MRI thoracolumbar spine and pelvis

Patient: Persistent / worsening thoracic pain, night pain, response to NSAIDs, severe unrelenting rib pain.

Imaging: MRI thoracolumbar spine and pelvis

Is Preauth Required? According to the ARC Criteria, patients who have acute, persistent or worsening thoracic pain, night pain, response to nonsteroidal anti-inflammatory drugs (NSAIDs), and severe unrelenting rib pain, may be authorized for MRI of the thoracolumbar spine and pelvis. Documentation of failure of at least two classes of medications prior to the imaging procedure should be provided as justification for the MRI. Will the claim be denied? The claim for an MRI of the thoracolumbar spine and pelvis for persistent/worsening thoracic pain, night pain, response to NSAIDs, and severe unrelenting rib pain may be denied if the symptoms do not bear a direct relationship to the level of subluxation, and if the location of pain is not described in relation to the vertebra listed that is capable of producing pain in the area determined. Additionally, if there is insufficient evidence to make a recommendation for or against the use of caudal or interlaminar epidural steroid injections in patients with low back pain, the claim may be denied. When is the following treatment medically necessary for the condition specified? Medically necessary treatment for persistent/worsening thoracic pain, night pain, response to NSAIDs, and severe unrelenting rib pain include MRI of the thoracolumbar spine and pelvis. MRI is recommended to evaluate the spine and pelvis for structural abnormalities that may cause or contribute to the pain, such as disc herniation, nerve compression, or other degenerative changes. It can also help to determine if there are any other conditions in the area that may be causing the pain, such as infection or tumor.