During my rounds to local GPs one of the questions I am often asked is what is rebatable for MRI and what is not. Here is what is currently rebatable for knee MRI according to the latest MBS schedule July 18.
Knee MRI – Meniscal/ACL Item Number 63560
Referral by a medical practitioner (excluding specialist or
consultant physician) for a scan of knee following acute knee trauma for patient >16yo with:
- Inability to extend the knee suggesting possibility of acute meniscal tear ( R ) (Contrast) (Anaest)
- Clinical findings suggesting acute anterior cruciate ligamant tear (R ) (Contrast) (Anaesth)
Fee: $403.20 Benefit: 75% = $302.40 85% = $342.75
KNEE MRI – Meniscal/ACL Item Number 63561
- Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of knee following acute knee trauma for a patient 16 year or older with:
- Inability to extend the knee suggesting the possibility of acute meniscal tear (R) (NK) (Contrast) (Anaes) or
- Clinical findings suggesting acute anterior cruciate ligament tear. (R) (NK) (Contrast) (Anaes)
Fee: $201.60 Benefit: 75% = $151.20 85% = $171.40
NOTES FOR GPs ON KNEE IMAGING
According to these RACGP clinical guidelines:
– Acute knee presentations are diagnosed by history, physical examination and plain X-ray (where indicated for suspected bony injury).
– Urgent further imaging is rarely indicated.
– The Lachman test is effective for assessing anterior cruciate ligament (ACL) integrity.
– The Thessaly test at 20° of knee flexion is an effective first-line screening for meniscal tears.
-Careful evaluation by an experienced examiner not only diagnoses ACL and meniscal tears as well as MRI does. It also identifies patients with surgically-treatable meniscal and ACL tears with equal (of better) reliability that MRI.
-It is important to note that not all meniscal and ACL tears require surgery. Rehabilitation is suggested as the primary treatment option for young adults following an acute ACL tear. more than half of meniscal tears will settle with conservative management
– MRI of the knees should be confined to more doubtful, difficult and complex knee injuries.
– For these sorts of presentations, MRI is an alternative to diagnostic arthroscopy and allows better treatment planning.
– MR imaging of the knee can give both false positive and false negative results, especially with meniscal injuries.
– Incidental findings, especially of the meniscus, are common and increase with age. Up to 90% of middle-aged and older people with no X-ray evidence of osteoarthritis have been shown to have knee abnormalities on MRI.
– As many acute knee injuries settle over time, imaging may only reveal self-limiting injuries in some cases. MRI cannot determine the natural course of each injury
To these RACGP measures I would also add not to use MRI for suspected arthritis, but just order a standing and sitting X-Ray. Here is my quick 2 minute knee examination video on knee pain on a footballer with previous knee injuries.