Frieda Menzer Case

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A review of the records reveals the member to be an adult female with a birth date of 11/15/1957. The member has worsening posterior neck pain. Her provider, Frieda Menzer, M.D. recommended an MRI of the cervical spine.

The carrier has denied coverage of an MRI of the cervical spine as not medically necessary. There is a letter to the member from the carrier dated 11/05/15. In the letter, the carrier states in part: “According to the American College of Radiology Appropriateness Criteria regarding MRI of the cervical spine, MRI may sometime be beneficial in patients with neck pain and no history of trauma and no neurologic deficits. If their neck pain is persistent and they have had findings of degenerative changes on plain radiographs and “following failure of conservative management only in select cases.” In this patient’s case, the patient has self directed her care, having seen specialists and chiropractors without a firm diagnosis
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Office notes from Dr. Menzer have been reviewed from 2014 and 2015. A normal musculoskeletal and neurologic examination is noted. There has not been any conservative care instituted including prescription strength NSAID’s, physical therapy, or activity modification. There is no documentation of plain radiographs. There is documentation of diffuse joint pain that has improved on phenteramine, and a consideration of the diagnosis of fibromyalgia.

A cervical MRI was ordered and denied as not medically necessary.

According to the American College of Radiology Criteria for cervical MRI, MRI may be beneficial in a patient with ongoing neck pain with no history of trauma or neurologic findings if the neck pain persists and there are degenerative changes demonstrated on plain
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