Diagnosis: Right ankle pain and swelling.
Treatment: MRI of leg without contrast.

The insurer denied the MRI of leg without contrast. The denial is overturned.

The patient is a female. She had an MRI (magnetic resonance image) of the right ankle after having right ankle pain and swelling. This showed edema that was nonspecific, effusion of the ankle. No tendon tear and mild tenosynovitis of the posterior tibial tendon.

The patient had presented with ankle pain that had been present for two months. On exam she was found to have swelling and weakness. X-rays were done in the office, which were negative and showed swelling only. Examination showed weakness of the mid-foot and pain in the mid-foot. An Unna boot was applied to reduce edema. The MRI (magnetic resonance image) was ordered to assess for Lisfranc fracture dislocation.

Yes, the MRI (magnetic resonance image) of leg without contrast (73718) is medically necessary.

The MRI (magnetic resonance image) was ordered to assess for a Lisfranc injury. A Lisfranc injury is a soft tissue injury of the midfoot often caused by a twisting type injury to the midfoot. This is an easily missed injury in that it typically involves a tear of a midfoot ligament, sometimes without bony abnormality. It is commonly missed because practitioners are often looking for a fracture and when none is found, patients are treated inappropriately. An MRI (magnetic resonance image) is indicated, as when there is a Lisfranc tear, surgery is required. It may also be treated with prolonged nonweightbearing and casting. The MRI (magnetic resonance image) in this case was necessary to assess for a Lisfranc injury, as that was the diagnosis that was suspected.

The office notes show that the MRI (magnetic resonance image) was ordered to rule out a Lisfranc injury. An MRI (magnetic resonance image) is needed to assess for this injury, as it is a soft tissue injury and not present on x-rays, which were negative.