Scheduling a Diagnostic Imaging Exam

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Scheduling a Diagnostic Imaging Exam A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP IN-HOUSE TEAM OF INSURANCE SPECIALISTS:

BELLEVUE:

Carrie Richardson, Scheduling and Insurance Manager 425.250.1155

Tel: 425.637.9729 Fax: 425.462.8309

Abi Roberts, Lead Insurance Specialist 425.250.1157

EVERETT: Tel: 425.740.5000 Fax: 425.740.5010

Aubrey Griswold 425.283.0103

FEDERAL WAY:

Lori Jaffurs 425.250.1132

KIRKLAND:

Jennifer Fischer 425.248.2441 Tonya Harris 253.248.2505 DEDICATED INSURANCE SPECIALISTS’ MAIN LINES: Phone: 425.250.1160 Fax: 425.462.4302

Tel: 253.942.7226 Fax: 253.942.3517

Tel: 425.821.3472 Fax: 425.820.4115 LAKEWOOD: Tel: 253.682.1666 Fax: 253.682.1667 RENTON: Tel: 425.228.4000 Fax: 425.228.2789 SEATTLE: Tel: 206.524.5599 Fax: 206.524.5338

Scheduling a Diagnostic Imaging Exam | A GUIDE FOR U.S. HEALTHWORKS MEDICAL GROUP

Table of Contents 1. Scheduling Patients with Private Insurance ........................................................................................................ 2 2. Price Quotes ........................................................................................................................................................ 5 3. Scheduling L&I Patients ....................................................................................................................................... 6 4. Qualis Questionnaires (17 Inserts) ...................................................................................................................... 7 5. Scheduling Self‐Insured L&I Patients ................................................................................................................... 8 6. Scheduling STAT Patients ..................................................................................................................................... 9 7. DSHS Eligibility Letter ........................................................................................................................................ 10 8. Health Screenings .............................................................................................................................................. 12 9. Exam Results Online .......................................................................................................................................... 13 10. Connect with Your Network Online ................................................................................................................ 14 11. Patient Exam Status Online ............................................................................................................................. 15 12. Cancellation Codes .......................................................................................................................................... 16 13. Radiology Groups, Tax IDs and NPI Numbers ................................................................................................. 17 14. MRI Options ..................................................................................................................................................... 18 15. Marketing Materials: Center Locations, Services, Subspecialized Radiologists .............................................. 19


1. Scheduling Patients with Private Insurance Patient with Insurance | Pre‐authorization Required 1. Submit an imaging order via fax along with:  Patient Signs and Symptoms  Patient Insurance ID Number  Relevant History  Differential Diagnosis with ICD‐9/ICD‐10 codes  Recent Chart Notes 2. Upon receiving the pre‐authorization number, a CDI scheduler will contact the patient to schedule their imaging exam. 3. Log on to www.insideCDI.com to check patients scheduling status. View the patient exam process − from confirmed appointment date through availability of exam results − on this secure medical professionals’ portal.* 4. In the event the authorization is delayed or will not be received prior to the scheduled appointment time, a representative from CDI will contact the patient to advise of the insurance delay and determine appropriateness of delaying the exam. Patient safety is our primary concern.

CDI MAY OBTAIN PRE‐AUTHORIZATION FOR THE FOLLOWING PAYERS: AARP Medicare Complete AETNA AmeriGroup Apple Health CIGNA Community Health Coordinated Care Great West

L&I / Workers’ Compensation Moda Health Molina Premera Regence Tricare Uniform Medical United Health Care

For insurances that use AIM, see the following pages.

Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA *Contact your CDI account executive for a portal username and password.


AIM GUIDELINES: For insurances that use AIM, please include information that answers the questions for the ordered exam listed below. In general, the more information we can get, the better the chance we have of obtaining the RQI without having to involve the referring provider’s office. PLEASE INCLUDE THE REFERRING PROVIDER’S TAX ID NUMBER. HEAD 1. What are you looking to rule out or evaluate? a. Headaches – which one applies: i. Sudden onset and severe, including thunderclap or worst headache of life; ii. Progressively worsening with increased frequency and severity over short timeframe and/or despite physician‐supervised appropriate therapy; iii. With new focal neurological signs, particularly papilledema, visual field defects and nuchal rigidity; iv. New, onset headaches in a cancer or immunodeficient patient b. Syncope – which one applies: i. Seizure activity was witnessed or is highly suspected at the time of the syncope ii. There is an abnormality on neurological examination iii. The patient has at least one persistent neurological symptom c. Sinus i. Acute Sinusitis 1. Have the symptoms persisted beyond 3‐4 weeks of adequate treatment? a. Antibiotics, steroids ii. Acute Recurrent Sinusitis 1. Have there been three or more separate episodes during the past year? iii. Chronic Sinusitis 1. Have the symptoms lasted 12 weeks or longer?

According to AIM, there are multiple indications for head or brain that may get an automatic approval. These include but are not limited to: neurological abnormality, CVA, congenital anomaly, hemorrhage, infectious or inflammatory process, MS, seizure disorders, vascular abnormalities, etc. Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA *Contact your CDI account executive for a portal username and password.


AIM GUIDELINES: (continued) SPINE IMAGING 1. Was there a specific injury or trauma? 2. Have there been X‐rays in the last six weeks? a. Were they normal or abnormal? 3. Has the patient completed a minimum of 3‐4 consecutive weeks of physician‐supervised conservative therapy for the current episode of pain? a. NSAIDS b. Muscle relaxants c. Steroids d. Physical therapy 4. Are there signs of compression (reflux abnormality, muscle weakness, etc.)? 5. What are you looking to rule out? UPPER/LOWER EXTREMITY 1. Was there a specific injury or trauma? 2. Have there been X‐rays in the last six weeks? a. Were they normal or abnormal? 3. Has the patient completed a minimum of 4‐6 consecutive weeks of conservative treatment? a. NSAIDS b. Muscle relaxants c. Steroids d. Physical therapy 4. What are you looking to rule out? According to AIM, there are multiple indications for spinal and extremity imaging that may get an automatic approval and not need to have conservative care. These include but are not limited to: fractures, infectious or inflammatory processes, syrinx, MS, tumor, AVN, intra‐articular loose body, etc.



2. Price Quotes

MAIN SCHEDULING LINE: 855.643.7226. Call CDI’s main scheduling line for an exam price quote. To reach any available insurance specialist, call CDI at 425.250.1160.



3. Scheduling L&I Patients

Department of Labor & Industries (L&I) Patient 1. Submit the order to CDI via fax, including:  Appropriate Qualis Questionnaire (Following Pages)  Chart Notes o The authorization process for L&I typically takes 7‐10 days after receipt of all chart notes and documentation. If submitting the order online, please fax the above listed information to the appropriate CDI location.

2. CDI keeps order pending until verification of approved claim is received from L&I. If an ordered CT or MRI is on the select list of procedures requiring authorization, a CDI Insurance Specialist will obtain an authorization through Qualis. The claims manager then has 24‐48 hours to review the Qualis recommendation and make a final decision and provide the facility with an authorization number if the claim is open and allowed. 3. Upon verification that L&I claim has been approved, CDI contacts patient to schedule their imaging exam.

4. Log on to www.insideCDI.com to check patients’ scheduling status. View the patient exam process − from confirmed appointment date through availability of exam results − on this secure medical professionals’ portal.*



4. Qualis Questionnaires (17 Inserts) Qualis Health Contact Information: Website: www.QualisHealth.org Phone: 1.800.541.2894 QUESTIONNAIRES ON FOLLOWING PAGES: 1. Lumbar Spine 2. Thoracic Spine 3. Cervical Spine 4. Headache 5. Upper Extremities 6. Lower Extremities 7. Injections OR ACCESS THE QUESTIONNAIRES ONLINE: 1. Go to www.QualisHealth.org 2. Click on “Healthcare Professionals” on the upper bar 3. On the left, click on “Washington Labor & Industries” 4. Select the “Provider Resources” line that opens up below “Washington Labor & Industries” on the left 5. Go to: “Questionnaires”


Lumbar Spine Imaging Questionnaire

1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator. 2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only. L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours. Acknowledge 3. (Mandatory) What is the duration of patient’s back pain (select one)? Within past 6 weeks (see 4 - 10) > 6 weeks (see 11 - 20) > 3mos w/no PRIOR MRI (see 21 - 31) > 3mos w/PRIOR MRI (see 32 - 34)

4. SECTION A: ACUTE LOW BACK PAIN (ONSET W/IN PAST 6 WKS) - MRI W/O CONTRAST unless specified otherwise. ANSWER QUESTIONS 5 – 10. 5. A1: Progressive (objective) neurological signs (select one): Progressive motor weakness present NA 6. A2: Suspect Cauda Equina Syndrome (select one) Acute bladder or bowel dysfunction Bilateral neurologic signs and symptoms NA 7. A3: Infection - MRI with and without contrast (select one): Elevated sedimentation rate Fever Immunosuppression (chronic steroid use) IV drug use Known bacteremia Suspicion of systemic or spinal infectn NA 8. A4: Is there history or suspicion of cancer with new onset of LBP? Yes No 9. A5: If Yes, Suspicion of cancer criterion can be met if any two of the following are present (select two): Age over 50 Failure to improve after one month Unexplained weight loss NA 10. A6: Low velocity trauma (e.g. fall from height or struck by object). If vertebral compression fx is suspected due to hx of osteoporosis, use of steroids, or age > or = 70 plain x-ray s/b completed prior to MRI. Select one: Vertebral compression fx on x-ray Other fractures NA Lumbar Spine Imaging updated 10/04/2011

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Patient Name

Claim #

11. SECTION B: SUBACUTE LOW BACK PAIN > 6 WEEKS: MRI W/O CONTRAST. ANSWER QUESTIONS 12 – 20. 12. B1: Progressive (objective) neurological signs (select one): Progressive motor weakness present NA 13. B2: Suspect Cauda Equina Syndrome (select one) Acute bladder or bowel dysfunction Bilateral neurologic signs and symptoms NA 14. B3: Infection - MRI with and without contrast (select one): Elevated sedimentation rate Fever Immunosuppression (chronic steroid use) IV drug use Known bacteremia Suspicion of systemic or spinal infectn NA 15. B4: Is there history or suspicion of cancer with new onset of LBP? Yes No 16. B5: If Yes, Suspicion of cancer criterion can be met if any two of the following are present (select two): Age over 50 Failure to improve after one month Unexplained weight loss NA 17. B6: Low velocity trauma (e.g. fall from height or struck by object). If vertebral compression fx is suspected due to hx of osteoporosis, use of steroids, or age > or = 70 plain x-ray s/b completed prior to MRI. Select one: Vertebral compression fx on x-ray Other fractures NA 18. B7: Did the patient have MEDICAL/CONSERVATIVE CARE? If No, stop and submit the questionnaire. Request will be pended and reviewed by Qualis Health. Yes No 19. B8: Suspected radiculopathy with (must select ALL and answer #20): Leg pain is greater than back pain Pain present in nerve root distribution 20. B9: Radiculopathy evidenced by (select one): EMG/NCS consistent with radiculopathy Motor weakness in a radicular distributn Pos SLR test <45 degrees Pos crossed SLR test Sensory loss in a radicular distributn

Lumbar Spine Imaging updated 10/04/2011

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Patient Name

Claim #

21. SECTION C: CHRONIC LOW BACK PAIN (> 3 MOS) W/NO PRIOR L-SPINE MRI W/O CONTRAST. ANSWER QUESTIONS 21 – 31. 22. C1: Progressive (objective) neurological signs (select one): Progressive motor weakness present NA 23. C2: Suspect Cauda Equina Syndrome (select one) Acute bladder or bowel dysfunction Bilateral neurologic signs and symptoms NA 24. C3: Infection - MRI with and without contrast (select one): Elevated sedimentation rate Fever Immunosuppression (chronic steroid use) IV drug use Known bacteremia Suspicion of systemic or spinal infectn NA 25. C4: Is there history or suspicion of cancer with new onset of LBP? Yes No 26. C5: If Yes, Suspicion of cancer criterion can be met if any two of the following are present (select two): Age over 50 Failure to improve after one month Unexplained weight loss NA 27. C6: Low velocity trauma (e.g. fall from height or struck by object). If vertebral compression fx is suspected due to hx of osteoporosis, use of steroids, or age > or = 70 plain x-ray s/b completed prior to MRI. Select one: Vertebral compression fx on x-ray Other fractures NA 28. C7: Did the patient have MEDICAL/CONSERVATIVE CARE? If No, stop and submit the questionnaire. Request will be pended and reviewed by Qualis Health. Yes No 29. C8: Suspected radiculopathy with (must select ALL and answer #30): Leg pain is greater than back pain Pain present in nerve root distribution 30. C9: Radiculopathy evidenced by (select one): EMG/NCS consistent with radiculopathy Motor weakness in a radicular distributn Pos SLR test <45 degrees Pos crossed SLR test Sensory loss in a radicular distributn


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Patient Name

Claim #

31. C10: Is there suspicion of spinal stenosis on x-ray? Yes No

32. SECTION D: CHRONIC LOW BACK PAIN (> 3 MOS) W/PRIOR L-SPINE MRI W/O CONTRAST - Select at least one of the following: Obj worsening of neuro stat by EDX test Obj worsening of neuro stat by PE Pt a candidate for spine surg (see #33) Prior lumbar surgery (go to #34) 33. D1: Patient is considered a candidate for spine surgery (select one): >1 yr since last MRI w/o obj chng Progressive changes in obj neuro signs 34. D2: Prior lumbar surgery (select one): Looking for epidural scarring Obj and/or new or worsen neuro signs X-ray OR clin signs suggest new adverse eff


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Patient Name

Claim #

Thoracic Spine MRI Imaging Questionnaire

1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator. 2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only. L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours. Acknowledge 3. SECTION A: ACUTE THORACIC BACK PAIN (ONSET W/IN PAST 6 WEEKS): MRI without contrast unless specified otherwise: Yes No 4. A1 - If Yes, select one: Bilat neuro weakness in low extrem by PE Focal pain follow fall from ht or trauma Bladder/bowel dysfunction follow trauma Sx compatible w/focal radiculopathy Infection: MRI w/o, w/contrast (go to 6) Hx of cancer w/new pain (go to 5) Suspicion of cancer w/new pain (go to 5) Low velocity trauma, >70yrs (go to 7) Osteoporosis, > 70yrs (go to 7) NA 5. A2 – If answer is Hx or suspicion of cancer w/new onset of thoracic pain, select any TWO: Age over 50 Failure to improve after one month Unexplained weight loss NA 6. A3 – If answer is Infection: MRI without and with contrast, select one: Elevated sedimentation rate Fever Immunosuppression (e.g. steroid use) IV drug use Known bacteremia Suspicion of systemic or spinal infection NA 7. A4 – If answer is Low velocity trauma OR osteoporosis, AND/OR age > 70 years, select one: Vertebral compression on x-ray Other fractures NA 8. SECTION B: SUBACUTE THORACIC BACK PAIN > 6 WEEKS, MRI W/O CONTRAST. Did the patient have MEDICAL/CONSERVATIVE CARE? If No, stop and submit the questionnaire. Request will be pended and reviewed by Qualis Health. Yes No

Thoracic Spine Imaging updated 01/18/2011

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Patient Name

Claim #

Cervical Spine Imaging Questionnaire

1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator. 2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only. L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours. Acknowledge

3. SECTION A: ACUTE CERVICAL PAIN (ONSET W/IN PAST 6 WKS): Any new objective neurological signs: Yes No 4. A1: If Yes, select one: Evidence of spinal fx on other IM test Evidence of spine instability on IM test Hx of great trauma (go to #5) Neuro signs suggest spine involvement Progressive neurological deficit Pt not evaluable 48hrs & suspect trauma Sensory loss, motor weakness, abn reflex Suspicion or obj evidence (go to #6) 5. A2: If answer is Hx of great trauma, select all applies: Cranial trauma Significant whiplash after hi speed impact Significant fall 6. A3: If answer is Suspicion or objective evidence, select one: Bone disc margin destruction on x-ray Immunosupression Infection Malignancy

7. SECTION B: SUBACUTE CERVICAL PAIN (>6 WKS) AND NO PRIOR MRI FOR SAME EPISODE OF PAIN - Select at least one: Any neurological signs or symptoms Complex congenital anomaly of the spine Complex congenital deformity of spine Evidence of spine fx on other IM test Evidence of spine instability on IM test Evidence of substantial spine stenosis Prior neck surgery & new neuro signs/sx

Cervical Spine Imaging updated 01/18/2011

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Patient Name

Claim #

8. SECTION C: CHRONIC OR RECURRENT CERVICAL PAIN (>3 MOS) AND PRIOR MRI FOR THE SAME EPISODE OF PAIN - Select at least one: > obj worsening of neuro status by EDX test > obj worsening of neuro status by PE Pt a candidate for spine surg (go to #9) Prior C-spine surgery (go to #10) 9. C1: If Patient is a candidate for C-spine surgery and (select one): At least 1 yr since last cervical MRI Progressive changes in obj neuro signs 10. C2: If Prior C-spine surgery and (select one): New or worsen significant obj neuro signs Other IM/clin finds suggest new adv eff

11. SECTION D: SUSPICION OF CERVICAL MULTIPLE SCLEROSIS WITH (select one): MS w/new onset of neuro def ref to CS Objective evidence of neuro signs & sx

Cervical Spine Imaging updated 01/18/2011

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Patient Name

Claim #

Headache Imaging Questionnaire

1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator. 2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only. L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours. Acknowledge 3. Is this a headache? Yes No 4. CT/MRI for acute, recurrent headache or chronic, persistent headache in any healthcare setting (select one): Unexplained new abnorm find on neur exam 5. New onset, secondary headache (caused by another condition) in the outpatient setting (non-hospital, non-ER). Select one: Cognitive disturbance (e.g. confusion) Fever or meningismus Focal neurological signs or symptoms HA precipitated by exertion HA precipitated by Valsalva maneuver Hx or suspicion of cancer Hx or suspicion of HIV infection Hx or suspicion of immune compromise Patient >50 years Pt w/risk factors for CVT (go to #6) 6. If answer is Patient w/risk factors for CVT, select one: Pregnancy or post-partum Severe dehydration

Headache Imaging updated 01/18/2011

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Patient Name

Claim #

Upper Extremity Imaging Questionnaire

1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator. 2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only. L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours. Acknowledge 3. (Mandatory) Side of body: Bilateral Left Right 4. (Mandatory) Body part: Wrist Hand Elbow Shoulder

5. Section A: WRIST/HAND - MRI is indicated for the following (select one): Severe acute wrist trauma w/norm x-ray Suspected soft tissue mass MRI w/o contr Suspected soft tissue mass MRI w/contrst

6. Section B: ELBOW - MRI is indicated for the following (select one): Severe acute elbow trauma w/norm x-ray Suspected avascular necrosis Suspected biceps tendon rupture Suspected cartilaginous defects Suspected heterotopic calcifications Suspected intra-articular loose bodies Suspected mass (MRI w/o or w/contrast)

7. Section C: SHOULDER - ACUTE/TRAUMATIC SHOULDER PAIN (select all applies): Acute pain follow conserv meas for 4 wks Clin signs/sx: rotator cuff tear >/= 35y Suspected instab/labral tear, age < 35y Trauma: pain/weak, susp rotat cuff tear 8. C1: If Suspected instab/labral tear, age < 35y is answered, select one of the following: Recurrent dislocation Suspected avascular necrosis Suspected intra-articular loose bodies

Upper Extremity Imaging updated 01/18/2011

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Patient Name

Claim #

9. Section D: SHOULDER - SUBACUTE/CHRONIC SHOULDER PAIN (select all applies): Evaluate abnormality, ‘red flags’ Prev surg & substant incr signs of impinge Subacute pain & suspect instab/lab tear Surgical planning and no MRI w/in 6 mos 10. D1: If answer is Evaluate abnormality, ‘red flags’ (select one): Hemarthrosis Imaging abnormality on x-ray Palpable mass Suspect neoplasm

Upper Extremity Imaging updated 01/18/2011

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Patient Name

Claim #

Lower Extremity Imaging Questionnaire

1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator. 2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only. L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours. Acknowledge 3. (Mandatory) Side of Body: Bilateral Left Right 4. (Mandatory) Body Part: Ankle Foot Knee Hip

5. SECTION A: CHRONIC ANKLE PAIN – MRI W/O CONTRAST. Plain films of the ankle(s) have been obtained and interpreted, AND additional imaging information is required. Select at least one of the following: Ankle impingemt syndrome suspected clin Ankle instability suspected clinically Mult sites of degen joint dis by x-rays Osteochondral injury is suspected clin Suspect infection or neoplasm Suspect stress fracture Tendon abnorm is suspected clinically

6. SECTION B: CHRONIC FOOT PAIN – MRI: Plain films of the foot (feet) have been obtained and interpreted, AND additional imaging information is required. Answer question 6, and 7 – 9 if all is applicable. Yes No 7. B1: If Yes AND Patient is a child or adolescent (select ALL): CT w/o contrast is contraindicated Tarsal coalition is suspected 8. B2: If Yes AND Patient has pain and tenderness over the navicular tuberosity (select ALL): Condition unresponsive to non-surg ther X-rays show an accessory navicular

Lower Extremity Imaging updated 01/18/2011

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Patient Name

Claim #

9. B3: If Yes AND Patient is clinically suspected to have one of the following conditions (select one): Avascular necrosis Inflammatory arthropathy Morton’s neuroma Neoplasm Osteomyelitis Plantar fasciitis Stress fracture Tarsal tunnel syndrome Tendinopathy

10. SECTION C: ACUTE TRAUMA TO THE KNEE – MRI is indicated if there is clinical suspicion for any of the following (select all applies): Cartilage injury Collateral ligament injury Dislocation Extensor mechanism injury Internal derangemt (menisc/cruc lig injury) Occult fracture Patellar subluxation/dislocation

11. SECTION D: NON-TRAUMATIC KNEE PAIN – MRI is indicated if there is clinical suspicion for any of the following (select all applies): Bursitis (incl the pes anserinus) Cartilage injury Collateral ligament injury Dislocation Extensor mechanism injury Hemarthrosis Inflammatory arthritis (w/neg x-rays) Internal derangemt (menisc/cruc lig injury) Occult injury Osteonecrosis Patellar subluxation/dislocation Severe osteoarthritis NOT on x-ray Stress or insufficiency fracture Tendinopathy (incl iliotibial band)


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Patient Name

Claim #

12. SECTION E: CHRONIC HIP PAIN – Have plain films been obtained and interpreted AND additional imaging information is required? Yes (score = 2) No (score = 0) 13. E1: If Yes, MUST select at least one of the following: Septic arthritis or osteomyelitis Severe muscle or tendon injury Stress or insufficiency fracture Surg plan affected were MR inf not avail X-ray occult condition X-rays are equivocal for osteonecrosis Xrays neg & bony/surrnd tiss abnorm susp Xrays neg/reveal mild osteoarthritis Hip is the suspected source of ref pain Xrays normal, avasc necro fem head susp Xrays pos for monoartic/atyp arthritis Xrays suggest of villonodular synovitis Xrays suggestive of osteochondromatosis


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THERAPEUTIC EPIDURAL INJECTION QUESTIONNAIRE

Patient Name: _____________________________ Claim ID #: _______________________ LNI Spinal Injections – Therapeutic Epidural Injection Questionnaire

CPT Codes: 62310, 62311, 62318, 62319, 64479, 64480, 64483, 64484, 0228T, 0229T, 0230T, 0231T

1. INSTRUCTIONAL NOTE: Spinal Injections UR program applies ONLY to STATE FUND WORKERS’

compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator.

2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a RECOMMENDATION ONLY. L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours. Acknowledge

3. NOTE: MRI is not a prerequisite for performance of Epidural Spinal Injection (ESI). 4. INSTRUCTIONAL NOTE: NO MORE THAN TWO (2) LEVELS & ONE SIDE ALLOWED PER DATE OF SERVICE.

5. (Mandatory) Indicate if Epidural Steroid Injection or Selective Nerve Root Block Epidural Spinal Injection Selective Nerve Root Block

6. (Mandatory) Indication for the Epidural Spinal Injection or Selective Nerve Root Block Therapeutic Diagnostic

7. (Mandatory) Side of Body: (Select ONE) Interlaminar Left Right Caudal 8. (Mandatory) Select injection: INSTRUCTIONAL NOTE: 3rd injection may require submission of medical records. 4th injection - submit medical records. (Select ONE) 1st injection: (see 9-16 only) 2nd injection: (see 9-20) 3rd injection: Complete entire questionnaire. 4th injection: Do NOT complete

Washington Department of Labor and Industries Therapeutic Epidural Injection Questionnaire

Page 1 of 3 Revised 2/1/2013

9. (Mandatory) Epidural Spinal Injection(s) to be done on the following levels: (Select up to two) C2 T1 L1 C3 T2 L2 C4 T3 L3 C5 T4 L4 C6 T5 L5 C7 T6 S1 T7 T8 T9 T10 T11 T12 10. (Mandatory) Please indicate which imaging guidance will be used. (Select ONE). INSTRUCTIONAL NOTE: REFER TO STATE FUND WORKERS’ COMPENSATION FOR PAYMENT POLICY. www.lni.wa.gov/ClaimsIns/Providers/Billing/FeeSched/2012/MARFS/Chapter16/default.asp CT guidance (See NOTE above) Fluoroscopic guidance Ultrasound guidance None of the above 11. Has patient had conservative care? Yes No 12. How many weeks of conservative care has the patient had? (Select ONE) Less than 2 weeks 2 – 5 weeks 6 or more weeks 13. Please indicate therapies used: (Select all that apply) Chiro/Massage Home exercise Narcotic therapy NSAIDs Steroids Structured PT 14. Is there a PHYSICAL EXAM documenting any of the following? [NOTE: Patient complaint/report NOT adequate] (Select ONE) Normal exam Dermatomal sensory loss Motor weakness Reflex asymmetry or loss



Patient Name

Claim #

Lumbar Spine Imaging Questionnaire

1. INSTRUCTIONAL NOTE: Advanced Imaging UR program applies ONLY to STATE FUND WORKERS’ compensation claims. For authorization of services pertaining to Self-Insured claims, please contact the injured worker’s employer or the third party administrator. 2. (Mandatory) DISCLAIMER: This is a guideline-based review that will result in a recommendation only. L&I must make the final determination of payment based on legal claim validity. Approval should occur within 24-48 hours. Acknowledge 3. (Mandatory) What is the duration of patient’s back pain (select one)? Within past 6 weeks (see 4 - 10) > 6 weeks (see 11 - 20) > 3mos w/no PRIOR MRI (see 21 - 31) > 3mos w/PRIOR MRI (see 32 - 34)

4. SECTION A: ACUTE LOW BACK PAIN (ONSET W/IN PAST 6 WKS) - MRI W/O CONTRAST unless specified otherwise. ANSWER QUESTIONS 5 – 10. 5. A1: Progressive (objective) neurological signs (select one): Progressive motor weakness present NA 6. A2: Suspect Cauda Equina Syndrome (select one) Acute bladder or bowel dysfunction Bilateral neurologic signs and symptoms NA 7. A3: Infection - MRI with and without contrast (select one): Elevated sedimentation rate Fever Immunosuppression (chronic steroid use) IV drug use Known bacteremia Suspicion of systemic or spinal infectn NA 8. A4: Is there history or suspicion of cancer with new onset of LBP? Yes No 9. A5: If Yes, Suspicion of cancer criterion can be met if any two of the following are present (select two): Age over 50 Failure to improve after one month Unexplained weight loss NA 10. A6: Low velocity trauma (e.g. fall from height or struck by object). If vertebral compression fx is suspected due to hx of osteoporosis, use of steroids, or age > or = 70 plain x-ray s/b completed prior to MRI. Select one: Vertebral compression fx on x-ray Other fractures NA Lumbar Spine Imaging updated 10/04/2011

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15. Has the patient had a diagnostic selective nerve root block? Yes (see 16) No 16. How was the selective nerve root block performed? (Select all that apply) Low-volume Post-block patient generated pain diary Single level Steroid-free 17. (Mandatory) Have prior injection(s) been given at the same level & side as this request? NOTE: 2 or more prior injections may require submission of medical records. 4th injection requires medical records. (Select ONE) No prior injections Only one prior injection 2 prior injections 3 or more prior injections (see NOTE) 18. Please enter dates for ANY prior injections for same level & side as this request. (Date format: mm/dd/yyyy) ___________ ___________ ___________ ___________ 19. How much improvement in function & pain was realized after the injection? (Select ONE) None Less than 30% Greater than 30% 20. How was the percentage of improvement determined? (Select all that apply) Documented decrease in use of pain medications Documented improvement in findings on physical examination Documented increased activity Patient generated pain diary Verbal report from patient




5. Scheduling Self‐Insured L&I Patients (EX: Jones Act, OWCP, Longshoreman)

If a claim number is not yet available, CDI will attempt to obtain one. Please include the patient’s: 1. Social security number 2. Name of employer 3. Date of Injury 1. Submit an imaging order to CDI via fax, including claim adjuster’s name, phone number and claim #. For claims with Eberle Vivian please, include the appropriate questionnaire with the order and social security number if the claim number is not available. 2. U.S. HealthWorks Medical Group faxes papers to the claim adjuster. CDI keeps order pending until verification of approved claim is received from L&I. If an ordered CT or MRI is on the select list of procedures requiring authorization, a CDI Insurance Specialist will obtain an authorization through Qualis (once the Qualis Questionnaire is received). The claims manager then has 24‐48 hours to review the Qualis recommendation and make a final decision and provide the facility with an authorization number if the claim is open and allowed. 3. CDI contacts claim adjuster for authorization number. 4. A CDI scheduler contacts patient to schedule their imaging exam. 5. Log on to http://www.insideCDI.comto check patients scheduling status. U.S. HealthWorks Medical Group can view the patient exam process − from confirmed appointment date through availability of exam results − on this secure medical professionals’ portal.* 6. Hand “Your Medical Imaging Exam” card to the patient.



6. Scheduling STAT Patients

1. Call your preferred cdi center to check on stat availability. Bellevue: 425.637.9729 Everett: 425.740.5000 Federal Way: 253.942.7226 Kirkland: 425.821.3472 Lakewood: 253.682.1666 Renton: 425.228.2789 Seattle: 206.524.5599 2. The CDI Front Office Associate will schedule the patient and transfer you to an insurance specialist. 3. The insurance specialist will work with you to get the information needed for a STAT authorization request. 4. In the case of any delay, the insurance specialist will consult with the center manager for further direction. 5. In the result of a reschedule, the CDI team will contact the patient.



7. WA State Department of Social and Health Services (DSHS) Eligibility Letter

For patients in the process of completing a physical functional evaluation for disability benefits determination.

1. Submit an imaging order to CDI via fax, including: • DSHS eligibility letter • DSHS client manager’s signature must be on letter

For a patient needing these services, a copy of a sample letter from their social worker is on the next page.

2. Log on to www.insideCDI.com to check patients scheduling status. View the patient exam process − from confirmed appointment date through availability of exam results − on this secure medical professionals’ portal.*





8. Health Screenings Center for Diagnostic Imaging offers health screenings. Below is an overview of what is offered and where. Call a listed CDI location for current pricing. CT Heart (also known as Coronary Artery Calcium Scoring)  Bellevue: 425.637.9729  Federal Way: 253.942.7226 Ultrasound Abdominal Aortic Aneurysm (AAA)  Bellevue: 425.637.9729  Kirkland: 425.821.3472



9. Exam Results Online Obtaining patient results is simple. Log into www.insideCDI.com and click on the Patient Exam Status tab. On this page, you can view current patient exam information, dating back one month. Filter results by:  Timeframe  Office Location  Referring Physician  Priority Status You can double click on the patient to access the report and images. You may also use the icons within the Results Column to print the report, view the report or view the images.

These quick icon directories may help you navigate the Patient Exam Status tab with greater confidence.

If you don’t see your patient listed, try searching for him/her in the Patient Search available on the right side of the page. In doing so, you can find patients whose exam occurred at any time, not only within the last 30 days.

If you are still having troubles finding a patient, please call the CDI scheduling team or your account executive. We are happy to help you throughout the patient imaging process, not just at the time of scheduling.



10. Connect with Your Network Online

1. Engage your CDI Account Executive to let us know where your patient is going. Let CDI assist in the patient’s care continuum. If your patient is being referred on to a specialist outside of your network, let us know so that we can make sure the specialist has access to the patient’s results via www.insideCDI.com.



11. Patient Exam Status Online Checking on a patient’s exam status is simple. Log into www.insideCDI.com and click on the Patient Exam Status tab. On this page, you can view current patient exam information dating back one month. If you notice the words “cancelled” or “aborted” under the status column, simply click on the word and a box will show up on the right. The information contained in this box will provide explanations as to why that particular exam was cancelled or aborted.

If you are still having troubles finding a patient or exam, please call the CDI scheduling team or your account executive. We are happy to help you throughout the entire patient imaging process.



12. Cancellation Codes Below is an overview of CDI’s internal cancellation codes. They appear on our portal to give you more information as to why an appointment was cancelled.

CODE

DESCRIPTION

ARS – Appt

R/S – Appointment rescheduled

ARS – No Show

R/S – No show back to orders/rescheduled

ARS – Order

R/S – Rescheduled back to orders

CX – Duplic

CX – Duplication order

CX – Expira

CX – Expired order

CX – Insur

CX – Insur/cost

CX – No Show

CX – No show

CX – Other

CX – Other

CX – Percip

CX – Percipio (Appropriateness advised not to image)

CX – Presch

CX – Prescheduled appointment not needed

CX – PriceQT

CX – Price quote only

CX – Refoff

CX – Referring office cancellation

CX – Transp

CX – Transportation/distance to center



13. Radiology Groups, Tax IDs and NPI Numbers We are proud to be served by two physician groups: MEDICAL SCANNING CONSULTANTS, PA  Federal Way, Lakewood  Tax ID: 41‐1410766  NPI Number: 1730156175 RADIOLOGY CONSULTANTS OF WASHINGTON, INC., PS (RCW)  Bellevue, Everett, Kirkland, Renton, Seattle  Tax ID: 91‐1509129  NPI Number: 1124046057 Our subspecialized radiologists are board‐certified by the American College of Radiology. They are on‐site and available for consultations to work with you and your patients in our seven conveniently located centers. 1. Bellevue: 425.637.9729 2. Everett: 425.740.5000 3. Federal Way: 253.942.7226 4. Kirkland: 425.821.3472 5. Lakewood: 253.682.1666 6. Renton: 425.228.4000 7. Seattle: 206.524.5599



14. MRI Options CDI has the most robust offering of MRI scanners in WA State. Videos showcasing the patient experience on our MRI’s are available on our blog at www.myCDI.com/WA. High‐field, Short‐bore MRI

High‐field Open MRI

Available in Lakewood. Open Upright MRI

Available in Kirkland.

High‐field, Wide‐bore MRI

Available in Federal Way.

Available in Renton. Secure Medical Professionals’ Portal*: www.insideCDI.com Website and Blog: www.myCDI.com/WA *Contact your CDI account executive for a portal username and password.


15. Marketing Materials: Center Locations, Services, Subspecialized Radiologists Enclosed are additional marketing pieces that describe our services and subspecialized radiologists at CDI. Thank you, from your Puget Sound Partners in Medical Imaging.


LOCATION

SERVICES

HOURS*

PHONE/FAX

STREET ADDRESS

BELLEVUE

• 1.5T MRI

7 a.m. – 8:30 p.m. M – F

Ph: 425.637.9729

1310 116th Ave NE

• 16-slice CT

9 a.m. – 5 p.m. M – F (X-ray)

Fx: 425.462.8309

Suite E

• Injections

Sat MRI by appt only

Bellevue, WA 98004

• Ultrasound

EVERETT

• X-ray

Bellevue’s physician services are provided by Radiology Consultants of Washington (RCW), Inc., PS

• 1.5T MRI

7 a.m. – 8 p.m. M – F

Ph: 425.740.5000

3131 Nassau Street

• 16-slice CT

8 a.m. – 5:30 p.m. M – F (X-ray)

Fx: 425.740.5010

Suite 102

• Injections

Sat MRI 8:30 a.m. - 2 p.m.

Everett, WA 98201

• Ultrasound

FEDERAL WAY

KIRKLAND

• Fluoro & X-ray

Everett’s physician services are provided by Radiology Consultants of Washington (RCW), Inc., PS

• 1.5T Wide bore MRI

7:30 a.m. – 9:30 p.m. M – F

Ph: 253.942.7226

33801 First Way S

• 16-slice CT

9 a.m. – 6 p.m. M – F (X-ray)

Fx: 253.942.3517

Suite 101

• Injections

Sat MRI 8 a.m. - 11:30 a.m.

• Ultrasound

Axial-loading option available for MR and CT.

• X-ray

Federal Way’s physician services are provided by Medical Scanning Consultants, PA

• 1.2T Open MRI

7 a.m. – 10 p.m. M – F

Ph: 425.821.3472

11811 NE 128th Street

• 1.5T MRI

9 a.m. – 5 p.m. M – F (X-ray)

Fx: 425.820.4115

Suite 101

• 16-slice CT

Sat MRI 8 a.m. - 12 p.m.

Federal Way, WA 98003

Kirkland, WA 98034

• Injections • Ultrasound

LAKEWOOD

• Fluoro & X-ray

Kirkland’s physician services are provided by Radiology Consultants of Washington (RCW), Inc., PS

• 1.5T MRI

8:30 a.m. - 9:30 p.m. M – F

Ph: 253.682.1666

7308 Bridgeport Way W

• Multi-slice CT

8:30 a.m. – 4 p.m. M – F (X-ray)

Fx: 253.682.1667

Suite 101

• Injections

Sat MRI 12:30 p.m. - 5 p.m.

• Ultrasound

Axial-loading option available for MR and CT.

Lakewood, WA 98499

Lakewood’s physician services are provided by Medical Scanning Consultants, PA

RENTON

• Open Upright MRI

8 a.m. – 6 p.m. M – F

Ph: 425.228.4000

220 SW 43rd Street

• 1.5T MRI

9 a.m. – 5:30 p.m. M – F (X-ray)

Fx: 425.228.2789

Renton, WA 98055

• Multi-slice CT • Injections

SEATTLE

• Fluoro & X-ray

Renton’s physician services are provided by Radiology Consultants of Washington (RCW), Inc., PS

• 1.5T MRI

7 a.m. – 5 p.m. M – F

Ph: 206.524.5599

115 NE 100th Street

• Multi-slice CT

8 a.m. – 4 p.m. M – F (X-ray)

Fx: 206.524.5338

Suite 101

• Injections

Seattle, WA 98125

• Ultrasound • Fluoro & X-ray

Seattle’s physician services are provided by Radiology Consultants of Washington (RCW), Inc., PS

NOTE: On-site creatinine testing available at all 7 CDI locations for your patients’ convenience. *Hours subject to change.

FOR YOU: insideCDI.com FOR YOUR PATIENTS: myCDI.com/WA

© 2014, Center for Diagnostic Imaging

Insurance Specialist Line: 425.250.1160

CPT Common Medical Imaging Procedures Below is an overview of commonly ordered studies. This information is intended to serve as a clinical education tool when communicating with insurance providers and others related to pre-authorization. It is not an all-inclusive list. If you have specific questions about a study or procedure, call 425.250.1160 and a member of our insurance team will assist you.

MRI MRI Abdomen w/o Cont....................................74181 MRI Abdomen w/ & w/o Cont.........................74183 MRI Brain w/o Cont........................................... 70551 MRI Brain w/ & w/o Cont................................ 70553 MRI TMJ............................................................... 70336 MRI Cervical w/o Cont....................................... 72141 MRI Cervical w/ & w/o Cont........................... 72156 MRI Chest w/o Cont.......................................... 71550 MRI Chest w/ & w/o Cont.................................71552 MRI Enterography w/ & w/o Cont.....74183, 72197

MRI Hip w/o Cont................................................73721 MRI Hip w/ & w/o Cont....................................73723 MRI Lower Extremity w/o Cont......................73718 MRI Lower Extremity w/ & w/o Cont.......... 73720 MRI Lower Extremity Joint w/o Cont............73721 MRI Lower Extremity Joint w/ & w/o Cont.. 73723 MRI Lumbar w/o Cont...................................... 72148 MRI Lumbar w/ & w/o Cont............................ 72158 MRI Orbit Face Neck w/o Cont.....................70540 MRI Orbit Face Neck w/ & w/o Cont........... 70543

MRI Pelvis w/o Cont.......................................... 72195 MRI Pelvis w/ & w/o Cont.................................72197 MRI Thoracic w/o Cont..................................... 72146 MRI Thoracic w/ & w/o Cont...........................72157 MRI Upper Extremity w/o Cont......................73218 MRI Upper Extremity w/ & w/o Cont.......... 73220 MRI Upper Extremity Joint w/o Cont...........73221 MRI Upper Extremity Joint w/ & w/o Cont............................................................73223

MRA Head w/Cont............................................70545 MRA Head w/ & w/o Cont..............................70546 MRA Neck w/o Cont......................................... 70547 MRA Neck w/Cont............................................70548

MRA Neck w/ & w/o Cont..............................70549 MRA Pelvis........................................................... 72198 MRA Upper Extremity......................................73225

CT IAC w/ & w/o Cont.....................................70482 CT Soft Tissue Neck w/o Cont .................... 70490 CT Soft Tissue Neck w/Cont...........................70491 CT Soft Tissue Neck w/ & w/o Cont............70492 CT Lower Extremity w/o Cont...................... 73700 CT Lower Extremity w/Cont........................... 73701 CT Lower Extremity w/ & w/o Cont.............73702 CT Lumbar w/o Cont..........................................72131 CT Lumbar w/Cont.............................................72132 CT Lumbar w/ & w/o Cont...............................72133 CT Maxillofacial w/o Cont...............................70486 CT Maxillofacial w/Cont.................................. 70487 CT Maxillofacial w/ & w/o Cont....................70488 CT Pelvis w/o Cont.............................................72192 CT Pelvis w/Cont................................................ 72193

CT Pelvis w/ & w/o Cont.................................. 72194 CT Thoracic w/o Cont........................................72128 CT Thoracic w/Cont.......................................... 72129 CT Thoracic w/ & w/o Cont............................. 72130 CT Upper Extremity w/o Cont......................73200 CT Upper Extremity w/Cont........................... 73201 CT Upper Extremity w/ & w/o Cont............ 73202 CT Abdomen & Pelvis w/o Cont.....................74176 CT Abdomen & Pelvis w/Cont........................74177 CT Abdomen & Pelvis w/ & w/o Cont...........74178 CTA Abdomen & Pelvis w/Cont......................74174 CTA Abdomen/Aorta w/Runoff.....................75635 CTA Carotid/Neck.............................................70498 CTA Chest.............................................................71275 CTA Head............................................................70496

MRA MRA Abdomen....................................................74185 MRA Chest........................................................... 71555 MRA Lower Extremity......................................73725 MRA Head w/o Cont........................................70544

CT CT Abdomen w/o Cont.................................... 74150 CT Abdomen w/Cont........................................ 74160 CT Abdomen w/ & w/o Cont.......................... 74170 CT Brain/Head w/o Cont................................70450 CT Brain/Head w/Cont................................... 70460 CT Brain/Head w/ & w/o Cont......................70470 CT Cervical w/o Cont.........................................72125 CT Cervical w/Cont........................................... 72126 CT Cervical w/ & w/o Cont...............................72127 CT Chest w/o Cont............................................ 71250 CT Chest w/Cont................................................71260 CT Chest w/ & w/o Cont.................................. 71270 CT Enterography w/ Cont................................74177 CT IAC w/o Cont...............................................70480 CT IAC w/Cont....................................................70481

myCDI.com/WA

ULTRASOUND Abdomen............................................................76700 Liver and Gallbladder...................................... 76705 OB – Less than 14 wks (Transvaginal will also have CPT 76817)...76801

Pelvis (Transvaginal will also have CPT 76830)............................................ 76856 Renal/Kidneys and Bladder........................... 76770

Scrotum/Testicles (Doppler will also have CPT 93975 or 93976).......................... 76870 Thyroid................................................................. 76536

DIAGNOSTIC AND THERAPEUTIC INJECTIONS (DTI) Arthrogram – Hip w/ Cont............................. 27093 Arthrogram – Shoulder w/ Cont.................. 23350 Arthrogram – Wrist w/ Cont......................... 25246 Epidural Steroid Injection (ESI) / Epidurography Lumbar Interlaminar.......... 62311

Epidural Steroid Injection (ESI) /Epidurography Lumbar Transforaminal...................................64483 Facet Injection Lumbar...................................64493 Lumbar Puncture.............................................. 62270 Nerve Block Injection Lumbar......................64483

SI Joint Injection...............................................27096 Therapeutic Arthrogram – Shoulder, Hip, Knee............................................................20610

CPT codes are a copyright of the American Medical Association (AMA). If you cannot find what you are looking for, please reference the “AMA CPT Manual.”

ORDERING AN IMAGING EXAM: To order an imaging exam at any of our Puget Sound Area locations or for prior authorization, call 855.643.7226 or order online at insideCDI.com. 5

Everett 99

TAX ID: 91-1509129 Physician services provided by Radiology Consultants of Washington, Inc., PS

405

BELLEVUE 425.637.9729

Seattle Northgate

EVERETT 425.740.5000 KIRKLAND 425.821.3472

Kirkland

Lake Washington

520 Bellevue

RENTON 425.228.4000 SEATTLE 206.524.5599

90

TAX ID: 41-1410766

Renton

Physician services provided by Medical Scanning Consultants, PA

Federal Way Lakewood

FEDERAL WAY 253.942.7226 LAKEWOOD 253.682.1666

myCDI.com/WA EFFECTIVE DATE: 1.1.14 - 12.31.14

myCDI.com/WA

Your Partner in Medical Imaging Center for Diagnostic Imaging (CDI) brings the Seattle and surrounding Puget Sound community a full range of medical imaging and interventional radiology services. We are proud to be served by three different physician groups. These subspecialized radiologists are board certified by the American College of Radiology. They are on-site and available for consultation to work with you and your patients in our eight conveniently located centers.

RADIOLOGY CONSULTANTS OF WASHINGTON (RCW), PS CALIXTO DIMAS, M.D. Body Radiologist BELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE

•• Fellowship: University of WA, Abdominal Imaging

•• Residency: University of MN •• Medical Degree: Yale University, New Haven, CT ANDREW D. BRONSTEIN, M.D. Neuroradiologist BELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE

•• Fellowship: University of WA Affiliated Hospitals, Neuroradiology

•• Residency: University of WA Affiliated Hospitals •• Medical Degree: Harvard Medical School, Boston, MA STACIE L. MARS, M.D. Body Radiologist BELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE

•• Fellowship: University of WA, Body Imaging •• Residency: University of WA; Santa Barbara Cottage Hospital •• Medical Degree: University of WA School of Medicine DAVIS A. GUILBERT, M.D. Neuroradiologist BELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE

•• Fellowship: Yale-New Haven Hospital, Neuroradiology

•• Residency: Christiana Health System, Newark, Delaware •• Medical Degree: University of Utah School of Medicine

ROBERT M. LIDDELL, M.D. Musculoskeletal, Pediatric & Body Radiologist BELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE

•• Fellowships: University of WA, Body CT/US/MRI;

•• ••

University of Cambridge, England, Pediatric Radiology; Children’s Hospital and Medical Center, Seattle, Pediatric Radiology Residency: University of WA Medical Degree: University of Rochester School of Medicine and Dentistry

SHANE E. MACAULAY, M.D. Musculoskeletal & Body Radiologist BELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE

•• Fellowship: University of WA,

MRI Research & Abdominal Imaging

•• Residency: University of WA •• Medical Degree: University of CA, San Diego School of Medicine

RANDALL K. PETERSEN, M.D. Musculoskeletal & Body Radiologist BELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE

•• Fellowship: University of Michigan

Medical Center, Diagnostic Radiology US/CT/MRI

•• Residency: Washington University Medical Center, St Louis, MO; University of MI Medical Center

•• Medical Degree: Johns Hopkins University School of Medicine

RADIOLOGY CONSULTANTS OF WASHINGTON (RCW), PS (continued)

MEDICAL SCANNING CONSULTANTS, PA

RANJEET B. SINGH, M.D. Musculoskeletal & Neuroradiologist

STEVEN R. POLLEI, M.D. Medical Director, Neuroradiologist

BELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE

FEDERAL WAY & LAKEWOOD

•• Fellowship: University of Utah

•• Fellowship: University of WA; •• ••

University of British Columbia, Neuroradiology & Musculoskeletal MRI Residency: Melbourne University, Australia Medical Degree: Monash University, Australia

MARK A. SKIRGAUDAS, M.D. Musculoskeletal Radiologist

Missouri

JIM SCHUMACHER, M.D. Musculoskeletal & Neuroradiologist FEDERAL WAY & LAKEWOOD

BELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE

•• Fellowship: The Neurological Institute

•• Fellowship: University of California in •• ••

Hospitals, Neuroradiology

•• Residency: University of New Mexico Hospitals •• Medical Degree: Washington University in St. Louis,

San Francisco, Musculoskeletal Radiology Residency: University of California in San Francisco Medical Degree: Yale University School of Medicine

•• ••

of Columbia and Brigham and Women’s Hospital of Harvard Medical School Residency: Eastern Virgina Medical School Medical Degree: University of Tennessee, Knoxville, TN

THOMAS P. SULLIVAN, M.D. Medical Director, Neuroradiologist BELLEVUE, EVERETT, KIRKLAND, RENTON, SEATTLE

•• Fellowship: University of WA, Neuroradiology

•• Residency: University of WA •• Medical Degree: UCLA School of Medicine

5

Everett

TO CONSULT WITH ANY OF OUR SUBSPECIALIZED RADIOLOGISTS, PLEASE CALL US TODAY!

99

405

BELLEVUE

LAKEWOOD

425.637.9729

253.682.1666

EVERETT

RENTON

425.740.5000

425.228.4000

FEDERAL WAY

SEATTLE

253.942.7226

206.524.5599

Seattle Northgate

myCDI.com/WA

520 Bellevue 90

KIRKLAND

425.821.3472

Kirkland

Lake Washington

Renton Federal Way Lakewood

Scheduling a Diagnostic Imaging Exam

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