scheduling a diagnostic imaging exam€¦ · scheduling a diagnostic imaging exam ... 7 5....
Post on 09-Jun-2018
227 Views
Preview:
TRANSCRIPT
Scheduling a Diagnostic Imaging ExamA GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP IN-HOUSE TEAM OF INSURANCE SPECIALISTS:
Carrie Richardson, Scheduling and Insurance Manager 425.250.1155
Abi Roberts, Lead Insurance Specialist 425.250.1157
Aubrey Griswold 425.283.0103
Lori Jaffurs 425.250.1132
Jennifer Fischer 425.248.2441
Tonya Harris 253.248.2505
DEDICATED INSURANCE SPECIALISTS’ MAIN LINES:
Phone: 425.250.1160Fax: 425.462.4302
myCDI.com/WA
BELLEVUE:
Tel: 425.637.9729Fax: 425.462.8309 EVERETT:
Tel: 425.740.5000Fax: 425.740.5010 FEDERAL WAY:
Tel: 253.942.7226Fax: 253.942.3517 KIRKLAND:
Tel: 425.821.3472Fax: 425.820.4115 LAKEWOOD:
Tel: 253.682.1666Fax: 253.682.1667 RENTON:
Tel: 425.228.4000Fax: 425.228.2789 SEATTLE:
Tel: 206.524.5599Fax: 206.524.5338
VISIT OUR WEBSITE AND BLOGVideos | Articles | Center Details
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
TableofContents1. Scheduling Patients with Private Insurance ........................................................................................................ 2
2. Price Quotes ........................................................................................................................................................ 5
3. Scheduling L&I Patients ....................................................................................................................................... 6
4. Qualis Questionnaires (17 Inserts) ...................................................................................................................... 7
5. Scheduling Self‐Insured L&I Patients ................................................................................................................... 8
6. Scheduling STAT Patients ..................................................................................................................................... 9
7. DSHS Eligibility Letter ........................................................................................................................................ 10
8. Health Screenings .............................................................................................................................................. 12
9. Exam Results Online .......................................................................................................................................... 13
10. Connect with Your Network Online ................................................................................................................ 14
11. Patient Exam Status Online ............................................................................................................................. 15
12. Cancellation Codes .......................................................................................................................................... 16
13. Radiology Groups, Tax IDs and NPI Numbers ................................................................................................. 17
14. MRI Options ..................................................................................................................................................... 18
15. Marketing Materials: Center Locations, Services, Subspecialized Radiologists .............................................. 19
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
1.SchedulingPatientswithPrivateInsurance
Patient with Insurance | Pre‐authorization Required 1. Submit an imaging order via fax along with:
Patient Signs and Symptoms
Patient Insurance ID Number
Relevant History
Differential Diagnosis with ICD‐9/ICD‐10 codes
Recent Chart Notes
2. Upon receiving the pre‐authorization number, a CDI scheduler will contact the patient to schedule
their imaging exam.
3. Log on to www.insideCDI.com to check patients scheduling status. View the patient exam process − from confirmed appointment date through availability of exam results − on this secure medical professionals’ portal.*
4. In the event the authorization is delayed or will not be received prior to the scheduled
appointment time, a representative from CDI will contact the patient to advise of the insurance
delay and determine appropriateness of delaying the exam. Patient safety is our primary concern.
ForinsurancesthatuseAIM,seethefollowingpages.
CDI MAY OBTAIN PRE‐AUTHORIZATION FOR THE FOLLOWING PAYERS: AARP Medicare Complete L&I / Workers’ Compensation AETNA Moda Health AmeriGroup Molina Apple Health Premera CIGNA Regence Community Health Tricare Coordinated Care Uniform Medical Great West United Health Care
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
AIM GUIDELINES: For insurances that use AIM, please include information that answers the questions for the ordered
exam listed below. In general, the more information we can get, the better the chance we have of
obtaining the RQI without having to involve the referring provider’s office.
HEAD
1. What are you looking to rule out or evaluate?
a. Headaches – which one applies:
i. Sudden onset and severe, including thunderclap or worst headache of life;
ii. Progressively worsening with increased frequency and severity over short
timeframe and/or despite physician‐supervised appropriate therapy;
iii. With new focal neurological signs, particularly papilledema, visual field
defects and nuchal rigidity;
iv. New, onset headaches in a cancer or immunodeficient patient
b. Syncope – which one applies:
i. Seizure activity was witnessed or is highly suspected at the time of the
syncope
ii. There is an abnormality on neurological examination
iii. The patient has at least one persistent neurological symptom
c. Sinus
i. Acute Sinusitis
1. Have the symptoms persisted beyond 3‐4 weeks of adequate
treatment?
a. Antibiotics, steroids
ii. Acute Recurrent Sinusitis
1. Have there been three or more separate episodes during the past
year?
iii. Chronic Sinusitis
1. Have the symptoms lasted 12 weeks or longer?
According to AIM, there are multiple indications for head or brain that may get an automatic
approval. These include but are not limited to: neurological abnormality, CVA, congenital anomaly,
hemorrhage, infectious or inflammatory process, MS, seizure disorders, vascular abnormalities,
etc.
PLEASE INCLUDE THE REFERRING PROVIDER’S TAX ID NUMBER.
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
AIM GUIDELINES: (continued)
SPINE IMAGING
1. Was there a specific injury or trauma?
2. Have there been X‐rays in the last six weeks?
a. Were they normal or abnormal?
3. Has the patient completed a minimum of 3‐4 consecutive weeks of physician‐supervised
conservative therapy for the current episode of pain?
a. NSAIDS
b. Muscle relaxants
c. Steroids
d. Physical therapy
4. Are there signs of compression (reflux abnormality, muscle weakness, etc.)?
5. What are you looking to rule out?
UPPER/LOWER EXTREMITY
1. Was there a specific injury or trauma?
2. Have there been X‐rays in the last six weeks?
a. Were they normal or abnormal?
3. Has the patient completed a minimum of 4‐6 consecutive weeks of conservative
treatment?
a. NSAIDS
b. Muscle relaxants
c. Steroids
d. Physical therapy
4. What are you looking to rule out?
According to AIM, there are multiple indications for spinal and extremity imaging that may get an
automatic approval and not need to have conservative care. These include but are not limited to:
fractures, infectious or inflammatory processes, syrinx, MS, tumor, AVN, intra‐articular loose
body, etc.
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
2.PriceQuotes
MAIN SCHEDULING LINE: 855.643.7226. Call CDI’s main scheduling line for an exam price quote. To reach any available insurance specialist, call CDI at 425.250.1160.
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
3.SchedulingL&IPatients
Department of Labor & Industries (L&I) Patient 1. Submit the order to CDI via fax, including:
Appropriate Qualis Questionnaire (Following Pages)
Chart Notes o The authorization process for L&I typically takes 7‐10 days after receipt of all
chart notes and documentation.
If submitting the order online, please fax the above listed information to the appropriate CDI location.
2. CDI keeps order pending until verification of approved claim is received from L&I.
If an ordered CT or MRI is on the select list of procedures requiring authorization, a CDI Insurance Specialist will obtain an authorization through Qualis. The claims manager then has 24‐48 hours to review the Qualis recommendation and make a final decision and provide the facility with an authorization number if the claim is open and allowed.
3. Upon verification that L&I claim has been approved, CDI contacts patient to schedule
their imaging exam.
4. Log on to www.insideCDI.com to check patients’ scheduling status.
View the patient exam process − from confirmed appointment date through availability of exam results − on this secure medical professionals’ portal.*
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
4.QualisQuestionnaires(17Inserts)
Qualis Health Contact Information: Website: www.QualisHealth.org Phone: 1.800.541.2894 QUESTIONNAIRES ON FOLLOWING PAGES: 1. Lumbar Spine 2. Thoracic Spine 3. Cervical Spine 4. Headache 5. Upper Extremities 6. Lower Extremities 7. Injections OR ACCESS THE QUESTIONNAIRES ONLINE: 1. Go to www.QualisHealth.org 2. Click on “Healthcare Professionals” on the upper bar 3. On the left, click on “Washington Labor & Industries” 4. Select the “Provider Resources” line that opens up below “Washington Labor & Industries” on
the left 5. Go to: “Questionnaires”
Lumbar Spine Imaging updated 10/04/2011 1
Lumbar Spine Imaging Questionnaire
1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’compensation claims. For authorization of services pertaining to Self-Insured claims, please contact theinjured worker’s employer or the third party administrator.
2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only.L&I must make the final determination of payment based on legal claim validity. Approval should occurwithin 24-48 hours.
Acknowledge
3. (Mandatory) What is the duration of patient’s back pain (select one)?Within past 6 weeks (see 4 - 10) > 6 weeks (see 11 - 20) > 3mos w/no PRIOR MRI (see 21 - 31) > 3mos w/PRIOR MRI (see 32 - 34)
4. SECTION A: ACUTE LOW BACK PAIN (ONSET W/IN PAST 6 WKS) - MRI W/O CONTRAST unlessspecified otherwise. ANSWER QUESTIONS 5 – 10.
5. A1: Progressive (objective) neurological signs (select one):Progressive motor weakness present NA
6. A2: Suspect Cauda Equina Syndrome (select one)Acute bladder or bowel dysfunction Bilateral neurologic signs and symptoms NA
7. A3: Infection - MRI with and without contrast (select one):Elevated sedimentation rate Fever Immunosuppression (chronic steroid use) IV drug use Known bacteremia Suspicion of systemic or spinal infectn NA
8. A4: Is there history or suspicion of cancer with new onset of LBP?Yes No
9. A5: If Yes, Suspicion of cancer criterion can be met if any two of the following are present (select two):Age over 50 Failure to improve after one month Unexplained weight loss NA
10. A6: Low velocity trauma (e.g. fall from height or struck by object). If vertebral compression fx issuspected due to hx of osteoporosis, use of steroids, or age > or = 70 plain x-ray s/b completed prior toMRI. Select one:
Vertebral compression fx on x-ray Other fractures NA
Lumbar Spine Imaging updated 10/04/2011 2
11. SECTION B: SUBACUTE LOW BACK PAIN > 6 WEEKS: MRI W/O CONTRAST. ANSWERQUESTIONS 12 – 20.
12. B1: Progressive (objective) neurological signs (select one):Progressive motor weakness present NA
13. B2: Suspect Cauda Equina Syndrome (select one)Acute bladder or bowel dysfunction Bilateral neurologic signs and symptoms NA
14. B3: Infection - MRI with and without contrast (select one):Elevated sedimentation rate Fever Immunosuppression (chronic steroid use) IV drug use Known bacteremia Suspicion of systemic or spinal infectn NA
15. B4: Is there history or suspicion of cancer with new onset of LBP?Yes No
16. B5: If Yes, Suspicion of cancer criterion can be met if any two of the following are present (select two):Age over 50 Failure to improve after one month Unexplained weight loss NA
17. B6: Low velocity trauma (e.g. fall from height or struck by object). If vertebral compression fx issuspected due to hx of osteoporosis, use of steroids, or age > or = 70 plain x-ray s/b completed prior toMRI. Select one:
Vertebral compression fx on x-ray Other fractures NA
18. B7: Did the patient have MEDICAL/CONSERVATIVE CARE? If No, stop and submit thequestionnaire. Request will be pended and reviewed by Qualis Health.
Yes No
19. B8: Suspected radiculopathy with (must select ALL and answer #20):Leg pain is greater than back pain Pain present in nerve root distribution
20. B9: Radiculopathy evidenced by (select one):EMG/NCS consistent with radiculopathy Motor weakness in a radicular distributn Pos SLR test <45 degrees Pos crossed SLR test Sensory loss in a radicular distributn
Lumbar Spine Imaging updated 10/04/2011 3
21. SECTION C: CHRONIC LOW BACK PAIN (> 3 MOS) W/NO PRIOR L-SPINE MRI W/O CONTRAST.
ANSWER QUESTIONS 21 – 31.
22. C1: Progressive (objective) neurological signs (select one): Progressive motor weakness present NA
23. C2: Suspect Cauda Equina Syndrome (select one)
Acute bladder or bowel dysfunction Bilateral neurologic signs and symptoms NA
24. C3: Infection - MRI with and without contrast (select one):
Elevated sedimentation rate Fever Immunosuppression (chronic steroid use) IV drug use Known bacteremia Suspicion of systemic or spinal infectn NA
25. C4: Is there history or suspicion of cancer with new onset of LBP?
Yes No
26. C5: If Yes, Suspicion of cancer criterion can be met if any two of the following are present (select two):
Age over 50 Failure to improve after one month Unexplained weight loss NA
27. C6: Low velocity trauma (e.g. fall from height or struck by object). If vertebral compression fx is
suspected due to hx of osteoporosis, use of steroids, or age > or = 70 plain x-ray s/b completed prior to MRI. Select one:
Vertebral compression fx on x-ray Other fractures NA
28. C7: Did the patient have MEDICAL/CONSERVATIVE CARE? If No, stop and submit the
questionnaire. Request will be pended and reviewed by Qualis Health. Yes No
29. C8: Suspected radiculopathy with (must select ALL and answer #30):
Leg pain is greater than back pain Pain present in nerve root distribution
30. C9: Radiculopathy evidenced by (select one):
EMG/NCS consistent with radiculopathy Motor weakness in a radicular distributn Pos SLR test <45 degrees Pos crossed SLR test Sensory loss in a radicular distributn
Lumbar Spine Imaging updated 10/04/2011 4
31. C10: Is there suspicion of spinal stenosis on x-ray?
Yes No
32. SECTION D: CHRONIC LOW BACK PAIN (> 3 MOS) W/PRIOR L-SPINE MRI W/O
CONTRAST - Select at least one of the following: Obj worsening of neuro stat by EDX test Obj worsening of neuro stat by PE Pt a candidate for spine surg (see #33) Prior lumbar surgery (go to #34)
33. D1: Patient is considered a candidate for spine surgery (select one):
>1 yr since last MRI w/o obj chng Progressive changes in obj neuro signs
34. D2: Prior lumbar surgery (select one):
Looking for epidural scarring Obj and/or new or worsen neuro signs X-ray OR clin signs suggest new adverse eff
Thoracic Spine Imaging updated 01/18/2011 1
Thoracic Spine MRI Imaging Questionnaire
1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator.
2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only.
L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours.
Acknowledge 3. SECTION A: ACUTE THORACIC BACK PAIN (ONSET W/IN PAST 6 WEEKS): MRI without contrast
unless specified otherwise: Yes No
4. A1 - If Yes, select one:
Bilat neuro weakness in low extrem by PE Focal pain follow fall from ht or trauma Bladder/bowel dysfunction follow trauma Sx compatible w/focal radiculopathy Infection: MRI w/o, w/contrast (go to 6) Hx of cancer w/new pain (go to 5) Suspicion of cancer w/new pain (go to 5) Low velocity trauma, >70yrs (go to 7) Osteoporosis, > 70yrs (go to 7) NA
5. A2 – If answer is Hx or suspicion of cancer w/new onset of thoracic pain, select any TWO:
Age over 50 Failure to improve after one month Unexplained weight loss NA
6. A3 – If answer is Infection: MRI without and with contrast, select one:
Elevated sedimentation rate Fever Immunosuppression (e.g. steroid use) IV drug use Known bacteremia Suspicion of systemic or spinal infection NA
7. A4 – If answer is Low velocity trauma OR osteoporosis, AND/OR age > 70 years, select one:
Vertebral compression on x-ray Other fractures NA
8. SECTION B: SUBACUTE THORACIC BACK PAIN > 6 WEEKS, MRI W/O CONTRAST. Did the patient
have MEDICAL/CONSERVATIVE CARE? If No, stop and submit the questionnaire. Request will be pended and reviewed by Qualis Health.
Yes No
Cervical Spine Imaging updated 01/18/2011 1
Cervical Spine Imaging Questionnaire
1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator.
2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only.
L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours.
Acknowledge
3. SECTION A: ACUTE CERVICAL PAIN (ONSET W/IN PAST 6 WKS): Any new objective neurological signs:
Yes No
4. A1: If Yes, select one:
Evidence of spinal fx on other IM test Evidence of spine instability on IM test Hx of great trauma (go to #5) Neuro signs suggest spine involvement Progressive neurological deficit Pt not evaluable 48hrs & suspect trauma Sensory loss, motor weakness, abn reflex Suspicion or obj evidence (go to #6)
5. A2: If answer is Hx of great trauma, select all applies:
Cranial trauma Significant whiplash after hi speed impact Significant fall
6. A3: If answer is Suspicion or objective evidence, select one:
Bone disc margin destruction on x-ray Immunosupression Infection Malignancy
7. SECTION B: SUBACUTE CERVICAL PAIN (>6 WKS) AND NO PRIOR MRI FOR SAME EPISODE OF PAIN - Select at least one:
Any neurological signs or symptoms Complex congenital anomaly of the spine Complex congenital deformity of spine Evidence of spine fx on other IM test Evidence of spine instability on IM test Evidence of substantial spine stenosis Prior neck surgery & new neuro signs/sx
Cervical Spine Imaging updated 01/18/2011 2
8. SECTION C: CHRONIC OR RECURRENT CERVICAL PAIN (>3 MOS) AND PRIOR MRI FOR THE
SAME EPISODE OF PAIN - Select at least one: > obj worsening of neuro status by EDX test > obj worsening of neuro status by PE Pt a candidate for spine surg (go to #9) Prior C-spine surgery (go to #10)
9. C1: If Patient is a candidate for C-spine surgery and (select one):
At least 1 yr since last cervical MRI Progressive changes in obj neuro signs
10. C2: If Prior C-spine surgery and (select one):
New or worsen significant obj neuro signs Other IM/clin finds suggest new adv eff
11. SECTION D: SUSPICION OF CERVICAL MULTIPLE SCLEROSIS WITH (select one):
MS w/new onset of neuro def ref to CS Objective evidence of neuro signs & sx
Headache Imaging updated 01/18/2011 1
Headache Imaging Questionnaire
1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator.
2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only.
L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours.
Acknowledge
3. Is this a headache? Yes No
4. CT/MRI for acute, recurrent headache or chronic, persistent headache in any healthcare setting (select
one): Unexplained new abnorm find on neur exam
5. New onset, secondary headache (caused by another condition) in the outpatient setting (non-hospital,
non-ER). Select one: Cognitive disturbance (e.g. confusion) Fever or meningismus Focal neurological signs or symptoms HA precipitated by exertion HA precipitated by Valsalva maneuver Hx or suspicion of cancer Hx or suspicion of HIV infection Hx or suspicion of immune compromise Patient >50 years Pt w/risk factors for CVT (go to #6)
6. If answer is Patient w/risk factors for CVT, select one:
Pregnancy or post-partum Severe dehydration
Upper Extremity Imaging updated 01/18/2011 1
Upper Extremity Imaging Questionnaire
1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator.
2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only.
L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours.
Acknowledge
3. (Mandatory) Side of body: Bilateral Left Right
4. (Mandatory) Body part:
Wrist Hand Elbow Shoulder
5. Section A: WRIST/HAND - MRI is indicated for the following (select one): Severe acute wrist trauma w/norm x-ray Suspected soft tissue mass MRI w/o contr Suspected soft tissue mass MRI w/contrst
6. Section B: ELBOW - MRI is indicated for the following (select one): Severe acute elbow trauma w/norm x-ray Suspected avascular necrosis Suspected biceps tendon rupture Suspected cartilaginous defects Suspected heterotopic calcifications Suspected intra-articular loose bodies Suspected mass (MRI w/o or w/contrast)
7. Section C: SHOULDER - ACUTE/TRAUMATIC SHOULDER PAIN (select all applies): Acute pain follow conserv meas for 4 wks Clin signs/sx: rotator cuff tear >/= 35y Suspected instab/labral tear, age < 35y Trauma: pain/weak, susp rotat cuff tear
8. C1: If Suspected instab/labral tear, age < 35y is answered, select one of the following:
Recurrent dislocation Suspected avascular necrosis Suspected intra-articular loose bodies
Upper Extremity Imaging updated 01/18/2011 2
9. Section D: SHOULDER - SUBACUTE/CHRONIC SHOULDER PAIN (select all applies):
Evaluate abnormality, ‘red flags’ Prev surg & substant incr signs of impinge Subacute pain & suspect instab/lab tear Surgical planning and no MRI w/in 6 mos
10. D1: If answer is Evaluate abnormality, ‘red flags’ (select one):
Hemarthrosis Imaging abnormality on x-ray Palpable mass Suspect neoplasm
Lower Extremity Imaging updated 01/18/2011 1
Lower Extremity Imaging Questionnaire
1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator.
2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only.
L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours.
Acknowledge
3. (Mandatory) Side of Body: Bilateral Left Right
4. (Mandatory) Body Part:
Ankle Foot Knee Hip
5. SECTION A: CHRONIC ANKLE PAIN – MRI W/O CONTRAST. Plain films of the ankle(s) have been obtained and interpreted, AND additional imaging information is required. Select at least one of the following:
Ankle impingemt syndrome suspected clin Ankle instability suspected clinically Mult sites of degen joint dis by x-rays Osteochondral injury is suspected clin Suspect infection or neoplasm Suspect stress fracture Tendon abnorm is suspected clinically
6. SECTION B: CHRONIC FOOT PAIN – MRI: Plain films of the foot (feet) have been obtained and interpreted, AND additional imaging information is required. Answer question 6, and 7 – 9 if all is applicable.
Yes No
7. B1: If Yes AND Patient is a child or adolescent (select ALL):
CT w/o contrast is contraindicated Tarsal coalition is suspected
8. B2: If Yes AND Patient has pain and tenderness over the navicular tuberosity (select ALL):
Condition unresponsive to non-surg ther X-rays show an accessory navicular
Lower Extremity Imaging updated 01/18/2011 2
9. B3: If Yes AND Patient is clinically suspected to have one of the following conditions (select one): Avascular necrosis Inflammatory arthropathy Morton’s neuroma Neoplasm Osteomyelitis Plantar fasciitis Stress fracture Tarsal tunnel syndrome Tendinopathy
10. SECTION C: ACUTE TRAUMA TO THE KNEE – MRI is indicated if there is clinical suspicion for any of the following (select all applies):
Cartilage injury Collateral ligament injury Dislocation Extensor mechanism injury Internal derangemt (menisc/cruc lig injury) Occult fracture Patellar subluxation/dislocation
11. SECTION D: NON-TRAUMATIC KNEE PAIN – MRI is indicated if there is clinical suspicion for any of the following (select all applies):
Bursitis (incl the pes anserinus) Cartilage injury Collateral ligament injury Dislocation Extensor mechanism injury Hemarthrosis Inflammatory arthritis (w/neg x-rays) Internal derangemt (menisc/cruc lig injury) Occult injury Osteonecrosis Patellar subluxation/dislocation Severe osteoarthritis NOT on x-ray Stress or insufficiency fracture Tendinopathy (incl iliotibial band)
Lower Extremity Imaging updated 01/18/2011 3
12. SECTION E: CHRONIC HIP PAIN – Have plain films been obtained and interpreted AND additional
imaging information is required? Yes (score = 2) No (score = 0)
13. E1: If Yes, MUST select at least one of the following:
Septic arthritis or osteomyelitis Severe muscle or tendon injury Stress or insufficiency fracture Surg plan affected were MR inf not avail X-ray occult condition X-rays are equivocal for osteonecrosis Xrays neg & bony/surrnd tiss abnorm susp Xrays neg/reveal mild osteoarthritis Hip is the suspected source of ref pain Xrays normal, avasc necro fem head susp Xrays pos for monoartic/atyp arthritis Xrays suggest of villonodular synovitis Xrays suggestive of osteochondromatosis
Washington Department of Labor and Industries Therapeutic Epidural Injection Questionnaire Page 1 of 3 Revised 2/1/2013
THERAPEUTIC EPIDURAL INJECTION QUESTIONNAIRE
Patient Name: _____________________________ Claim ID #: _______________________ LNI Spinal Injections – Therapeutic Epidural Injection Questionnaire CPT Codes: 62310, 62311, 62318, 62319, 64479, 64480, 64483, 64484, 0228T, 0229T, 0230T, 0231T
1. INSTRUCTIONAL NOTE: Spinal Injections UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator.
2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a RECOMMENDATION
ONLY. L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours.
Acknowledge 3. NOTE: MRI is not a prerequisite for performance of Epidural Spinal Injection (ESI). 4. INSTRUCTIONAL NOTE: NO MORE THAN TWO (2) LEVELS & ONE SIDE ALLOWED PER DATE OF
SERVICE.
5. (Mandatory) Indicate if Epidural Steroid Injection or Selective Nerve Root Block Epidural Spinal Injection Selective Nerve Root Block
6. (Mandatory) Indication for the Epidural Spinal Injection or Selective Nerve Root Block
Therapeutic Diagnostic
7. (Mandatory) Side of Body: (Select ONE)
Interlaminar Left Right Caudal
8. (Mandatory) Select injection: INSTRUCTIONAL NOTE: 3rd injection may require submission of medical records. 4th injection - submit medical records. (Select ONE)
1st injection: (see 9-16 only) 2nd injection: (see 9-20) 3rd injection: Complete entire questionnaire.
4th injection: Do NOT complete
Washington Department of Labor and Industries Therapeutic Epidural Injection Questionnaire Page 2 of 3 Revised 2/1/2013
9. (Mandatory) Epidural Spinal Injection(s) to be done on the following levels: (Select up to two)
C2 T1 L1 C3 T2 L2 C4 T3 L3 C5 T4 L4 C6 T5 L5 C7 T6 S1
T7 T8 T9 T10 T11 T12
10. (Mandatory) Please indicate which imaging guidance will be used. (Select ONE). INSTRUCTIONAL NOTE: REFER TO STATE FUND WORKERS’ COMPENSATION FOR PAYMENT POLICY. www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2012/MARFS/Chapter16/default.asp
CT guidance (See NOTE above) Fluoroscopic guidance Ultrasound guidance None of the above
11. Has patient had conservative care?
Yes No
12. How many weeks of conservative care has the patient had? (Select ONE)
Less than 2 weeks 2 – 5 weeks 6 or more weeks
13. Please indicate therapies used: (Select all that apply)
Chiro/Massage Home exercise Narcotic therapy NSAIDs Steroids Structured PT
14. Is there a PHYSICAL EXAM documenting any of the following?
[NOTE: Patient complaint/report NOT adequate] (Select ONE) Normal exam Dermatomal sensory loss Motor weakness Reflex asymmetry or loss
Lumbar Spine Imaging updated 10/04/2011 1
Lumbar Spine Imaging Questionnaire
1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator.
2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only.
L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours.
Acknowledge
3. (Mandatory) What is the duration of patient’s back pain (select one)? Within past 6 weeks (see 4 - 10) > 6 weeks (see 11 - 20) > 3mos w/no PRIOR MRI (see 21 - 31) > 3mos w/PRIOR MRI (see 32 - 34)
4. SECTION A: ACUTE LOW BACK PAIN (ONSET W/IN PAST 6 WKS) - MRI W/O CONTRAST unless
specified otherwise. ANSWER QUESTIONS 5 – 10. 5. A1: Progressive (objective) neurological signs (select one):
Progressive motor weakness present NA
6. A2: Suspect Cauda Equina Syndrome (select one)
Acute bladder or bowel dysfunction Bilateral neurologic signs and symptoms NA
7. A3: Infection - MRI with and without contrast (select one):
Elevated sedimentation rate Fever Immunosuppression (chronic steroid use) IV drug use Known bacteremia Suspicion of systemic or spinal infectn NA
8. A4: Is there history or suspicion of cancer with new onset of LBP?
Yes No
9. A5: If Yes, Suspicion of cancer criterion can be met if any two of the following are present (select two):
Age over 50 Failure to improve after one month Unexplained weight loss NA
10. A6: Low velocity trauma (e.g. fall from height or struck by object). If vertebral compression fx is
suspected due to hx of osteoporosis, use of steroids, or age > or = 70 plain x-ray s/b completed prior to MRI. Select one:
Vertebral compression fx on x-ray Other fractures NA
Washington Department of Labor and Industries Therapeutic Epidural Injection Questionnaire Page 3 of 3 Revised 2/1/2013
15. Has the patient had a diagnostic selective nerve root block? Yes (see 16) No
16. How was the selective nerve root block performed? (Select all that apply)
Low-volume Post-block patient generated pain diary Single level Steroid-free
17. (Mandatory) Have prior injection(s) been given at the same level & side as this request? NOTE: 2 or more prior injections may require submission of medical records. 4th injection requires medical records. (Select ONE)
No prior injections Only one prior injection 2 prior injections 3 or more prior injections (see NOTE)
18. Please enter dates for ANY prior injections for same level & side as this request.
(Date format: mm/dd/yyyy) ___________ ___________ ___________ ___________
19. How much improvement in function & pain was realized after the injection? (Select ONE) None Less than 30% Greater than 30%
20. How was the percentage of improvement determined? (Select all that apply)
Documented decrease in use of pain medications Documented improvement in findings on physical examination Documented increased activity Patient generated pain diary Verbal report from patient
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
5.SchedulingSelf‐InsuredL&IPatients(EX: Jones Act, OWCP, Longshoreman)
1. Submit an imaging order to CDI via fax, including claim adjuster’s name, phone number and
claim #.
For claims with Eberle Vivian please, include the appropriate questionnaire with the order and
social security number if the claim number is not available.
2. U.S. HealthWorks Medical Group faxes papers to the claim adjuster. CDI keeps order pending
until verification of approved claim is received from L&I.
If an ordered CT or MRI is on the select list of procedures requiring authorization, a CDI
Insurance Specialist will obtain an authorization through Qualis (once the Qualis
Questionnaire is received). The claims manager then has 24‐48 hours to review the Qualis
recommendation and make a final decision and provide the facility with an authorization
number if the claim is open and allowed.
3. CDI contacts claim adjuster for authorization number.
4. A CDI scheduler contacts patient to schedule their imaging exam.
5. Log on to http://www.insideCDI.comto check patients scheduling status.
U.S. HealthWorks Medical Group can view the patient exam process − from confirmed
appointment date through availability of exam results − on this secure medical professionals’
portal.*
6. Hand “Your Medical Imaging Exam” card to the patient.
If a claim number is not yet available, CDI will attempt to obtain one. Please include the patient’s:
1. Social security number 2. Name of employer 3. Date of Injury
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
6.SchedulingSTATPatients
1. Call your preferred cdi center to check on stat availability.
Bellevue: 425.637.9729
Everett: 425.740.5000
Federal Way: 253.942.7226
Kirkland: 425.821.3472
Lakewood: 253.682.1666
Renton: 425.228.2789
Seattle: 206.524.5599
2. The CDI Front Office Associate will schedule the patient and transfer you to an insurance
specialist.
3. The insurance specialist will work with you to get the information needed for a STAT
authorization request.
4. In the case of any delay, the insurance specialist will consult with the center manager for further
direction.
5. In the result of a reschedule, the CDI team will contact the patient.
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
7.WAStateDepartmentofSocialandHealthServices(DSHS)EligibilityLetter
For patients in the process of completing a physical functional evaluation for disability benefits determination.
1. Submit an imaging order to CDI via fax, including: • DSHS eligibility letter • DSHS client manager’s signature must be on letter
For a patient needing these services, a copy of a sample letter from their social worker is on the next page.
2. Log on to www.insideCDI.com to check patients scheduling status. View the patient exam process − from confirmed appointment date through availability of
exam results − on this secure medical professionals’ portal.*
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
8.HealthScreenings Center for Diagnostic Imaging offers health screenings. Below is an overview of what is offered and where. Call a listed CDI location for current pricing. CT Heart (also known as Coronary Artery Calcium Scoring)
Bellevue: 425.637.9729
Federal Way: 253.942.7226 Ultrasound Abdominal Aortic Aneurysm (AAA)
Bellevue: 425.637.9729
Kirkland: 425.821.3472
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
9.ExamResultsOnline Obtaining patient results is simple. Log into www.insideCDI.com and click on the Patient Exam Status tab. On this page, you can view current patient exam information, dating back one month. Filter results by:
Timeframe
Office Location
Referring Physician
Priority Status You can double click on the patient to access the report and images. You may also use the icons within the Results Column to print the report, view the report or view the images.
These quick icon directories may help you navigate the Patient Exam Status tab with greater confidence.
If you don’t see your patient listed, try searching for him/her in the Patient Search available on the right side of the page. In doing so, you can find patients whose exam occurred at any time, not only within the last 30 days.
If you are still having troubles finding a patient, please call the CDI scheduling team or your account executive. We are happy to help you throughout the patient imaging process, not just at the time of scheduling.
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
10.ConnectwithYourNetworkOnline
1. Engage your CDI Account Executive to let us know where your patient is going.
Let CDI assist in the patient’s care continuum. If your patient is being referred on to a specialist
outside of your network, let us know so that we can make sure the specialist has access to the
patient’s results via www.insideCDI.com.
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
11.PatientExamStatusOnline Checking on a patient’s exam status is simple. Log into www.insideCDI.com and click on the Patient Exam Status tab. On this page, you can view current patient exam information dating back one month. If you notice the words “cancelled” or “aborted” under the status column, simply click on the word and a box will show up on the right. The information contained in this box will provide explanations as to why that particular exam was cancelled or aborted.
If you are still having troubles finding a patient or exam, please call the CDI scheduling team or your account executive. We are happy to help you throughout the entire patient imaging process.
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
12.CancellationCodes
Below is an overview of CDI’s internal cancellation codes. They appear on our portal to give you more
information as to why an appointment was cancelled.
CODE DESCRIPTION
ARS – Appt R/S – Appointment rescheduled
ARS – No Show R/S – No show back to orders/rescheduled
ARS – Order R/S – Rescheduled back to orders
CX – Duplic CX – Duplication order
CX – Expira CX – Expired order
CX – Insur CX – Insur/cost
CX – No Show CX – No show
CX – Other CX – Other
CX – Percip CX – Percipio (Appropriateness advised not to image)
CX – Presch CX – Prescheduled appointment not needed
CX – PriceQT
CX – Price quote only
CX – Refoff
CX – Referring office cancellation
CX – Transp
CX – Transportation/distance to center
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
13.RadiologyGroups,TaxIDsandNPINumbers
We are proud to be served by two physician groups: MEDICAL SCANNING CONSULTANTS, PA
Federal Way, Lakewood Tax ID: 41‐1410766 NPI Number: 1730156175
RADIOLOGY CONSULTANTS OF WASHINGTON, INC., PS (RCW)
Bellevue, Everett, Kirkland, Renton, Seattle
Tax ID: 91‐1509129 NPI Number: 1124046057
Our subspecialized radiologists are board‐certified by the American College of Radiology. They are on‐site and available for consultations to work with you and your patients in our seven conveniently located centers.
1. Bellevue: 425.637.9729
2. Everett: 425.740.5000
3. Federal Way: 253.942.7226
4. Kirkland: 425.821.3472
5. Lakewood: 253.682.1666
6. Renton: 425.228.4000
7. Seattle: 206.524.5599
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
14.MRIOptions CDI has the most robust offering of MRI scanners in WA State. Videos showcasing the patient
experience on our MRI’s are available on our blog at www.myCDI.com/WA.
High‐field, Short‐bore MRI High‐field Open MRI
Available in Lakewood. Available in Kirkland.
Open Upright MRI High‐field, Wide‐bore MRI
Available in Federal Way.
Available in Renton.
Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP
Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA
*Contact your CDI account executive for a portal username and password.
15.MarketingMaterials:CenterLocations,Services,SubspecializedRadiologists
Enclosed are additional marketing pieces that describe our services and subspecialized radiologists at
CDI. Thank you, from your Puget Sound Partners in Medical Imaging.
LOCATION SERVICES HOURS* PHONE/FAX STREET ADDRESS
BELLEVUE • 1.5T MRI
• 16-slice CT
• Injections
• Ultrasound
• X-ray
7 a.m. – 8:30 p.m. M – F
9 a.m. – 5 p.m. M – F (X-ray)
Sat MRI by appt only
Ph: 425.637.9729
Fx: 425.462.8309
1310 116th Ave NE
Suite E
Bellevue, WA 98004
EVERETT • 1.5T MRI
• 16-slice CT
• Injections
• Ultrasound
• Fluoro & X-ray
7 a.m. – 8 p.m. M – F
8 a.m. – 5:30 p.m. M – F (X-ray)
Sat MRI 8:30 a.m. - 2 p.m.
Ph: 425.740.5000
Fx: 425.740.5010
3131 Nassau Street
Suite 102
Everett, WA 98201
FEDERAL WAY • 1.5T Wide bore MRI
• 16-slice CT
• Injections
• Ultrasound
• X-ray
7:30 a.m. – 9:30 p.m. M – F
9 a.m. – 6 p.m. M – F (X-ray)
Sat MRI 8 a.m. - 11:30 a.m.
Ph: 253.942.7226
Fx: 253.942.3517
33801 First Way S
Suite 101
Federal Way, WA 98003
KIRKLAND • 1.2T Open MRI
• 1.5T MRI
• 16-slice CT
• Injections
• Ultrasound
• Fluoro & X-ray
7 a.m. – 10 p.m. M – F
9 a.m. – 5 p.m. M – F (X-ray)
Sat MRI 8 a.m. - 12 p.m.
Ph: 425.821.3472
Fx: 425.820.4115
11811 NE 128th Street
Suite 101
Kirkland, WA 98034
LAKEWOOD • 1.5T MRI
• Multi-slice CT
• Injections
• Ultrasound
8:30 a.m. - 9:30 p.m. M – F
8:30 a.m. – 4 p.m. M – F (X-ray)
Sat MRI 12:30 p.m. - 5 p.m.
Ph: 253.682.1666
Fx: 253.682.1667
7308 Bridgeport Way W
Suite 101
Lakewood, WA 98499
RENTON • Open Upright MRI
• 1.5T MRI
• Multi-slice CT
• Injections
• Fluoro & X-ray
8 a.m. – 6 p.m. M – F
9 a.m. – 5:30 p.m. M – F (X-ray)
Ph: 425.228.4000
Fx: 425.228.2789
220 SW 43rd Street
Renton, WA 98055
SEATTLE • 1.5T MRI
• Multi-slice CT
• Injections
• Ultrasound
• Fluoro & X-ray
7 a.m. – 5 p.m. M – F
8 a.m. – 4 p.m. M – F (X-ray)
Ph: 206.524.5599
Fx: 206.524.5338
115 NE 100th Street
Suite 101
Seattle, WA 98125
Bellevue’s physician services are provided by Radiology Consultants of Washington (RCW), Inc., PS
Everett’s physician services are provided by Radiology Consultants of Washington (RCW), Inc., PS
Axial-loading option available for MR and CT.
Lakewood’s physician services are provided by Medical Scanning Consultants, PA
Axial-loading option available for MR and CT.
Federal Way’s physician services are provided by Medical Scanning Consultants, PA
Kirkland’s physician services are provided by Radiology Consultants of Washington (RCW), Inc., PS
Renton’s physician services are provided by Radiology Consultants of Washington (RCW), Inc., PS
Seattle’s physician services are provided by Radiology Consultants of Washington (RCW), Inc., PS
NOTE: On-site creatinine testing available at all 7 CDI locations for your patients’ convenience.
*Hours subject to change.
© 2014, Center for Diagnostic Imaging
FOR YOU: insideCDI.com FOR YOUR PATIENTS: myCDI.com/WA
CPT Common Medical Imaging Procedures
CT Abdomen w/o Cont ................................... 74150CT Abdomen w/Cont ....................................... 74160CT Abdomen w/ & w/o Cont ......................... 74170CT Brain/Head w/o Cont ...............................70450CT Brain/Head w/Cont .................................. 70460CT Brain/Head w/ & w/o Cont .....................70470CT Cervical w/o Cont ........................................72125CT Cervical w/Cont .......................................... 72126CT Cervical w/ & w/o Cont ..............................72127CT Chest w/o Cont ........................................... 71250CT Chest w/Cont ...............................................71260CT Chest w/ & w/o Cont ................................. 71270CT Enterography w/ Cont ...............................74177CT IAC w/o Cont ..............................................70480CT IAC w/Cont ...................................................70481
CT IAC w/ & w/o Cont ....................................70482CT Soft Tissue Neck w/o Cont ................... 70490CT Soft Tissue Neck w/Cont ..........................70491CT Soft Tissue Neck w/ & w/o Cont ...........70492CT Lower Extremity w/o Cont ..................... 73700CT Lower Extremity w/Cont .......................... 73701CT Lower Extremity w/ & w/o Cont ............73702CT Lumbar w/o Cont .........................................72131CT Lumbar w/Cont ............................................72132CT Lumbar w/ & w/o Cont ..............................72133CT Maxillofacial w/o Cont ..............................70486CT Maxillofacial w/Cont .................................70487CT Maxillofacial w/ & w/o Cont ...................70488CT Pelvis w/o Cont ............................................72192CT Pelvis w/Cont ............................................... 72193
CT Pelvis w/ & w/o Cont ................................. 72194CT Thoracic w/o Cont .......................................72128CT Thoracic w/Cont ......................................... 72129CT Thoracic w/ & w/o Cont ............................ 72130CT Upper Extremity w/o Cont .....................73200CT Upper Extremity w/Cont .......................... 73201CT Upper Extremity w/ & w/o Cont ........... 73202CT Abdomen & Pelvis w/o Cont ....................74176CT Abdomen & Pelvis w/Cont .......................74177CT Abdomen & Pelvis w/ & w/o Cont ..........74178 CTA Abdomen & Pelvis w/Cont .....................74174 CTA Abdomen/Aorta w/Runoff ....................75635 CTA Carotid/Neck ............................................70498 CTA Chest.............................................................71275 CTA Head ...........................................................70496
CT
MRI Abdomen w/o Cont ...................................74181MRI Abdomen w/ & w/o Cont ........................74183MRI Brain w/o Cont .......................................... 70551MRI Brain w/ & w/o Cont ............................... 70553MRI TMJ .............................................................. 70336MRI Cervical w/o Cont ...................................... 72141MRI Cervical w/ & w/o Cont........................... 72156MRI Chest w/o Cont ......................................... 71550MRI Chest w/ & w/o Cont ................................71552MRI Enterography w/ & w/o Cont ....74183, 72197
MRI Hip w/o Cont ...............................................73721MRI Hip w/ & w/o Cont ...................................73723MRI Lower Extremity w/o Cont .....................73718MRI Lower Extremity w/ & w/o Cont ......... 73720MRI Lower Extremity Joint w/o Cont ...........73721MRI Lower Extremity Joint w/ & w/o Cont .73723MRI Lumbar w/o Cont ..................................... 72148MRI Lumbar w/ & w/o Cont ........................... 72158MRI Orbit Face Neck w/o Cont ....................70540MRI Orbit Face Neck w/ & w/o Cont ..........70543
MRI Pelvis w/o Cont ......................................... 72195MRI Pelvis w/ & w/o Cont ................................72197MRI Thoracic w/o Cont .................................... 72146MRI Thoracic w/ & w/o Cont...........................72157MRI Upper Extremity w/o Cont .....................73218MRI Upper Extremity w/ & w/o Cont ......... 73220MRI Upper Extremity Joint w/o Cont ..........73221MRI Upper Extremity Joint w/ & w/o Cont............................................................73223
MRI
MRA Abdomen ...................................................74185MRA Chest .......................................................... 71555MRA Lower Extremity .....................................73725MRA Head w/o Cont .......................................70544
MRA Head w/Cont ...........................................70545MRA Head w/ & w/o Cont .............................70546MRA Neck w/o Cont ........................................ 70547MRA Neck w/Cont ...........................................70548
MRA Neck w/ & w/o Cont .............................70549MRA Pelvis .......................................................... 72198MRA Upper Extremity .....................................73225
MRA
Below is an overview of commonly ordered studies. This information is intended to serve as a clinical education tool when communicating with insurance providers and others related to pre-authorization. It is not an all-inclusive list. If you have specific questions about a study or procedure, call 425.250.1160 and a member of our insurance team will assist you.
myCDI.com/WA
Insurance Specialist Line: 425.250.1160
EFFECTIVE DATE: 1.1.14 - 12.31.14
CPT codes are a copyright of the American Medical Association (AMA). If you cannot find what you are looking for, please reference the “AMA CPT Manual.”
Abdomen ...........................................................76700Liver and Gallbladder...................................... 76705OB – Less than 14 wks (Transvaginal will also have CPT 76817) ..76801
Pelvis (Transvaginal will also have CPT 76830) ........................................... 76856 Renal/Kidneys and Bladder .......................... 76770
Scrotum/Testicles (Doppler will also have CPT 93975 or 93976) ......................... 76870Thyroid ................................................................ 76536
ULTRASOUND
Arthrogram – Hip w/ Cont ............................ 27093Arthrogram – Shoulder w/ Cont ................. 23350Arthrogram – Wrist w/ Cont ........................ 25246Epidural Steroid Injection (ESI) / Epidurography Lumbar Interlaminar ......... 62311
Epidural Steroid Injection (ESI) /Epidurography Lumbar Transforaminal ..................................64483Facet Injection Lumbar ..................................64493Lumbar Puncture ............................................. 62270Nerve Block Injection Lumbar .....................64483
SI Joint Injection ..............................................27096Therapeutic Arthrogram – Shoulder, Hip, Knee ...........................................................20610
DIAGNOSTIC AND THERAPEUTIC INJECTIONS (DTI)
ORDERING AN IMAGING EXAM:To order an imaging exam at any of our Puget Sound Area locations or for prior authorization, call 855.643.7226 or order online at insideCDI.com.
90
Everett
Bellevue
Renton
Kirkland
Federal Way
Lakewood
SeattleNorthgate
99
5
520
405
Lake Washington
TAX ID: 91-1509129
Physician services provided by Radiology Consultants of Washington, Inc., PS
BELLEVUE 425.637.9729
EVERETT 425.740.5000
KIRKLAND 425.821.3472
RENTON 425.228.4000
SEATTLE 206.524.5599
TAX ID: 41-1410766
Physician services provided by Medical Scanning Consultants, PA
FEDERAL WAY 253.942.7226
LAKEWOOD 253.682.1666
myCDI.com/WA
CALIXTO DIMAS, M.D. Body RadiologistBELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE
•• Fellowship: University of WA, Abdominal Imaging
•• Residency: University of MN•• Medical Degree: Yale University, New Haven, CT
ANDREW D. BRONSTEIN, M.D.NeuroradiologistBELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE
•• Fellowship: University of WA Affiliated Hospitals, Neuroradiology
•• Residency: University of WA Affiliated Hospitals•• Medical Degree: Harvard Medical School, Boston, MA
STACIE L. MARS, M.D.Body RadiologistBELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE
•• Fellowship: University of WA, Body Imaging•• Residency: University of WA; Santa Barbara Cottage Hospital•• Medical Degree: University of WA School of Medicine
DAVIS A. GUILBERT, M.D.NeuroradiologistBELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE
•• Fellowship: Yale-New Haven Hospital, Neuroradiology
•• Residency: Christiana Health System, Newark, Delaware•• Medical Degree: University of Utah School of Medicine
ROBERT M. LIDDELL, M.D.Musculoskeletal, Pediatric & Body RadiologistBELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE
•• Fellowships: University of WA, Body CT/US/MRI; University of Cambridge, England, Pediatric Radiology; Children’s Hospital and Medical Center, Seattle, Pediatric Radiology
•• Residency: University of WA•• Medical Degree: University of Rochester School of
Medicine and Dentistry
SHANE E. MACAULAY, M.D.Musculoskeletal & Body RadiologistBELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE
•• Fellowship: University of WA, MRI Research & Abdominal Imaging
•• Residency: University of WA•• Medical Degree: University of CA, San Diego School of
Medicine
RANDALL K. PETERSEN, M.D.Musculoskeletal & Body RadiologistBELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE
•• Fellowship: University of Michigan Medical Center, Diagnostic Radiology US/CT/MRI
•• Residency: Washington University Medical Center, St Louis, MO; University of MI Medical Center
•• Medical Degree: Johns Hopkins University School of Medicine
RADIOLOGY CONSULTANTS OF WASHINGTON (RCW), PS
Your Partner in Medical ImagingCenter for Diagnostic Imaging (CDI) brings the Seattle and surrounding Puget Sound community a full range of medical imaging and interventional radiology services. We are proud to be served by three different physician groups. These subspecialized radiologists are board certified by the American College of Radiology. They are on-site and available for consultation to work with you and your patients in our eight conveniently located centers.
myCDI.com/WA
90
Everett
Bellevue
Renton
Kirkland
Federal Way
Lakewood
SeattleNorthgate
99
5
520
405
Lake Washington
TO CONSULT WITH ANY OF OUR SUBSPECIALIZED RADIOLOGISTS,
PLEASE CALL US TODAY!
BELLEVUE425.637.9729EVERETT425.740.5000FEDERAL WAY253.942.7226KIRKLAND425.821.3472
LAKEWOOD253.682.1666RENTON425.228.4000SEATTLE206.524.5599
STEVEN R. POLLEI, M.D. Medical Director, NeuroradiologistFEDERAL WAY & LAKEWOOD
•• Fellowship: University of Utah Hospitals, Neuroradiology
•• Residency: University of New Mexico Hospitals•• Medical Degree: Washington University in St. Louis,
Missouri
JIM SCHUMACHER, M.D.Musculoskeletal & NeuroradiologistFEDERAL WAY & LAKEWOOD
•• Fellowship: The Neurological Institute of Columbia and Brigham and Women’s Hospital of Harvard Medical School
•• Residency: Eastern Virgina Medical School •• Medical Degree: University of Tennessee, Knoxville, TN
MEDICAL SCANNING CONSULTANTS, PARADIOLOGY CONSULTANTS OF WASHINGTON (RCW), PS (continued)
RANJEET B. SINGH, M.D.Musculoskeletal & NeuroradiologistBELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE
•• Fellowship: University of WA; University of British Columbia, Neuroradiology & Musculoskeletal MRI
•• Residency: Melbourne University, Australia•• Medical Degree: Monash University, Australia
MARK A. SKIRGAUDAS, M.D.Musculoskeletal RadiologistBELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE
•• Fellowship: University of California in San Francisco, Musculoskeletal Radiology
•• Residency: University of California in San Francisco•• Medical Degree: Yale University School of Medicine
THOMAS P. SULLIVAN, M.D.Medical Director, NeuroradiologistBELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE
•• Fellowship: University of WA, Neuroradiology
•• Residency: University of WA•• Medical Degree: UCLA School of Medicine
myCDI.com/WA
top related