MRN aka MRI neurogram of the pudendal nerve

Discussion of magnetic resonance imaging and magnetic resonance neurography

MRN aka MRI neurogram of the pudendal nerve

Postby Dr. Jason G. Attaman » Sun Jan 11, 2015 10:54 pm

I would like to help many of you out.

Many radiologists can perform MRN aka MRI neurogram of the pudendal nerves and it is covered by insurance.

There are a number of imaging centers in the Seattle area where I send my patients for this study. It is covered by insurance if you can get it authorized.

Not all imaging centers offer this diagnostic study. If you are curious, call the imaging center and ask them if they perform the following "MRI neurogram of the pudendal nerves"

If they say yes, get a referral there and get your study done!

Secondly, even if you do have abnormaliteis of the pudendal nerve on MRI neurogram, that does NOT mean you have pudendal neuralgia. An imaging abnormality does not mean that the abnormality is the cause of your pain. The best way to prove whether you have pudendal neuralgia is an image guided local anesthetic injection (block) of the pudendal nerve. If this gives you excellent pain relief for at least a few hours, the diagnosis is likely.

Therefore I generally only order MRI neurograms of the pudendal nerve if diagnostic blocks have rendered the diagnosis of pudendal neuralgia definitively, but my patient continues to have pain. In that case, I know that the problem is pudendal neuralgia, but I want to see if there is any specific area of entrapment or injury that may explain why pain persists.
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Re: MRN aka MRI neurogram of the pudendal nerve

Postby Karyn » Mon Jan 12, 2015 8:45 pm

Welcome to HOPE Dr. Attaman! :)
I appreciate the stated research you've done with PN(E) and what appears to be a sincere effort to help patients.

You've acknowledged in other threads that this particular anatomy isn't a large focus in medical school and it's not uncommon for patients to have seen at least 5 - 10 specialists before consulting with you.

Personally, I've had three MRI "Neurograms" over the past several years utilizing 3T technology. My first was at HSS in NYC and the images were interpreted by Dr. Hollis Potter.
The other two were done more locally to me, supposedly using Dr. Potter's protocol. These subsequent MRN's were not only non-diagnostic, but contained errors with the interpretation reporting.

What advice would you offer to patients (when seeking this study outside of the Seattle area) in regards to locating a skilled radiologist who is adept at identifying anatomical and pathological factors leading to pelvic neuropathies?

Kind regards,
Karyn
Ultra Sound in 03/08 showed severely retroverted, detaching uterus with mulitple fibroids and ovarian cysts.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
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Re: MRN aka MRI neurogram of the pudendal nerve

Postby Dr. Jason G. Attaman » Tue Jan 13, 2015 12:09 am

Karyn wrote:Welcome to HOPE Dr. Attaman! :)
I appreciate the stated research you've done with PN(E) and what appears to be a sincere effort to help patients.

You've acknowledged in other threads that this particular anatomy isn't a large focus in medical school and it's not uncommon for patients to have seen at least 5 - 10 specialists before consulting with you.

Personally, I've had three MRI "Neurograms" over the past several years utilizing 3T technology. My first was at HSS in NYC and the images were interpreted by Dr. Hollis Potter.
The other two were done more locally to me, supposedly using Dr. Potter's protocol. These subsequent MRN's were not only non-diagnostic, but contained errors with the interpretation reporting.

What advice would you offer to patients (when seeking this study outside of the Seattle area) in regards to locating a skilled radiologist who is adept at identifying anatomical and pathological factors leading to pelvic neuropathies?

Kind regards,
Karyn


Dear Karyn,

I think this is not just my experience; any physician that deals with pelvic pain or specifically pudendal neuralgia has similar stories.

I wish I could give you useful advice on finding radiologists such as you ask. Technically any diagnostic radiologist is qualified to interpret such studies. If you want to split hairs, radiologists who do fellowship training in a subspecialty called "neuroradiology" may be the top experts in interpreting peripheral nerve entrapments, but generally they spend 99% of their time reading brain and spine MRIs, not peripheral nerves studies and certainly not pudendal studies.

Therefore the best idea is to call the radiology department near you, and ask them if they offer MRI neurography studies of the pelvis, focusing on the pudendal nerves. Some will do this, some will not.

Best Regards.
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Re: MRN aka MRI neurogram of the pudendal nerve

Postby Violet M » Sat Jun 13, 2015 2:30 am

Dr. Attaman, (or anyone else who might know) what codes should be used in order to get insurance to cover this type of MRI/MRN? I think it's partly a matter of the physician writing the correct cpt procedure codes as to whether it's covered or not.

Thanks,

Violet M
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Re: MRN aka MRI neurogram of the pudendal nerve

Postby Karyn » Sat Jun 13, 2015 1:45 pm

Hi Violet,

To the best of my knowledge, MRN's are not covered by insurance. I'm not even sure there's an appropriate code for it.

I've gotten all of my 3-T MRI's (MRN) covered under the MRI coding. The orders were for an "MRI of the Pelvis", with a note to Radiology specifying 3-T neurography of the PN or other pelvic nerves.

Hope this helps ...

Kind regards,
Karyn
Ultra Sound in 03/08 showed severely retroverted, detaching uterus with mulitple fibroids and ovarian cysts.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
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Re: MRN aka MRI neurogram of the pudendal nerve

Postby Violet M » Sun Jun 14, 2015 12:23 am

Thanks, Karyn. Did you have the 3T MRI from Hollis Potter?

I recall when I was considering having an MRN done by the Neurography Institute that they gave me cpt codes for a pelvic MRI to check with insurance on whether it was covered. I never had it done so I don't know if it would have been covered.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Re: MRN aka MRI neurogram of the pudendal nerve

Postby Karyn » Sun Jun 14, 2015 2:50 pm

Hi Violet,
Yes, I've had the 3T from Dr. Potter in in New York. Another done in Rhode Island and the last one in Boston. Not all radiologists are created equal.

I'm curious as to what cpt codes the NI gave you. Do you happen to remember? I understand it was quite a while ago ... ;)

Best,
Karyn
Ultra Sound in 03/08 showed severely retroverted, detaching uterus with mulitple fibroids and ovarian cysts.
Pressure and pain in lower abdomen and groin area was unspeakable and devastating.
Total lap hysterectomy in 06/08, but damage was already done.
EMG testing in NH in 04/10 - bilateral PN and Ilioinguals
3T MRI at HSS, NY in 09/10
Bilateral TG surgery with Dr. Conway on 03/29/11. Bilat ilioinguinal & iliohypogastric neurectomy 03/12. TCD surgery 04/14.
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Karyn
 
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Re: MRN aka MRI neurogram of the pudendal nerve

Postby Violet M » Tue Jun 16, 2015 1:12 am

Karyn,

Yes, it was over 10 years ago and I don't know if the codes would still be the same but if I find them buried somewhere I will let you know.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Re: MRN aka MRI neurogram of the pudendal nerve

Postby Dr. Jason G. Attaman » Fri Jul 24, 2015 6:52 am

Violet M wrote:Dr. Attaman, (or anyone else who might know) what codes should be used in order to get insurance to cover this type of MRI/MRN? I think it's partly a matter of the physician writing the correct cpt procedure codes as to whether it's covered or not.

Thanks,

Violet M


Generally MRNs are covered by most insurances at least in my state of Washington. I have not heard of many being denied. The ordering physician does not write any CPT codes in order to request the MRN. You'd have to speak to the radiologist and the radiology billing department to see how they charge for it. I wish I could be of more help on this.
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Re: MRN aka MRI neurogram of the pudendal nerve

Postby Violet M » Thu Jul 30, 2015 10:39 pm

OK, thanks. Quite a few years back when I was considering having an MRN through Dr. Filler's office I thought they gave me the cpt codes to see if it would be covered by my insurance but now that I think of it, maybe it was the Neurography Institute who actually does the MRN's who gave me the codes.

Violet
PNE since 2002. Started from weightlifting. PNE surgery from Dr. Bautrant, Oct 2004. Pain now is usually a 0 and I can sit for hours on certain chairs. No longer take medication for PNE. Can work full time and do "The Firm" exercise program. 99% cured from PGAD. PNE surgery was right for me but it might not be for you. Do your research.
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Posts: 5467
Joined: Mon Sep 06, 2010 6:04 am
Location: United States

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