Shoulder Arthrography
DESCRIPTION
A shoulder arthrography is a special x-ray that is used in the examination of the ligaments and cartilages in the shoulder joint. Contrast material, which is injected into the joint, is visible under fluoroscopy and assists in confirming the presence or absence of abnormalities.
POLICY
Shoulder arthrography for the diagnosing of rotator cuff tears is considered not medically necessary.
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
The current literature verifies that MR imaging with or without contrast is generally considered superior to ultrasonography and conventional arthrography in the assessment of tears and abnormalities of the rotator cuff.
SOURCES
Blanchard, T. K., Bearcroft, P. W., Constant, C. R., Griffin, D. R., & Dixon, A. K. (1999). Diagnostic and therapeutic impact of MRI and arthrography in the investigation of full-thickness rotator cuff tears. European Radiology, 9 (4), 638 - 642.( Level 4 Evidence)
Blanchard, T. K., Bearcroft, P. W., Maibaum, A., Hazelman, B. L., Sharma, S., & Dixon, A. K. (1999). Magnetic resonance imaging or arthrography for shoulder problems: A randomized study. European Journal of Radiology, 30 (1), 5 - 10. (Level 4 Evidence)
Cothran, R. L., (2006) Imaging in evaluating the rotator cuff. Journal of Surgical Orthopaedic Advances, 15 (3), 132 - 9. (Level 5 Evidence)
DeLee, J. C., Drez, D., & Miller, M. D. (Eds.), (2003) DeLee & Drez's Orthopaedic Sports Medicine (2nd ed., pp. 4871 - 914). Philadelphia: W. B. Saunders Company.
National Institute of Arthritis and Musculoskeletal and Skin Diseases. (2006, May). Questions and Answers About Shoulder Problems. Retrieved April 2, 2009 from http://www.niams.nih.gov/hi/topics/shoulderprobs/shoulderqa.htm.
Parmar, H., Jhankaria, B., Maheshwari, M. Singrakhia, M., Shanbag, S., Chawla, A., et al. (2002). Magnetic resonance arthrography in recurrent anterior shoulder instability as compared to arthroscopy: A prospective comparative study. Journal of Postgraduate Medicine, 48 (4), 270 - 273.(Level 4 Evidence)
Resnick, D. (Ed.). (1995) Diagnosis of Bone and Joint Disorders (3 rd ed., pp. 2965 - 2984). Philadelphia: W. B. Saunders Company.
ORIGINAL EFFECTIVE DATE: 3/1/2000
MOST RECENT REVIEW DATE: 5/14/2009
ID_BT
Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.
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