DWD 81.05(1)(e)2.2. To monitor a therapy or treatment that is known to result in a change in imaging findings and imaging of these changes are necessary to determine the efficacy of the therapy or treatment; repeat imaging is not appropriate solely to determine the efficacy of physical therapy or chiropractic treatment. DWD 81.05(1)(e)4.4. To diagnose a change in the patient’s condition marked by new or altered physical findings. DWD 81.05(1)(e)5.5. To evaluate a new episode of injury or exacerbation that in itself warrants an imaging study. DWD 81.05(1)(e)6.6. When the treating health care provider and a radiologist from a different practice have reviewed a previous imaging study and agree that it is a technically inadequate study. DWD 81.05(1)(f)1.1. Persistence of a patient’s subjective complaint or failure of the condition to respond to treatment are not legitimate indications for repeat imaging. In this instance an alternative imaging study may be necessary if another etiology of the patient’s condition is suspected because of the failure of the condition to improve. DWD 81.05(1)(f)2.2. Alternative imaging may not follow up negative findings unless there has been a change in the suspected etiology and the first imaging study is not an appropriate evaluation for the suspected etiology. DWD 81.05(1)(f)3.3. Alternative imaging may follow up abnormal but inconclusive findings in another imaging study. An inconclusive finding may not provide an adequate basis for accurate diagnosis. DWD 81.05(2)(2) Specific imaging procedures for low back pain. DWD 81.05(2)(a)(a) Except for the emergency evaluation of significant trauma, a health care provider shall document in the medical record an appropriate history and physical examination, along with a review of any existing medical records and laboratory or imaging studies regarding the patient’s condition, before ordering any imaging study of the low back. DWD 81.05(2)(b)(b) A health care provider may order computed tomography scanning for any of the following: DWD 81.05(2)(b)3.3. When bony lesion is suspected on the basis of other tests or imaging procedures. DWD 81.05(2)(c)(c) Except as specified in par. (b), a health care provider may not order computed tomography scanning in the first 4 weeks after an injury. Computed tomography scanning is necessary after 4 weeks if the patient continues with symptoms and physical findings after the course of initial nonsurgical care and if the patient’s condition prevents the resumption of the regular activities of daily life, including regular vocational activities. DWD 81.05(2)(d)(d) A health care provider may order magnetic resonance imaging scanning for any of the following: DWD 81.05(2)(d)3.3. When previous spinal surgery has been performed and there is a need to differentiate scar due to previous surgery from disc herniation, tumor, or hemorrhage. DWD 81.05(2)(e)(e) Except as specified in par. (d), a health care provider may not order magnetic resonance imaging scanning in the first 4 weeks after an injury. Magnetic resonance imaging scanning is necessary after 4 weeks if the patient continues with symptoms and physical findings after the course of initial nonsurgical care and if the patient’s condition prevents the resumption of the regular activities of daily life, including regular vocational activities. DWD 81.05(2)(f)(f) A health care provider may order myelography for any of the following: DWD 81.05(2)(f)1.1. Myelography may be substituted for otherwise necessary computed tomography scanning or magnetic resonance imaging scanning in accordance with pars. (b) and (d), if those imaging modalities are not locally available. DWD 81.05(2)(f)2.2. In addition to computed tomography scanning or magnetic resonance imaging scanning, if there are progressive neurologic deficits or changes and computed tomography scanning or magnetic resonance imaging scanning has been negative. DWD 81.05(2)(f)3.3. For preoperative evaluation in cases of surgical intervention, but only if computed tomography scanning or magnetic resonance imaging scanning have failed to provide a definite preoperative diagnosis. DWD 81.05(2)(g)(g) A health care provider may order computed tomography myelography for any of the following: DWD 81.05(2)(g)1.1. The patient’s condition is predominantly sciatica, there has been previous spinal surgery, and tumor is suspected.