Joseph Cresanti

MRI is currently the gold standard for identifying radicular pathology, but unfortunately, it requires preauthorization, which isn’t easy to obtain. Physical tests are what most practitioners depend on – despite the marginal reliability of the tests. The information in this article brings history and observation to the forefront of radicular diagnostics. Each factor listed can significantly increase the clinician’s ability to diagnose radiculopathies.

With some plans – and it starts with Medicare (CMS) – there is a payment protocol called the multiple-procedure payment reduction (MPPR). This protocol means that if a health care provider performs multiple procedures during a single patient encounter, Medicare (and many commercial insurers) typically will pay “full price” for only the highest-valued procedure. The subsequent procedures will be reduced, as there is overlap.

A 42-year-old male former patient arrives at your chiropractic office with excruciating low back pain that travels all the way down his right leg to his foot. A spinal surgeon previously recommended surgery to correct an MRI-confirmed disc herniation (sequestration) at L5, but the patient chose conservative chiropractic care. Although conservative treatment is effective for many lumbar disc herniations, the warning signs in this case call for escalation.