Louisiana Administrative Code › Title 40 - LABOR AND EMPLOYMENT › Part I - Workers' Compensation Administration › Subpart 2 - Medical Guidelines › Chapter 23 - Upper and Lower Extremities Medical Treatment Guidelines › Subchapter A - Lower Extremities › Section I-2307 - Follow-Up Diagnostic Imaging and Testing Procedures

Current through Register Vol. 50, No. 6, June 20, 2024
A. One diagnostic imaging procedure may
					 provide the same or distinctive information as obtained by other procedures.
					 Therefore, prudent choice of procedure(s) for a single diagnostic procedure, a
					 complementary procedure in combination with other procedures(s), or a proper
					 sequential order in multiple procedures will ensure maximum diagnostic
					 accuracy; minimize adverse effect to patients and cost effectiveness by
					 avoiding duplication or redundancy.
B. All diagnostic imaging procedures have a
					 significant percentage of specificity and sensitivity for various diagnoses.
					 None is specifically characteristic of a certain diagnosis. Clinical
					 information obtained by history taking and physical examination should be the
					 basis for selection and interpretation of imaging procedure results.
C. When a diagnostic procedure, in
					 conjunction with clinical information, provides sufficient information to
					 establish an accurate diagnosis, the second diagnostic procedure will become a
					 redundant procedure. At the same time, a subsequent diagnostic procedure can be
					 a complementary diagnostic procedure if the first or preceding procedures, in
					 conjunction with clinical information, cannot provide an accurate diagnosis.
					 Usually, preference of a procedure over others depends upon availability, a
					 patient's tolerance, and/or the treating practitioner's familiarity with the
					 procedure.
1. Imaging studies. When indicated,
					 the following additional imaging studies can be utilized for further evaluation
					 of the lower extremity, based upon the mechanism of injury, symptoms, and
					 patient history. For specific clinical indications, see Section E, Specific
					 Lower Extremity Injury Diagnosis, Testing, and Treatment. The studies below are
					 listed in frequency of use, not importance.
a.
					 Magnetic Resonance Imaging (MRI) are generally accepted, well-established, and
					 widely used diagnostic procedures. It provides a more definitive visualization
					 of soft tissue structures, including ligaments, tendons, joint capsule, menisci
					 and joint cartilage structures, than x-ray or Computed Axial Tomography in the
					 evaluation of traumatic or degenerative injuries. The addition of intravenous
					 or intra-articular contrast can enhance definition of selected pathologies.
i. The high field, closed MRI with 1.5 or
					 higher tesla provides better resolution. A lower field scan may be indicated
					 when a patient cannot fit into a high field scanner or is too claustrophobic
					 despite sedation. Inadequate resolution on the first scan may require a second
					 MRI using a different technique or with a reading by a musculoskeletal
					 radiologist. All questions in this regard should be discussed with the MRI
					 center and/or radiologist.
ii. MRIs
					 have high sensitivity and specificity for meniscal tears and ligamentous
					 injuries although in some cases when physical exam findings and functional
					 deficits indicate the need for surgery an MRI may not be necessary. MRI is less
					 accurate for articular cartilage defects (sensitivity 76 percent) than for
					 meniscal and ligamentous injury (sensitivity greater than 90
					 percent).
iii. MRIs have not been
					 shown to be reliable for diagnosing symptomatic hip bursitis.