This webinar was sponsored by Esaote North America and Musculoskeletal Imaging Consultants.
In an Oct. 2 webinar titled "Weight-Bearing MRI in Modern Spine Practice: Addressing Milliman Criteria," Douglas Smith, MD, and Stephen Hochschuler, MD, discussed the advantages of using a standing or supine weight-bearing imaging system, specifically the G-Scan Brio from Esaote, as opposed to a traditional MRI scan.
Dr. Smith is the founder and owner of Musculoskeletal Imaging Consultants. He has conducted extensive research on orthopedic magnetic resonance imaging since his orthopedic residency at the Mayo Clinic in Rochester, Minn., in 1984. Dr. Hochschuler is the co-founder of Texas Back Institute and an orthopedic spine surgeon who focuses on failed back surgery syndrome.
While discussing how using a weight-bearing imaging system can be beneficial to properly diagnosing patients, Dr. Smith and Dr. Hochschuler also discussed how to present the tests to CMS and commercial payers in order to meet the Milliman Care Guidelines, now known as MCG, for evidence-based medicine.
Weight-bearing (stand-up) imaging provides many possible benefits to the surgeon and the patient, according to Dr. Smith. The G-scan Brio system is more cost effective than other whole body MRIs, in part because it includes a free-standing RF pavilion instead of an expensive copper-lined RF-shielded room. The Esaote RF pavilion also allows for a large exam or treatment room to be easily turned into an MR imaging room.
The G-scan Brio is a low field strength MRI system. Still, Dr. Smith vouched for image clarity and accuracy.
"Low field strength machines are better for imaging hardware," he said. "You get less metallic artifact, and have to use fewer metallic artifact reduction sequences to compensate for the metal."
In contrast with the traditional MRI's closed tube, the G-scan Brio's open design allows for more patient interaction with the physician and less noise and claustrophobia.
However, the largest benefit of weight-bearing MRI comes from being able to see spinal problems in action. Some symptoms require a positional MRI, Dr. Smith says, and the weight-bearing images can show flexion and extension to demonstrate cord compression that is not visible in a neutral position. Similarly, dynamic foraminal stenosis is visible on a G-scan Brio image, which shows the body weight compressing the disc, the facet joint overriding and the disc compressing the nerve root in the neural foramen.
Dr. Smith also described how the Brio MRI can contribute to a synergistic approach to meeting the Milliman criteria. Milliman guidelines are specific to the diagnosis and proposed surgical treatment code. Unless the guidelines are specifically documented in a pre-authorization request, most payers will deny pre-authorization for the imaging as not medically necessary, he says.
He describes the four "Ts" necessary for an optimal Milliman reporting program:
• Talent — A qualified spine radiologist should conduct the scan.
• Terminology — Use the correct wording as dictated by the payer.
• Timing — Submit all information with the application, as opposed to waiting for the appeal.
• Technology — Use accurate technology, such as the Brio device.
He also recommends using a computer program, such as RadCloud, to generate your radiology report with all of the necessary information.
"You have to have the full package when you approach insurance company," Dr. Hochschuler says. "That means you have to come in pre-defining everything Milliman has laid out. It's absurd, but if you want to have surgeries available for patient, you have to get through it."
Dr. Hochschuler foresees healthcare reform causing problems for patient treatment, especially when patients come to a spine physician with poor existing MRIs; it will be harder for the physician to obtain a second MRI unless it meets the Milliman criteria.
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Download a copy of the presentation by clicking here (pdf).