Wis. Admin. Code Department of Workforce Development DWD 81.05 - Guidelines for medical imaging
(1) GENERAL
PRINCIPLES.
(a)
Documentation. Except for emergency evaluation of significant
trauma, a health care provider shall document in the medical record an
appropriate history and physical examination, along with a review of any
existing medical records and laboratory or imaging studies regarding the
patient's condition before ordering any imaging study. All medical imaging
shall comply with all of the following:
(b)
Effective imaging. A
health care provider shall initially order the single most effective imaging
study for diagnosing the suspected etiology of a patient's condition. No
concurrent or additional imaging studies shall be ordered until the results of
the first study are known and reviewed by the treating health care provider. If
the first imaging study is negative, no additional imaging is necessary except
for repeat and alternative imaging allowed under pars. (e) and (f).
(c)
Appropriate imaging.
Imaging solely to rule out a diagnosis not seriously being considered as the
etiology of the patient's condition is not necessary.
(d)
Routine imaging. Imaging
on a routine basis is not necessary unless the information from the study is
necessary to develop a treatment plan.
(e)
Repeat imaging. Repeat
imaging of the same views of the same body part with the same imaging modality
is not necessary except for any of the following:
1. To diagnose a suspected fracture or
suspected dislocation.
2. To
monitor a therapy or treatment that is known to result in a change in imaging
findings and imaging of these changes are necessary to determine the efficacy
of the therapy or treatment; repeat imaging is not appropriate solely to
determine the efficacy of physical therapy or chiropractic treatment.
3. To follow up a surgical
procedure.
4. To diagnose a change
in the patient's condition marked by new or altered physical
findings.
5. To evaluate a new
episode of injury or exacerbation that in itself warrants an imaging
study.
6. When the treating health
care provider and a radiologist from a different practice have reviewed a
previous imaging study and agree that it is a technically inadequate
study.
(f)
Alternative imaging.
1.
Persistence of a patient's subjective complaint or failure of the condition to
respond to treatment are not legitimate indications for repeat imaging. In this
instance an alternative imaging study may be necessary if another etiology of
the patient's condition is suspected because of the failure of the condition to
improve.
2. Alternative imaging may
not follow up negative findings unless there has been a change in the suspected
etiology and the first imaging study is not an appropriate evaluation for the
suspected etiology.
3. Alternative
imaging may follow up abnormal but inconclusive findings in another imaging
study. An inconclusive finding may not provide an adequate basis for accurate
diagnosis.
(2) SPECIFIC IMAGING PROCEDURES FOR LOW BACK
PAIN.
(a) Except for the emergency evaluation
of significant trauma, a health care provider shall document in the medical
record an appropriate history and physical examination, along with a review of
any existing medical records and laboratory or imaging studies regarding the
patient's condition, before ordering any imaging study of the low
back.
(b) A health care provider
may order computed tomography scanning for any of the following:
1. When cauda equina syndrome is
suspected.
2. For evaluation of
progressive neurologic deficit.
3.
When bony lesion is suspected on the basis of other tests or imaging
procedures.
(c) Except
as specified in par. (b), a health care provider may not order computed
tomography scanning in the first 4 weeks after an injury. Computed tomography
scanning is necessary after 4 weeks if the patient continues with symptoms and
physical findings after the course of initial nonsurgical care and if the
patient's condition prevents the resumption of the regular activities of daily
life, including regular vocational activities.
(d) A health care provider may order magnetic
resonance imaging scanning for any of the following:
1. When cauda equina syndrome is
suspected.
2. For evaluation of
progressive neurologic deficit.
3.
When previous spinal surgery has been performed and there is a need to
differentiate scar due to previous surgery from disc herniation, tumor, or
hemorrhage.
4. Suspected
discitis.
(e) Except as
specified in par. (d), a health care provider may not order magnetic resonance
imaging scanning in the first 4 weeks after an injury. Magnetic resonance
imaging scanning is necessary after 4 weeks if the patient continues with
symptoms and physical findings after the course of initial nonsurgical care and
if the patient's condition prevents the resumption of the regular activities of
daily life, including regular vocational activities.
(f) A health care provider may order
myelography for any of the following:
1.
Myelography may be substituted for otherwise necessary computed tomography
scanning or magnetic resonance imaging scanning in accordance with pars. (b)
and (d), if those imaging modalities are not locally available.
2. In addition to computed tomography
scanning or magnetic resonance imaging scanning, if there are progressive
neurologic deficits or changes and computed tomography scanning or magnetic
resonance imaging scanning has been negative.
3. For preoperative evaluation in cases of
surgical intervention, but only if computed tomography scanning or magnetic
resonance imaging scanning have failed to provide a definite preoperative
diagnosis.
(g) A health
care provider may order computed tomography myelography for any of the
following:
1. The patient's condition is
predominantly sciatica, there has been previous spinal surgery, and tumor is
suspected.
2. The patient's
condition is predominantly sciatica, there has been previous spinal surgery,
and magnetic resonance imaging scanning is equivocal.
3. When spinal stenosis is suspected and the
computed tomography scanning or magnetic resonance imaging scanning is
equivocal.
4. If there are
progressive neurologic symptoms or changes and computed tomography scanning or
magnetic resonance imaging scanning has been negative.
5. For preoperative evaluation in cases of
surgical intervention, but only if computed tomography scanning or magnetic
resonance imaging scanning have failed to provide a definite preoperative
diagnosis.
(h) A health
care provider may order intravenous enhanced computed tomography scanning only
if there has been previous spinal surgery, and the imaging study is being used
to differentiate scar due to previous surgery from disc herniation or tumor,
but only if intrathecal contrast for computed tomography-myelography is
contraindicated and magnetic resonance imaging scanning is not available or is
also contraindicated.
(i) A health
care provider may order enhanced magnetic resonance imaging scanning for any of
the following:
1. There has been previous
spinal surgery, and the imaging study is being used to differentiate scar due
to previous surgery from disc herniation or tumor.
2. Hemorrhage is suspected.
3. Tumor or vascular malformation is
suspected.
4. Infection or
inflammatory disease is suspected.
5. Unenhanced magnetic resonance imaging
scanning was equivocal.
(j) A health care provider may order
discography for any of the following:
1. All
of the following are present:
a. Back pain is
the predominant complaint.
b. The
patient has failed to improve with initial nonsurgical management.
c. Other imaging has not established a
diagnosis.
d. Lumbar fusion surgery
or other surgical procedures are being considered as a therapy.
2. There has been previous spinal
surgery, and pseudoarthrosis, recurrent disc herniation, annular tear, or
internal disc disruption is suspected.
(k) A health care provider may order computed
tomography discography when it is necessary to view the morphology of a disc.
(L) A health care provider may not
order nuclear isotope imaging including technicium, indium, and gallium scans,
unless tumor, stress fracture, infection, avascular necrosis, or inflammatory
lesion is suspected on the basis of history, physical examination findings,
laboratory studies, or the results of other imaging studies.
(m) A health care provider may not order
thermography for the diagnosis of any of the clinical categories of low back
conditions in s.
DWD 81.06(1)
(b).
(n) A health care provider may order
anterior-posterior and lateral X-rays of the lumbosacral spine for any of the
following:
1. When there is a history of
significant acute trauma as the precipitating event of the patient's condition,
and fracture, dislocation, or fracture dislocation is suspected.
2. When the history, signs, symptoms, or
laboratory studies indicate possible tumor, infection, or inflammatory
lesion.
3. For postoperative
follow-up of lumbar fusion surgery.
4. When the patient is more than 50 years of
age.
5. Before beginning a course
of treatment with spinal adjustment or manipulation.
6. Eight weeks after an injury if the patient
continues with symptoms and physical findings after the course of initial
nonsurgical care and if the patient's condition prevents the resumption of the
regular activities of daily life, including regular vocational
activities.
(o) A health
care provider may not order anterior-posterior and lateral X-rays of the
lumbosacral spine for any of the following:
1.
To verify progress during initial nonsurgical treatment.
2. To evaluate a successful initial
nonsurgical treatment program.
(p) A health care provider may order oblique
X-rays of the lumbosacral spine for any of the following:
1. To follow up abnormalities detected on
anterior-posterior or lateral X-ray.
2. For postoperative follow-up of lumbar
fusion surgery.
3. To follow up
spondylolysis or spondylolisthesis not adequately diagnosed by other necessary
imaging procedures.
(q)
A health care provider may not order oblique X-rays of the lumbosacral spine as
part of a package of X-rays including anterior-posterior and lateral X-rays of
the lumbosacral spine.
(r) A health
care provider may not order electronic X-ray analysis of plain radiographs and
diagnostic ultrasound of the lumbar spine for diagnosis of any of the low back
conditions in s.
DWD 81.06(1)
(b).
Notes
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