The following medical necessity macros are provided as an educational tool to properly document the clinical rationale for a detailed spinal biomechanical study. Please copy this into your EMR system to include with your Symverta analysis, should you deem it clinically necessary. It is also provided in a PDF format in the link below if you choose to download and write in the information.
TESTING ORDERS – X-RAYS
NOTE: For medical-legal issues, you must list the views being ordered
- X-Rays of the Cervical Spine – Davis Series: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following cervical x-rays are ordered to rule out anatomical and biomechanical pathology: Davis Series
a. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.
Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261.
- X-Rays of the Cervical Spine – AP/Lateral: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following cervical x-rays are ordered to rule out anatomical and biomechanical pathology: AP/Lateral
a. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.
Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261.
- X-Rays of the Cervical Spine – AP/Lateral + Obliques: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following cervical x-rays are ordered to rule out anatomical and biomechanical pathology: AP/Lateral/Obliques
a. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.
Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261.
- X-Rays of the Thoracic Spine – AP/Lateral: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following thoracic x-rays are ordered to rule out anatomical and biomechanical pathology: AP/Lateral
a. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.
Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261.
- X-Rays of the Thoracic Spine – AP/Lateral + Obliques: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following thoracic x-rays are ordered to rule out anatomical and biomechanical pathology: AP/Lateral/Oblique
a. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.
Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261.
- X-Rays of the Lumbar Spine – AP/Lateral: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following lumbar x-rays are ordered to rule out anatomical and biomechanical pathology: AP/Lateral
a. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.
Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261.
- X-Rays of the Lumbar Spine – AP/Lateral + Obliques: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following lumbar x-rays are ordered to rule out anatomical and biomechanical pathology: AP/Lateral/Oblique
a. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.
Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261.
- X-Rays of the Lumbar Spine – AP/Lateral + Obliques + Flexion/Extension: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following lumbar x-rays are ordered to rule out anatomical and biomechanical pathology: AP/Lateral/Oblique/Flexion/Extension
a. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.
Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261.
- X-Rays of the Lumbar Spine – AP/Lateral + Flexion/Extension: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following lumbar x-rays are ordered to rule out anatomical and biomechanical pathology: AP/Lateral/Flexion/Extension
a. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.
Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261.
- X-Rays of the Cervical (Davis Series) and Lumbar (AP/Lateral + Flexion/Extension) Spine: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following cervical and lumbar x-rays are ordered to rule out anatomical and biomechanical pathology: Cervical Spine: Davis Series, Lumbar Spine: AP/Lateral/Flexion/Extension
a. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261.
- X-Rays of the Cervical (AP/Lateral/Flexion-Extension) and Lumbar (AP/Lateral + Flexion/Extension) Spine: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following cervical and lumbar x-rays are ordered to rule out anatomical and biomechanical pathology: Cervical Spine: AP/Lateral/Flexion-Extension, Lumbar Spine: AP/Lateral/Flexion/Extensiona. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
- X-Rays of the Cervical (AP/Lateral) and Lumbar (AP/Lateral) Spine: Pathology + Biomechanics: Based on [Mr/Ms./Mrs. xxxxx]’s history and clinical findings, the following cervical and lumbar x-rays are ordered to rule out anatomical and biomechanical pathology: Cervical Spine: AP/Lateral, Lumbar Spine: AP/Laterala. “Among humans, there is no evidence of a carcinogenic effect for acute irradiation”. Diagnostic x-rays have had virtually no negative adverse health sequelae based upon this and the totality of other literature.Tubiana, M., Feinendegen, L. E., Yang, C., & Kaminski, J. M. (2009). The linear no-threshold relationship is inconsistent with radiation biologic and experimental data. Radiology, 251(1), 13-22
b. “The use of X-ray has been found to be significantly consistent in accuracy and repeatability in assessing osseous pathology.”
Tracy, L. M., Temple, S. M., Bennett, D. C., Sprayberry, K. A., Makagon, M. M., & Blatchford, R. A. (2019). The Reliability and Accuracy of Palpation, Radiography, and Sonography for the Detection of Keel Bone Damage. Animals, 9(11), 894.
c. “When utilizing X-ray, digitization, and measurement protocols in conjunction with the coordinate system created by Panjabi et al. and digitized directly into a computer, it assures accuracy in reporting biomechanics and stability.”
Lin, R. M., Tsai, K. H., Chu, L. P., & Chang, P. Q. (2001). Characteristics of sagittal vertebral alignment in flexion determined by dynamic radiographs of the cervical spine. Spine, 26(3), 256-261.
TREATMENT ORDERS FOR BIOMECHANICS
- Cervical: X-Ray digitizing revealed demonstrable biomechanical pathology at C [xx,xx,xx, etc.] altering the treatment plan to render a chiropractic spinal adjustment at those levels, based upon the vectors determined in the digitization report.
- Lumbar: X-Ray digitizing also revealed demonstrable biomechanical pathology at L [xx,xx,xx, etc.] altering the treatment plan to render a chiropractic spinal adjustment at those levels, based upon the vectors determined in the digitization report.
TESTING ORDERS – X-RAYS AT MMI TO RE-DIGITIZE
- X-Rays of the Cervical Spine Flexion/Extension at MMI: Biomechanical Determination & Recommendations: Based on [Mr/Ms./Mrs. xxxxx]’s pathologic biomechanical clinical findings on previous x-rays, an end-care follow-up x-ray study is being ordered to determine if MMI has been attained.
“The study of the subsequent subject-specific spinal loading could help further the understanding of cervical spine biomechanics, degeneration mechanisms, and complications…”
Muth-Seng, Christophe, et al. “Personalized gravitational loading of the cervical spine from biplanar X-rays for asymptomatic and clinical subjects in neutral standing position.” Clinical Biomechanics (2022): 105577.
2. X-Rays of the Lumbar Spine Flexion/Extension at MMI: Biomechanical Determination & Recommendations: Based on [Mr/Ms./Mrs. xxxxx]’s lumbar pathologic biomechanical clinical findings on previous x-rays, an end-care follow-up x-ray study is being ordered to determine if MMI has been attained.
“The study of the subsequent subject-specific spinal loading could help further the understanding of cervical spine biomechanics, degeneration mechanisms, and complications…”
Muth-Seng, Christophe, et al. “Personalized gravitational loading of the cervical spine from biplanar X-rays for asymptomatic and clinical subjects in neutral standing position.” Clinical Biomechanics (2022): 105577.
3. X-Rays of the Cervical and Lumbar Spine Flexion/Extension at MMI: Biomechanical Determination & Recommendations: Based on [Mr/Ms./Mrs. xxxxx]’s cervical and lumbar pathologic biomechanical clinical findings on previous x-rays, an end-care follow-up x-ray study is being ordered to determine if MMI has been attained.
“The study of the subsequent subject-specific spinal loading could help further the understanding of cervical spine biomechanics, degeneration mechanisms, and complications…”
Muth-Seng, Christophe, et al. “Personalized gravitational loading of the cervical spine from biplanar X-rays for asymptomatic and clinical subjects in neutral standing position.” Clinical Biomechanics (2022): 105577.