Wisconsin Administrative Code › Department of Workforce Development › DWD 80-81 - Worker's Compensation › Chapter DWD 81 - Worker's compensation treatment guidelines › Section DWD 81.05 - Guidelines for medical imaging

Current through June 24, 2024
(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.