The records have been reviewed. The member is an adult female with a birth date of 06/13/1961. She has a diagnosis of Alzheimer’s disease, other dementia. Her treating provider, David S. Knopman, MD, recommended that she have a fluorodeoxyglucose (FDG)-Positron Emission Tomography (PET) scan, which was performed on 01/26/2016.
The carrier has denied coverage of FDG-PET scan as not medically necessary. A letter from the carrier to the member, dated 05/08/2016, states in part:
“…After carefully reviewing the medical information, we are upholding the original decision to deny the above stated service(s). The denial is based on the Plan provisions. Based on the medical information the criteria for approval were not met.
Please refer to your Mayo Premier Summary Plan Documents: Utilization Management- Utilization
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Findings:
The member is a 55-year-old female with a history of cognitive impairment. She has had progressive difficulty with cognition and short-term memory for more than four years. This has affected her ability to work. Her treating physician, David Knopman, MD, ordered an FDG-PET scan, which was completed on 1/26/2016. The subject scan is being denied by the member’s plan as not medically necessary due to a provision in the member’s Plan regarding her diagnosis of dementia.
FDG-Positron Emission Tomography (PET) is not routinely performed as part of the diagnostic work up for Alzheimer’s disease. Thus, it is not the standard of care to rule in or rule out a diagnosis of Alzheimer’s disease.
The member’s treating physician notes that certain subtypes of dementia such as Alzheimer’s versus frontotemporal dementia (FTD) can be distinguished and that this can influence treatment. He reports that medications such as Aricept can have a negative impact on FTD, while they are the standard of care for Alzheimer’s disease. In this member’s case, however, she has been taking Aricept without any apparent side
Alzheimer’s Disease is a disease of the future. With the growing aged population, this disease, which affects primarily the elderly, will become of increasing relevance to the medical profession. Also, the high frequency of Alzheimer’s, and the high cost in labor, money, and material of caring for its victims shall put considerable burden on the society as a whole. Here, however, these issues are not going to be debated. Instead the pathology of Alzheimer’s will be reviewed to the extent it is known today.
“This article discusses how Medicare Carriers and Fiscal Intermediaries use coverage determinations to establish medical necessity. When the condition(s) of a patient are expected to not meet medical necessity requirements for a test, procedure, or service, the provider has the obligation under the
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
As a result of this, a sizeable number of medical practitioners are not acquainted with the nuances of imaging modalities." (Sohoni, C. A. (2013, March 23). When you give an incorrect diagnosis or failure to diagnose and they decide to sue you this can lead to medical malpractice which means in other words negligence. When there is a case of negligence they have to prove the following steps, duty of care owned by the RT, breach of duty occurred by the RT, cause of injury due to negligence of RT and the injury actually occurring.
The issue with case #1 is the failure of the PT to adhere to the surgeons referral order which is
Before the PET scan the patient is given an injection containing a small amount of FDG. The patient then must sit quietly for about 60 minutes. During this time they must sit and relax. They are not get up and walk around, talk, read or do anything else that would require them to
Burcham and Rosentheal (2016) talk about a medication called Aricept. Aricept is a cholinesterase inhibitor that was approved by the FDA to treat early stages of Alzheimer's disease. Cholinesterase inhibitors prevent the breakdown of acetylcholine, a chemical in the brain and the body that helps to communicate with other cells in the body. For AD patients, Aricept would increase the amount of acetylcholine and improve the function of neuron that have not been destroyed. Furthermore, Aricept does not cure the disease, it helps delaying the disease and preventing symptoms form becoming worse.
Alzheimer's Disease is a condition that affects 50% of the population over the age of eighty five, which equals four million Americans each year. It is becoming an important and high-profile issue in today's society for everyone. There are rapid advancements being made in the fight against this disease now more than ever, and the purpose of this essay is to educate the public on the background as well as the new discoveries. There are many new drugs that are being tested and studied every day which slow down, and may even halt the progress of the disease.
The results were somewhat on the positive side. A diagnosis that was based on molecular biomarkers showed the best fit with the end diagnosis at a long follow up. The t-maps had the best and highest diagnostic accuracy in Alzheimer’s disease, and different non-alzheimer dementias. A significant classification rate was provided for alzheimer’s disease, and it was provided by the p-tau/A[beta.sub.42 ratio. The best predictor of conversation to Alzheimer’s disease includes the Alzheimer’s disease positive metabolic pattern, which was portrayed by FDG PET SPM, and MCI.
In 1906 a physician, named Alois Alzheimer, cared for a fifty-one year old patient with severe dementia. Upon her death, he was able to examine her brain at autopsy. Dr. Alzheimer was able to take advantage of recent innovations in microscopy and histological techniques that allowed him to study in detail the cellular components in nervous tissue. He found that the brain of his patient had severe cortical atrophy and described the neurofibrillary bundles and plaques that are now the hallmark for definitive diagnosis of what he at that time called “presenile dementia”. An account of his first patient was published in 1907. It is a little ironic that reevaluation this case has lead some to believe that this first patient did not suffer from the Alzheimer’s disease at all. Instead they believe she suffered from a different, rare disease called metachromatic leukodystrophy (Izenberg, 2000).
The use of positron emission tomography (PET) is one of the most advanced imaging techniques used in the world of neuroscience. A PET scan consists of injecting the bloodstream with a radioactive substance called a tracer that is able to identify diseases within the body. This scan is a huge part of the breakthrough in the attempt to further understand neurodegenerative disorders including Alzheimer’s disease by providing visible biomarkers that allow for clinical diagnosis. In this article the primary focus is on current updates of PET radioactive tracers and fluorescence indicators that are continually benefitting our further understanding of Alzheimer’s disease.
(Reynolds, 2013). AD is an irreversible disease of the brain which causes confusion, decline of memory, loss of cognitive function and disables an individual to perform simple day-to-day activities (Reynolds, 2013). Reynolds further stated, an estimated 50% - 80% of all patients who suffer dementia are found to have AD. There are several imaging modalities used to help aid physicians in the diagnosis of AD such as, magnetic resonance imaging (MRI), computed tomography (CT), and photon emission tomography (PET). Each have advantages and disadvantages to help diagnose patients who might have unique circumstances.
Positron emission tomograph (PET) is a medical imaging procedure that provides unique information about how an organ or system in the body is functioning. PET scans are mainly used to assess cancers, neurological diseases and cardiovascular disease. PET scan involves the injection of a small amount of a ‘positron-emitting’ radioactive material, often referred to as a radiopharmaceutical. Images of the body are then taken using a PET scanner. The camera used is able to detect emissions coming from the injected radiopharmaceutical. The specialised computer attached to the camera manipulates the image creating two and three-dimensional images of the area that is being examined. Areas where the injected radiopharmaceutical gathers appear much ‘brighter’
If your doctor ever refers you for a PET scan, you will be introduced to a fairly new medical imaging technique. Since this emerging modality is so new, a lot of the general public is not aware of what a PET scan exactly is. This essay will help explain the concept of this modality and the characteristics of it that allow doctors to diagnose and manage the proper care for some of today's most devastating medical conditions known to man.