ABD & PELVIS W/O CONTRAST 1

Surgical Oncology Approval 74176 CT ABD & PELVIS W/O CONTRAST


Surgical Oncology Approval 74176 CT ABD & PELVIS W/O CONTRAST

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; alkali is elevated, ASP elevated 1

Surgical Oncology Approval 77058 MRI breast,without and/or with contrast material(s);unilateral

This is a request for Breast MRI.; This study is being ordered as a screening examination following genetic testing for breast cancer.; Yes, the patient have a known mutation such as BRCA1, BRCA2, PTEN or TP53. 1


This is a request for Breast MRI.; This study is being ordered as a screening examination for known family history of breast cancer.; There is NOT a pattern of breast cancer history in at least two first-degree relatives (parent, sister, brother, or children).; There are NOT benign lesions in the breast associated with an increased cancer risk.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for Breast MRI.; This study is being ordered for a known history of breast cancer.; No, this is not an individual who has known breast cancer in the contralateral (other) breast.; No, this is not a confirmed breast cancer.; No, this patient does not have axillary node adenocarcinoma.; Yes, there are anatomic factors (deformity or extreme density) that make a simple mammogram impossible. 1




This is a request for Breast MRI.; This study is being ordered for a known history of breast cancer.; Yes, this is an individual who has known breast cancer in the contralateral (other) breast. 3


This is a request for Breast MRI.; This study is being ordered for known breast lesions.; It is unknown if there are benign lesions in the breast associated with an increased cancer risk.; No, this is not an individual who has known breast cancer in the contralateral (other) breast.; No, this is not a confirmed breast cancer.; No, this patient does not have axillary node adenocarcinoma.; No, there are no anatomic factors (deformity or extreme density) that make a simple mammogram impossible.; MRI needed for further evaluation 1

Surgical Oncology Approval 78813 PET IMAGING WHOLE BODY 1

Surgical Oncology Approval 78813 PET IMAGING WHOLE BODY


Surgical Oncology Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary

A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; Enter answer here - or Type In Unkn8/20/15 41 y/o pleasant man referred to our office for abnormal findings on CT of chest and hemoptysis. He presents today with copies of his CT chest and his PET/CT performed at Baptist hospital in Little Rock. He sta 1

Thoracic Surgery Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST 2Thoracic Surgery Approval 71250 CT CHEST, THORAX 7

Thoracic Surgery Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST

Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will not be performed in conjunction with a Chest CT.; This study is being ordered for another reason besides Known or Suspected Congenital Abnormality, Known or suspected Vascular Disease.; Pt has dialation of the ascending aorta .. Mdo is using auth to monitor the aorta 1

Thoracic Surgery Approval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST This is a request for CT Angiography of the Abdomen and Pelvis. 1Thoracic Surgery Approval 78813 PET IMAGING WHOLE BODY 1Thoracic Surgery Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY 2

Unknown Approval 70450 CT BRAIN, HEAD


Unknown Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for history of stroke, (CVA) known or follow-up. 1

Unknown Approval 70450 CT BRAIN, HEAD This is a request for a brain/head CT.; The study is requested for known or suspected bleed such as subdural hematoma or subarachnoid bleed. 3





Unknown Approval 70486 CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST


Unknown Approval 70490 CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST

This is a request for neck soft tissue CT.; The patient has a neck lump or mass.; There is a palpable neck mass or lump.; The neck mass is larger than 1 cm.; A fine needle aspirate was NOT done.; Enter answer here - or Type In Unknown If No Info GivLAN: Health checkup Consulted with Dr. John Scott Erwin, diagnostics reviewed with physician, *Med issued per Dr. Erwin*. LABORATORY: Labs ordered to be performed today include, CBC, and lipid 1

Unknown Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST Yes, this is a request for CT Angiography of the Neck. 1

Unknown Approval 70540 MRI ORBIT/FACE/NECK W/O DYE



This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; PATIENT HAD CHEMO. TUMOR MARKERS ARE ABNORMAL. LAST MRI ON 3/11/15. NEED TO RESTAGE DISEASE. 1



Unknown Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This is a request for an Internal Auditory Canal MRI.; There is a suspected Acoustic Neuroma or tumor of the inner or middle ear. 1

Unknown Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST






Unknown Approval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST This request is for a Brain MRI; The study is being requested for evaluation of a headache.; The patient has a chronic or recurring headache.; 1







Unknown Approval 71250 CT CHEST, THORAX

A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Patient is experiencing shortness of breath and wheezing and having some bronchospasms 1


A Chest/Thorax CT is being ordered.; This study is being ordered for screening of lung cancer.; The patient had a Low Dose CT for Lung Cancer Screening or a Chest CT in the past 11 months.; multiple lung nodules being monitored every 6 months 1




A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There IS evidence of a lung, mediastinal or chest mass noted within the last 30 days."; They had a previous Chest x-ray.; ABNORMAL CHEST XRAY 1


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Re-staging 1

Unknown Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST

Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will not be performed in conjunction with a Chest CT.; This study is being ordered for Known Vascular Disease.; This is a pre-operative evaluation.; This surgey is scheduled/planned.; A catheter angiogram has not been performed within the last month.; Patient is here for eval of tachycardia. Dr. Steeley started pt on Multaq 3-4 years ago, but he reports that it hasn't been working as well as before. Patient is on ASA 81mg q day for stroke prevention. He has both paroxysmal AF and PVCs - says breaking t 1

Unknown Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST

Yes, this is a request for a Chest CT Angiography.; This study is not requested to evaluate suspected pulmonary embolus.; This study will not be performed in conjunction with a Chest CT.; This study is being ordered for Suspected Vascular Disease.; It is not known whether there are new signs or symptoms indicative of a dissecting aortic aneurysm.; This is not an evaluation for thoracic outlet syndrome.; There are no signs or symptoms indicative of vascular insufficiency to the neck or arms.; There are no signs or symptoms indicative of Superior Vena Cava syndrome.; New patient referred by Dr. Henry to eval Afib and discuss Afib ablation. He was dx'd about 2 months ago. He is on ASA for stroke prevention was sitting was getting out of the bed 8/2015, 9/2015, went to ER associated with 1

Unknown Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST Yes, this is a request for a Chest CT Angiography.; This study is requested to evaluate suspected pulmonary embolus. 1

Unknown Approval 71550 MRI CHEST






Unknown Approval 72131 CT LUMBAR SPINE, LOW BACK This is a request for a lumbar spine CT.; The patient has a history of severe low back trauma or lumbar injury. 1

Unknown Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST






Unknown Approval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST This is a request for cervical spine MRI; Neurological deficits; Yes, the patient is experiencing or presenting new symptoms of upper extremity weakness. 1










This study is being ordered for a neurological disorder.; 10-12-2012; There has been treatment or conservative therapy.; Physical therapy, and LESI's; He presents with worsening back and leg pain and neck and arm pain; He did well again for a period of time and is now having more pain. We talked again about options. We will repeat the films and follow up. I will then make further recommendations. 1


This study is being ordered for trauma or injury.; 09/10/2015; There has been treatment or conservative therapy.; meloxicam, tramadol with alternating ice/heat therapy.; pain, radiculopathy with numbness tingling weakness from neck all the way down her left arm.; 1


This study is being ordered for trauma or injury.; Eight years ago; There has been treatment or conservative therapy.; NSAID's, OTC's, physical therapy, rest, heat therapy, ice, massage; Pain in shoulders, neck, back, both legs. Increased pain in shins while walking. Pain is aching, throbbing, shooting, numbness/tingling. and sharp, leg weakness; Conservative therapy unsuccessful and pain continues to increase. 1

Unknown Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST

This is a request for a thoracic spine MRI.; The study is being ordered due to Neurological deficits.; The patient is experiencing or presenting symptoms of lower extremity weakness documented on physical exam.; being treated by a physician in little rock for osteomyelitis and discitis at the T6-7 level and the only way to tell if he has improved is with a MRI 1








This study is being ordered for a neurological disorder.; Feb. 2014; There has been treatment or conservative therapy.; Physical therapy, LESI's and NSAID's, and pain mgmt.; mid back, low back pain, and leg pain; 1


This study is being ordered for trauma or injury.; Eight years ago; There has been treatment or conservative therapy.; NSAID's, OTC's, physical therapy, rest, heat therapy, ice, massage; Pain in shoulders, neck, back, both legs. Increased pain in shins while walking. Pain is aching, throbbing, shooting, numbness/tingling. and sharp, leg weakness; Conservative therapy unsuccessful and pain continues to increase. 1


This study is being ordered for trauma or injury.; Over 3 years ago; There has been treatment or conservative therapy.; RX medications, cortisone shots, and accupuncture; neck pain radiation to left should and arm pain, now with increasing headaches.; She describes neck and upper back pain with headaches 1

Unknown Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 1

Unknown Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does not have new or changing neurologic signs or symptoms.; The patient has had back pain for over 4 weeks.; The patient has seen the doctor more then once for these symptoms.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient was treated with oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has directed a home exercise program for at least 6 weeks.; The home treatment did include exercise, prescription medication and follow-up office visits.; PATIENT IS CURRENTLY IN PHYSICAL THERAPY HAS BEEN DOING FOR 4 WEEKS NOW.; PATIENT ON WEEK 4 OF 6 WEEK OF THERAPY. NOT HELPING. 1

Unknown Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient does NOT have acute or chronic back pain.; This procedure is being requested for Neurologic deficits 1



Unknown Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has an Abnormal x-ray indicating a significant abnormality 5

Unknown Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 10

Unknown Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Low back pain radiating to R LE (heal). Clinical suspicion for L5/S1 radiculopathy. Disc degeneration. 1








This study is being ordered for a neurological disorder.; 10-12-2012; There has been treatment or conservative therapy.; Physical therapy, and LESI's; He presents with worsening back and leg pain and neck and arm pain; He did well again for a period of time and is now having more pain. We talked again about options. We will repeat the films and follow up. I will then make further recommendations. 1


This study is being ordered for a neurological disorder.; Feb. 2014; There has been treatment or conservative therapy.; Physical therapy, LESI's and NSAID's, and pain mgmt.; mid back, low back pain, and leg pain; 1

Unknown Approval 72192 CT PELVIS WITHOUT CONTRAST

This is a request for a Pelvis CT.; This study is being ordered for some other reason than the choices given.; Abnormal CT of Abdomen 7/29/15 recommended to follow up with CT Of Pelvis CT of pelvis recommended for abnormal left pelvis process is otherwise suspected clinically. 1

Unknown Approval 72196 MRI PELVIS






Unknown Approval 73200 CT ARM OR UPPER EXTREMITY

This is a request for an upper extremity, shoulder, scapula, elbow, hand, or wrist joint CT.; There is not a history of upper extremity joint or long bone trauma or injury.; This is a preoperative or recent postoperative evaluation. 1

Unknown Approval 73220 MRI UPPER EXTREMITY , ENTIRE EXTREMITY, NOT A JOINT






Unknown Approval 73221 MRI JOINT OF UPPER EXTREMITY 1

Unknown Approval 73221 MRI JOINT OF UPPER EXTREMITY



The requested study is a Shoulder MRI.; Study being ordered for suspicious mass/tumor/metastasis.; The patient has had recent plain films of the shoulder.; The plain films were not normal. 1




The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from an old injury.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient recevied joint injection(s). 1


This request is for a wrist MRI.; This study is requested for evalutation of wrist pain.; The pain is described as chronic; The member has failed a 4 week course of conservative management in the past 3 months. 1




This study is being ordered for trauma or injury.; 09/10/2015; There has been treatment or conservative therapy.; meloxicam, tramadol with alternating ice/heat therapy.; pain, radiculopathy with numbness tingling weakness from neck all the way down her left arm.; 1

Unknown Approval 73700 CT LEG OR LOWER EXTREMITY 1

Unknown Approval 73700 CT LEG OR LOWER EXTREMITY

This is a request for a foot CT.; "There is a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is a suspected tarsal coalition.; There is a history of new onset of severe pain in the foot within the last two weeks.; The patient has a documented limitation of their range of motion. 1




This is a request for an ankle CT.; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the ankle."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the ankle within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient had an abnormal plain film study of the ankle other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has been treated with and failed a course of supervised physical therapy. 1

Unknown Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT 2

Unknown Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a foot MRI.; The study is being ordered for known fracture.; The study is being ordered to evaluate a possible non union facrture. 1

Unknown Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT This is a request for a Knee MRI.; Suspected meniscus, tendon, or ligament injury; The ordering physician is an orthopedist. 2

Unknown Approval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT









This is a request for bilateral foot MRI.; <Enter answer here OR type 'Unknown' if no info given.>; "There is not a history (within the past six weeks) of significant trauma, dislocation, or injury to the foot."; There is not a suspected tarsal coalition.; There is not a history of new onset of severe pain in the foot within the last two weeks.; The patient does not have a documented limitation of their range of motion.; The patient does not have an abnormal plain film study of the foot other than arthritis.; The patient has not used a cane or crutches for greater than four weeks.; The patient has not been treated with and failed a course of supervised physical therapy.; The patient has not been treated with anti-inflammatory medications in conjunction with this complaint.; This is not for pre-operative planning. 2

Unknown Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT 1

Unknown Approval 73721 MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT JOINT


Unknown Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered for a kidney/ureteral stone.; This patient is experiencing hematuria.; The hematuria is not newly diagnosed, it's known previous history.; There are new signs or symptoms other than hematuria. 1




This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; PATIENT HAD ABD US DONE ON 8/28/15 AND THE RADIOLOGIST OPINION WAS TO SUGGEST A 3 PHRASE CT WITH AND WITHOUT CONTRAST LOOKING AT THE LIVER 1


This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; pt presents with new onset of abdominal pain and has a history of chronic liver disease 1

Unknown Approval 74176 CT ABD & PELVIS W/O CONTRAST




Unknown Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; There is a known or a strong suspicion of kidney or ureteral stones. 9


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Hist of pancreatic neoplasm, worsening ab pain w occasional nausea. 1


This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are no new symptoms including hematuria.; There are no new lab results or other imaging studies including ultrasound, Doppler or plain films findings.; There is a suspicion of an adrenal mass. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is female.; A pelvic exam was NOT performed.; Abnormal liver enzymes or chemistry. Nausea, vomiting and pain radiating to back. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is not the first visit for this complaint.; There has been a physical exam.; The patient is male.; A rectal exam was not performed.; Known kidney stones. hematuria. flank pain on visit 9/8/15 1


This study is being ordered for a metastatic disease.; There are 3 exams are being ordered.; One of the studies being ordered is a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; Re-staging 1

Unknown Approval 77058 MRI breast,without and/or with contrast material(s);unilateral

This is a request for Breast MRI.; This study is being ordered for a suspected implant rupture.; Yes,this study is being ordered to evaluate a suspected silicone implant rupture. 1

Unknown Approval 77084 Magnetic resonance imaging, bone marrow blood supply






Unknown Approval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study

This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; It is not known if the patient has had a stress echocardiogram within the past eight weeks.; 1


This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The patient's age is between 45 and 64.; The patient has not had a stress echocardiogram within the past eight weeks.; The study is being ordered for known CAD.; This patient had a previous cardiac surgery or angioplasty.; The patient is presenting new symptoms of chest pain or increasing shortness of breath. 1



Unknown Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY



This is a request for a Tumor Imaging PET Scan; This study is being requested for Lymphoma or Myeloma.; This study is being ordered for subsequent treatment.; The patient completed a course of treatment initiated within the last 8 weeks.; 1 PET Scans has already been performed on this patient for this cancer. 1





Unknown Approval 93307 TTHRC R-T IMG 2D +-M-MODE REC COMPL



This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Cardiac Valves.; This is an evaluation of new or changing symptoms of valve disease. 1


This a request for an echocardiogram; This is a request for a Transthoracic Echocardiogram.; This study is being ordered for Evaluation of Cardiac Valves.; This is an initial evaluation of suspected valve disease. 1



Unknown Approval 93312 TEE R-T IMG 2D W/PRB IMG ACQUISJ I&R

This a request for an echocardiogram; This is a request for a Transesophageal Echocardiogram.; This study is beibg requested for evalutaion of atrial fibrillation or flutter to determine the presence or absence of left atrial thrombus or evaluate for radiofrequency ablation procedure. 1

Unknown Approval 93350 ECHO TTHRC R-T 2D -+M-MODE COMPLETE REST&STRS

This is a request for a Stress Echocardiogram.; The member has known or suspected coronary artery disease.; The patient has NOT had cardiac testing including Stress Echocardiogram, Nuclear Cardiology (SPECT/MPI), Coronary CT angiography (CCTA) or Cardiac Catheterization in the last 2 years. 2

Unknown Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary This is a request for a brain/head CT.; None of the listed reasons for the study have been selected.; pt has a change of mental status 1

Unknown Disapproval 70450 CT BRAIN, HEAD Radiology Services Denied Not Medically Necessary



This is a request for a brain/head CT.; The study is requested for headache.; There is not headache not improved by pain medications.; "There are no recent neurological symptoms or deficits such as one-sided weakness, vision defects, speech impairments or sudden onset of severe dizziness."; 1



Unknown Disapproval 70551 MRI HEAD, BRAIN, BRAINSTEM WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for trauma or injury.; Over 3 years ago; There has been treatment or conservative therapy.; RX medications, cortisone shots, and accupuncture; neck pain radiation to left should and arm pain, now with increasing headaches.; She describes neck and upper back pain with headaches 1

Unknown Disapproval 71250 CT CHEST, THORAX Radiology Services Denied Not Medically Necessary

A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; Evaluation of patient with Septic Sternoclavicular Joint. 1

Unknown Disapproval 72125 CT CERVICAL SPINE, NECK SPINE NO CONTRAST Radiology Services Denied Not Medically Necessary This is a request for a Cervical Spine CT; This study is not to be part of a Myelogram.; There is no reason why the patient cannot have a Cervical Spine MRI.; 1

Unknown Disapproval 72141 MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; No, the patient does not demonstrate neurological deficits.; There has not been a supervised trial of conservative management for at least 6 weeks.; patient had xray, radiologist recommending mri, degenerative changes noted. 1


This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is reflex abnormality.; Ms Hufford comes in complaining of pain in her posterior neck area, neck musculature down into the shoulders and shoulder blades and upper back area. This has been going on in her words "for years". She is getting more severe and finally she has decided t; A lady with a lot of proximal muscle soreness and pain. Could be fibromyalgia. I need to rule out some more severe degenerative disk disease of the spine and possibly some involving the left shoulder. 1




This is a request for cervical spine MRI; Acute or Chronic neck and/or back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent cervical spine fracture.; There is weakness.; patient has had physical therapy and Nsaids for more then six weeks, has had epidurel injections, with no relief. patient now complains of numbness and tingling down left leg and weakness.; Due to worsening syptomes of numbness and tingling into extremities wanting to be sure nothing worseing in neck area 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; unknown; There has been treatment or conservative therapy.; unknown; chronic left shoulder pain radiating; The patient is a 32-year-old male presenting with chronic left upper extremity pain as well as pain that radiates in a dermatomal pattern along the torso. He complains of pain at the xiphoid process as well. He has a history of a fall from a significant h 1

Unknown Disapproval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for a thoracic spine MRI.; The caller indicated the the study was not ordered for: Chronic Back pain, Trauma, Known or suspected tumor with or without metastasis, Follow up to or Pre-operative evalution, or Neurological deficits."; There are no documented clinical findings of immune system suppression.; The patient is not experiencing back pain associated with abdominal pain.; Patient has had xrays that were inconclusive. She has received Heat US treatment that has not resolved her pain. Patient pain is worsening. 1


This study is being ordered for a neurological disorder.; 05-27-2014; There has been treatment or conservative therapy.; ; weakness but with worse back and right leg pain the pain is rated as moderate-to-severe Duration - several years; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; unknown; There has been treatment or conservative therapy.; unknown; chronic left shoulder pain radiating; The patient is a 32-year-old male presenting with chronic left upper extremity pain as well as pain that radiates in a dermatomal pattern along the torso. He complains of pain at the xiphoid process as well. He has a history of a fall from a significant h 1

Unknown Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; It is not known if the patient has a new foot drop.; It is not known if the patient has new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; ; 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; It is not known if the patient has new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is reflex abnormality.; The patient describes a ABRUPT course of their pain. The pain is located LOW BACK. The LEFT LOW BACK pain radiates to the LEFT LEG. The pain is described as ACHING, SHOOTING, NUMBNESS AND TINGLING. The pain is better with REST. The pain is worse with WALK; Musculoskeletal: BACK PAIN Neurologic: RADIC RLE incapacitating pain complaint of LOW BACK PAIN whose history of present illness and physical exam is consistent with LUMBAR RADICULOPATHY as their primary pain generator. Secondary pain generators incl 1


The study requested is a Lumbar Spine MRI.; Acute or Chronic back pain; The patient does have new or changing neurologic signs or symptoms.; The patient does not have a new foot drop.; The patient does not have new signs or symptoms of bladder or bowel dysfunction.; There is not x-ray evidence of a recent lumbar fracture.; There is weakness.; The patient describes a ABRUPT course of their pain. The pain is located LOW BACK. The LEFT LOW BACK pain radiates to the LEFT LEG. The pain is described as ACHING, SHOOTING, NUMBNESS AND TINGLING. The pain is better with REST. The pain is worse with WALK; The patient describes a ABRUPT course of their pain. The pain is located LOW BACK. The LEFT LOW BACK pain radiates to the LEFT LEG. The pain is described as ACHING, SHOOTING, NUMBNESS AND TINGLING. The pain is better with REST. The pain is worse with WALK 1


The study requested is a Lumbar Spine MRI.; The patient does NOT have acute or chronic back pain.; This procedure is being requested for None of the above; Patient is experiencing left leg and foot pain for 2 weeks. Other tests have been inconclusive for diagnosis. 1



Unknown Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has Neurological deficit(s) 1

Unknown Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; 1


The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; Patient complains of reoccurring pain of lumbar spine and lower extremities since fall injury in 2014. Pain makes difficult to ambulate at times. Decreased range of motion in lumbar spine with tenderness 1


This study is being ordered for a neurological disorder.; 05-27-2014; There has been treatment or conservative therapy.; ; weakness but with worse back and right leg pain the pain is rated as moderate-to-severe Duration - several years; 1

Unknown Disapproval 73221 MRI JOINT OF UPPER EXTREMITY Radiology Services Denied Not Medically Necessary

The requested study is a Shoulder MRI.; "The caller indicated the study was not ordered for: Known or Suspicious Mass or Tumor with or without metastasis, Known or suspected Joint Infection, Aseptic Necrosis, Trauma, Chronic Pain, or Pre or Post operative evaluation."; 1


The requested study is a Shoulder MRI.; Study being ordered due to non-acute or chronic pain.; The patient has not completed and failed a course of conservative treatment of at least 4 weeks.; unknown 1


The requested study is a Shoulder MRI.; The request is for shoulder pain.; The pain is from an old injury.; The physician has directed conservative treatment for the past 6 weeks.; The patient has not completed 6 weeks of physical therapy?; The patient has been treated with medication.; The patient received oral analgesics.; The patient has not completed 6 weeks or more of Chiropractic care.; The physician has not directed a home exercise program for at least 6 weeks.; has had previous shoulder surgery on this shoulder and has re-injured it 1

Unknown Disapproval 73720 MRI LEG OR LOWER EXTREMITY , OTHER THAN JOINT Radiology Services Denied Not Medically Necessary

This is a request for a Knee MRI.; Non-acute Chronic Pain; The ordering physician is not an orthopedist.; Pain greater than 3 days; It is not known if patient had recent plain films of the knee.; 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; patient comes in for evaluation of his right ankle Been having pain and swelling in the ankle for about one year; There has been treatment or conservative therapy.; He's been taking tramadol to help with his discomfort.; pain and swelling in the ankle Comments on exam today the patient has flexible flat feet on both sides. He has some swelling along the peroneal tendons posterior to the lateral malleolus. He is tender to palpate through this area. He cannot E. Burch h; Comments on exam today the patient has flexible flat feet on both sides. He has some swelling along the peroneal tendons posterior to the lateral malleolus. He is tender to palpate through this area. He cannot E. Burch his foot despite multiple attempts 2


This study is being ordered for trauma or injury.; 7/27/2015; There has been treatment or conservative therapy.; Pt has been in a cast boot/brace for 6 weeks, elevation as much as possible adn NSAID therapy; Continued pain; Pt is having pain in her ankle, heel and forefoot. We are looking for a stress fracture 2

Unknown Disapproval 74150 CT ABDOMEN WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary


Unknown Disapproval 74150 CT ABDOMEN WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an Abdomen CT.; This study is being ordered for another reason besides Kidney/Ureteral stone, Known Tumor, Cancer, Mass, or R/O metastases, Suspicious Mass or Tumor, Organ Enlargement, Known or suspected infection such as pancreatitis, etc..; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Abdominal Pain 1

Unknown Disapproval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST Radiology Services Denied Not Medically Necessary This is a request for CT Angiography of the Abdomen and Pelvis. 1

Unknown Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary This is a request for an abdomen-pelvis CT combination.; Organ Enlargement; There is evidence of organ enlargement on ultrasound, plain film, or IVP. 1

Unknown Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary



This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Severe pain to right upper quadrant for several months with aching, burning and pressure after she eats. Very tender to touch. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; There has been a physical exam.; The patient is male.; A rectal exam was not performed.; Pt with history of and current Kidney Stones. Has flank pain and back pain 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has not been completed.; Patient has experienced abdominal pain and Hematochezia 1

Unknown Disapproval 78451 Myocardial perfusion imaging, tomographic (SPECT); single study Radiology Services Denied Not Medically Necessary This is a request for Myocardial Perfusion Imaging (Nuclear Cardiology Study).; The study is requested for known or suspected valve disorders. 1

Urology Approval 70450 CT BRAIN, HEAD

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; THIS PATIENT HAS KNOWN TESTICULAR CANCER WITH METASTATIC DISEASE AND RADIOLOGIST HAS RECOMMENDED BRAIN AND CHEST CT FOR FUTHER EVALUATION 1

Urology Approval 71250 CT CHEST, THORAX A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; LING NODULE 1

Urology Approval 71250 CT CHEST, THORAX

A Chest/Thorax CT is being ordered.; The study is being ordered for none of the above.; This study is being ordered for non of the above.; MEMBER WITH CHRONIC COUGH STATUS POST KIDNEY TRANSPLANT, STAGE III CHRONIC KIDNEY DISEASE, CHRONIC ALLOGRAFT NEPHROPATHY. CT CHEST RECOMMENDED TO LOOK FOR INTERSTITIAL LUNG DISEASE/BRONCHIOLITIS OBILTERNS. 1




A Chest/Thorax CT is being ordered.; This study is being ordered for work-up for suspicious mass.; "There is NO evidence of a lung, mediastinal or chest mass noted within the last 30 days."; PATIENT HAS TESTICULAR MASS 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is a hematologist/ oncologist.; The diagnosis of cancer or tumor has been established.; Restaging of Cancer; Imaging studies have been performed on the member in the past 3 months.; < Enter answer here - or Type In Unknown If No Info Given. > 2


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; Prostate CA newly diagnosis. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; THIS PATIENT HAS KNOWN TESTICULAR CANCER WITH METASTATIC DISEASE AND RADIOLOGIST HAS RECOMMENDED BRAIN AND CHEST CT FOR FUTHER EVALUATION 1

Urology Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST 1

Urology Approval 72146 MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST


Urology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST 1

Urology Approval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST

The study requested is a Lumbar Spine MRI.; The patient has acute or chronic back pain.; The patient has none of the above; PT IS HAVING COMPRESSIEVE NEUROPAYTHY AND BACK PAIN WITH LUMBAR RADICULOPATHY WILL NEED MRI TO CHECK FOR SURE 1




This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; patient began having problems 2 years ago; There has not been any treatment or conservative therapy.; back/flank pain,luts,leg weakness; r/o kidney stones,r/o tethered spinal cord 1

Urology Approval 72192 CT PELVIS WITHOUT CONTRAST This is a request for a Pelvis CT.; This study is being ordered due to hematuria.; The patient has painful hematuria.; The patient has had an IVP.; unknown 1

Urology Approval 72192 CT PELVIS WITHOUT CONTRAST

This is a request for a Pelvis CT.; This study is being ordered due to known or suspected infection.; "The ordering physician is a surgeon, gynecologist, urologist, gastroenterologist, or infectious disease specialist or PCP ordering on behalf of a specialist who has seen the patient."; S/P for penal prosthesis. 1

Urology Approval 72196 MRI PELVIS This is a request for a Pelvis MRI.; The request is for suspicion of tumor, mass, neoplasm, or metastatic disease? 7

Urology Approval 74150 CT ABDOMEN WITHOUT CONTRAST 1

Urology Approval 74150 CT ABDOMEN WITHOUT CONTRAST





This is a request for an Abdomen CT.; This study is being ordered for a suspicious mass or tumor.; There is no suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; There are new symptoms including hematuria. 1



Urology Approval 74176 CT ABD & PELVIS W/O CONTRAST 31

Urology Approval 74176 CT ABD & PELVIS W/O CONTRAST There is a known or a strong suspicion of kidney or ureteral stones.; Kidney/Ureteral stone; This is a request for an abdomen-pelvis CT combination. 1

Urology Approval 74176 CT ABD & PELVIS W/O CONTRAST

This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; It is not known if there is a strong suspicion of kidney or ureteral stones.; This patient is experiencing hematuria. 4

Urology Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; There is a known or a strong suspicion of kidney or ureteral stones. 91


This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; There is neither a known nor a strong suspicion of kidney or ureteral stones.; This patient is experiencing hematuria. 1





Urology Approval 74176 CT ABD & PELVIS W/O CONTRAST This is a request for an abdomen-pelvis CT combination.; Other; There are clinical findings or indications of Hematuria. 41




This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Chronic Prostatitis x 7 Months. pressure in the back, 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; RECURRENT UTI'S 1




This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; It is not known if the pain is acute or chronic.; This is the first visit for this complaint.; It is unknown if the patient had an Amylase or Lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were abnormal.; The urinalysis was positive for hematuria/blood. 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for acute pain.; It is unknown if there has been a physical exam.; The patient did not have a amylase or lipase lab test.; A urinalysis has been completed.; The results of the urinalysis were normal.; 1


This is a request for an abdomen-pelvis CT combination.; This study is being requested for abdominal and/or pelvic pain.; The study is being ordered for chronic pain.; This is the first visit for this complaint.; The patient did not have a amylase or lipase lab test.; A urinalysis has been completed.; It is not known if the urinalysis results were normal or abnormal.; kidney stones; flank pain; 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is known tumor.; The patient is male.; This is a request for evaluation of prostate cancer.; The patient did not have a prior Abdomen/Pelvis CT.; There is not a PSA greater than 10.; There is a Gleason Score (sum) 7 or greater. 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is renal calculi, kidney or ureteral stone.; A urinalysis has been completed.; The results of the urinalysis were abnormal.; The urinalysis was positive for hematuria/blood. 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is renal calculi, kidney or ureteral stone.; A urinalysis has been completed.; The results of the urinalysis were normal.; < Enter answer here - or Type In Unknown If No Info Given. > 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is renal calculi, kidney or ureteral stone.; A urinalysis has been completed.; The results of the urinalysis were normal.; PATIENT HAS KIDNEY STONES AND FLANK PAIN 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is not requested for hematuria.; The reason for the study is suspicious mass or suspected tumor or metastasis.; The patient had an abnormal abdominal Ultrasound, CT or MR study.; The patient has NOT completed a course of chemotherapy or radiation therapy within the past 90 days.; It is not known if the patient is presenting new symptoms.; The last Abdomen/Pelvis CT was performed within the past 10 months.; ReferralFrom Dr. Hewett for right side renal mass Modifying factors:CT scan report: IMPRESSION: 1. There is a complex calcified and cystic mass within the superior pole of the right kidney. Differential diagnosis includes a complex cystic lesion with 1




This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is requested for hematuria.; The reason for the hematuria is not known.; A urinalysis has been completed.; The results of the urinalysis were abnormal.; The urinalysis was positive for hematuria/blood. 6


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is requested for hematuria.; The reason for the hematuria is not known.; A urinalysis has been completed.; The results of the urinalysis were abnormal.; The urinalysis was positive for something other than billirubin, ketones, nitrites, hematuria/blood, glucose or protein.; GROSS HEMATURIA 1


This is a request for an abdomen-pelvis CT combination.; This study is not being requested for abdominal and/or pelvic pain.; The study is requested for hematuria.; The reason for the hematuria is not known.; A urinalysis has been completed.; The results of the urinalysis were normal.; Gross hematuria, unknown cause. 1




This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; Prostate CA newly diagnosis. 1


This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; staging purpses 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; patient began having problems 2 years ago; There has not been any treatment or conservative therapy.; back/flank pain,luts,leg weakness; r/o kidney stones,r/o tethered spinal cord 1

Urology Approval 74181 MRI ABDOMEN

This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; 6 mouth f/u 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; evaluate the mass 1


This request is for an Abdomen MRI.; This study is being ordered for suspicious mass or suspected tumor/ metastasis.; "There are no documented physical findings (painless hematuria, etc.) consistent with an abdominal mass or tumor."; "The patient has had an abdominal ultrasound, CT, or MR study."; lesions kidney 1

Urology Approval 78813 PET IMAGING WHOLE BODY 1

Urology Approval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY

This study is being ordered for a metastatic disease.; There are 2 exams are being ordered.; One of the studies being ordered is NOT a Breast MRI, CT Colonoscopy, EBCT, MRS, PET Scan, or Unlisted CT/MRI.; The ordering physician is not a hematologist/ oncologist.; staging purpses 1

Urology Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2013; There has not been any treatment or conservative therapy.; IRRATATIVE URINARY TRACT SYMPTOMS, WITH HEADACHE,AND LEG WEAKNESS; R/O TETHERED SPINAL CORD, KIDNEY STONES 1

Urology Disapproval 72148 MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Radiology Services Denied Not Medically Necessary

This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 9/8/2015; There has been treatment or conservative therapy.; medications; Severe Pain; Unknown 1

Urology Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary This is a request for an abdomen-pelvis CT combination.; Kidney/Ureteral stone; There is a known or a strong suspicion of kidney or ureteral stones. 1

Urology Disapproval 74176 CT ABD & PELVIS W/O CONTRAST Radiology Services Denied Not Medically Necessary

This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; Abdominal Pain 1


This is a request for an abdomen-pelvis CT combination.; Other; There are no findings of Hematuria, Lymphadenopathy,weight loss,abdominal pain,diabetic patient with gastroparesis; none given 1


This is a request for an abdomen-pelvis CT combination.; Suspicious Mass or Tumor; It is not known if there is a suspicious mass found using ultrasound, IVP, Endoscopy, colonoscopy, or sigmoidoscopy.; It is not known if there are new symptoms including hematuria.; There are new lab results or other imaging studies including ultrasound, Doppler or plain films findings. 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 2013; There has not been any treatment or conservative therapy.; IRRATATIVE URINARY TRACT SYMPTOMS, WITH HEADACHE,AND LEG WEAKNESS; R/O TETHERED SPINAL CORD, KIDNEY STONES 1


This study is being ordered for something other than: known trauma or injury, metastatic disease, a neurological disorder, inflammatory or infectious disease, congenital anomaly, or vascular disease.; 9/8/2015; There has been treatment or conservative therapy.; medications; Severe Pain; Unknown 1

Urology Disapproval 78816 PET IMAGING FOR CT ATTENUATION WHOLE BODY Radiology Services Denied Not Medically Necessary

This is a request for a Tumor Imaging PET Scan; This study is being ordered for something other than Breast CA, Lymphoma, Myeloma, Ovarian CA, Esophageal CA, Lung CA, Colorectal CA, Head/Neck CA, Melanoma, Soft Tissue Sarcoma, Pancreatic CA or Testicular CA.; This study is being requested for an other solid tumor.; It is unknown why the study is being ordered. 1

Vascular Surgery Approval 70498 CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST 1Vascular Surgery Approval 71275 CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST 2Vascular Surgery Approval 72191 CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST 1

Vascular Surgery Approval 74150 CT ABDOMEN WITHOUT CONTRAST

This is a request for an Abdomen CT.; This study is being ordered as a pre-op or post op evaluation.; The requested study is for pre-operative evaluation.; The study is requested by a surgeon, specialist or PCP on behalf of a specialist who has seen the patient. 1

Vascular Surgery Approval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST 1Vascular Surgery Approval 74174 CT ANGIOGRAPHY ABDOMEN AND PELVIS W/CONTRAST/NONCONTRAST This is a request for CT Angiography of the Abdomen and Pelvis. 2Vascular Surgery Approval 74175 CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST 2Vascular Surgery Approval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING 2Vascular Surgery Approval 75635 CTA AA&BI ILIOFEM LXTR RS&I C-/C+ POST-PXESSING Yes, this is a request for CT Angiography of the abdominal arteries. 1

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