Policy Number: PAT – 6010 / Page(s): 1of1
Approved by: / Effective Date:
PURPOSE:Radiology services will be available to the patients of the Clinic in an effort to provide comprehensive healthcare services.
POLICY:Basic radiological services will be provided under the direction of the treating doctor. Personnel will be appropriately licensed or trained to perform radiology services in a safe and timely manner. Services will be provided in accordance with all applicable state, federal and other regulatory agency requirements.
PROCEDURE:
- An “X-ray Medical Necessity Request Form” is filled out on each patient requiring x-rays prior to the service being provided.
- Licensed or adequately trained personnel will perform radiology services.
- Indications for Plain x-ray studies include, but are not limited to:
- Patient is over the age of 65
- Patient is a male over the age of 50 with acute low back pain
- History of trauma sufficient to cause fracture
- Neuromotor deficits (i.e. urinary retention, muscle weakness)
- Constitutional symptoms such as fever higher than 100 degrees, chills and/or unexplained weight loss
- Intense pain at rest
- Prolonged use of steroids
- Previous spinal fracture or surgery
- Recurrent back pain with no x-rays in past 2 years
- Personal history of drug and alcohol abuse
- Personal history of cancer
- Failure to improve under treatment without prior x-rays
- History of x-ray abnormality, as reported by the patient, but no films or report available
- Unexplained significant structural and or postural deformity
- Radicular subjective symptoms correlated with objective findings
- Patient unable to give a reliable history
- Need for immediate decision about career or athletic future
- Suspicion of, or confirmed inflammatory arthritis
- Symptoms of urinary tract dysfunction
- Contraindications for Plain View X-rays include (but is not limited to);
- Pregnancy or possible pregnancy
- Infants
- If patient has had recent high levels of exposure to therapeutic or occupational radiation
- Positioning difficulty due to physical or mental state
- Asymptomatic people – excluding scoliosis study
- Information included on each x-ray study includes;
- Complete patient name
- Clinic or doctor’s name
- Address location of clinic
- Date of Service
- Age of patient