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Are X-rays necessary prior to MRI after CT-scan has indicated multilevel degenerative cervical disease?
Recently while in the hospital for atrial fibrillation, I told my cardiologist that I am having intermittent tingling and numbness in my left arm. He ordered a CT-scan to evaluate for cervical disc disease or herniated disc.
The three-page report impression stated "multilevel degenerative disease throughout the cervical spine, as detailed above..." and ended with "Correlation with MRI may be useful to further characterize central canal stenosis and disc disease." Examples of the details are mild to moderate central canal narrowing, mild anterolisthesis, moderate left neuroforaminal narrowing, disc osteophyte complex, uncovertebral osteophytosis and facet arthropathy.
As suggested by my cardiologist, I gave a copy of the report to my new primary care physician (PCP) when I met with him for the very first time. I told him I also have sharp pain in my left hip now and then. He gave me an order for x-rays on my spine and hip, saying the purpose of the x-rays is "to confirm the narrowing is there." I found this surprising because I thought the CT-scan had established different types of narrowing, but I did not question it.
When I saw my PCP a week later I told him about my reluctance to have the x-rays unless they are necessary. He said he thinks Medicare won't pay for the MRI unless I have X-rays first. I plan to call Medicare but would appreciate a second medical opinion on whether, at this point in the diagnostic process, X-rays are needed, desirable, or the best practice before I get an MRI?
BTW, I'm all for necessary x-rays; think I'm about to have a lot of radiation when I get an afib ablation...I'm very thankful for radiology. I like my new PCP and regret that I'm having difficulty asking the right questions when talking with him. Any help will be greatly appreciated.
I called Medicare and was told that x-rays are not required prior to an MRI; all that is required is for a doctor to order an MRI because it is medically necessary. So I'm still wondering why my doctor wants x-rays after I've already had a CT-scan. I think of a CT-scan as being an advanced x-ray. I think of x-rays as providing less information than CT-scans, not more. Is that right? Even so, I can imagine that, after a CT-scan and MRI to do the primary diagnosis, x-rays might be needed to better define conditions in very specific areas. Are x-rays used like this?
I am to see my PCP again in three weeks. In the meantime I will continue to search for and to welcome more information to give me a better understanding.
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