- Jul 31, 2001
- 269
- 68
- 28
- School/Org
- Pennsylvania College of Optometry
- City
- voorhees
- State
- NJ
One of my patients, a 70 y/o WF, came in yesterday for routine monitoring of her cataracts and drusen.
I found a unilateral swollen right disk with hemorrhages and additional dot hemes in the macula and blot hemes in the periphery. She claimed to be totally asymptomatic and her vision was OD 20/25 and OS 20/20, the same as when I saw her in January when her disk was normal.\
She has a history of breast cancer and a pacemaker for arrhythmia. She had bilateral blepharoplasties in January 2024 and the only meds were Metoprolol and baby aspirin. She is very claustrophobic and hates MRI's but had one for her knee surgery at Penn.
I referred her to the Wills Eye ER where they did extensive blood work and discharged her at 2:00 AM this morning with instructions to have me request an MRI at Penn. The problem is the pacemaker makes the MRI more dangerous and Penn said they would only do it for a Penn doctor since it requires more elaborate monitoring.
She would also probably require some sedation due to her anxiety in tight spaces. I looked up the CPT4 codes and while normally a brain scan 70553 wo/w contrast would be indicated for bilateral papilledema I think the 70543 code for MRI of the orbit is more appropriate for unilateral disk edema. I've had very limited experience in ordering MRI's so would appreciate advice. Which MRI to order and how do I find an MRI site that would be able to handle this type of case and accept an outside script?
I have optomap photos but I'm not sure how to delete her name from them.
I found a unilateral swollen right disk with hemorrhages and additional dot hemes in the macula and blot hemes in the periphery. She claimed to be totally asymptomatic and her vision was OD 20/25 and OS 20/20, the same as when I saw her in January when her disk was normal.\
She has a history of breast cancer and a pacemaker for arrhythmia. She had bilateral blepharoplasties in January 2024 and the only meds were Metoprolol and baby aspirin. She is very claustrophobic and hates MRI's but had one for her knee surgery at Penn.
I referred her to the Wills Eye ER where they did extensive blood work and discharged her at 2:00 AM this morning with instructions to have me request an MRI at Penn. The problem is the pacemaker makes the MRI more dangerous and Penn said they would only do it for a Penn doctor since it requires more elaborate monitoring.
She would also probably require some sedation due to her anxiety in tight spaces. I looked up the CPT4 codes and while normally a brain scan 70553 wo/w contrast would be indicated for bilateral papilledema I think the 70543 code for MRI of the orbit is more appropriate for unilateral disk edema. I've had very limited experience in ordering MRI's so would appreciate advice. Which MRI to order and how do I find an MRI site that would be able to handle this type of case and accept an outside script?
I have optomap photos but I'm not sure how to delete her name from them.
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