Imaging Request: One Of The Most Common PAs You’re Probably Fighting Wrong

Imaging Request: One Of The Most Common PA You’re Probably Fighting Wrong

There is a very good chance that you have had to pause the delivery of care because of a prior authorization. The chances of it being for an MRI or CT scan is likely pretty high. Imaging requests are among the most frequently delayed or denied services. This is across primary care, ortho, neuro, pain management, and even in OB/GYN. While prior authorizations feel like an unwanted, yet necessary, part of the healthcare grind, they can quickly bring things to a halt and result in real roadblocks for timely diagnoses for patients and supporting a smooth continuity of care.

The challenge being faced is that many imaging denials aren’t based on the outcome of the actual scan itself, but they’re based on how the request was submitted initially before the procedure was even completed. Let’s discuss how to be proactive and ensure your request is succinct and complete.

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Why Imaging Gets Denied So Often

Most denials for diagnostic imaging boil down to insufficient or unclear clinical rationale for the procedure or missing documentation to support the request. It could be the wording, or even the structure to the request. FightPaperwork helps you figure out the right information that should be included and generates the correct documentation needed. The goal is to help you submit the required documents to meet the version of medical necessity based on payer guidelines.

Here are a few common reasons:

• Failure to document initial conservative treatment attempts (e.g., Physical Therapy, NSAIDs, or careful monitoring)
• Lack of functional impairment that justifies jumping straight to advanced imaging
• Non-specific ICD-10 codes (e.g., “back pain” without clarification on if it’s radicular, traumatic, or chronic)
• Missing indication of duration, severity, or progression of symptoms that have led to the need for imaging
• Requesting the wrong study for the documented concern (specifically requesting the most aligned study for the patient’s need for imaging)

Healthcare payers are not always reasonable, and at times, you may feel they can be very rigid. Unfortunately, that rigidity can be very expensive, for your practice, your time, and most importantly, your patients.

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So What to Include in a Solid Imaging PA

There is nothing new that needs to be done in your process. What you do need to do is provide a clear, structured justification that anticipates what the reviewer is looking for in your request. Make sure you have the following:

1. Chief Complaint With Duration of the Complaint
   State the exact concern, symptom, or issue. When did it start, how has it changed?
   Example: “Ms X reports a worsening of her low back pain which radiates down her left leg for the past 8 weeks. This is interfering with mobility and daily function despite 6 weeks of conservative management.”
2. Functional Impact
   Document how the issue affects daily activities, work, or safety.
   Example: “Mr X is unable to sit or stand for > 30 minutes: Has missed 8 days of work over the last three weeks.”
3. Prior Treatments Attempted Prior to Request
   List any medications, physical therapy, injections, or other interventions, and whether they helped and to what degree.
   Example: “Mrs S completed 8 weeks of physical therapy 3x per week and used NSAIDs with very minimal relief. Continues to rate her pain 8/10.”
4. Clinical Exam Findings
   Highlight any abnormal findings on the patient's physical exam.
   Example: “Mr T has positive straight leg raise at 45 degrees. There are significantly diminished ankle reflexes on the left.”
5. Why Imaging is Being Requested Now
   Explain why imaging will guide next steps in the continuity of care. This is critical when you are considering surgery, need specialist referral, or escalation of treatment plans.
   Example: “An MRI is being requested for Mrs C to evaluate her disc herniation or nerve root impingement in order to guide the next steps in her medical treatment.”

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Where FightPaperwork Makes This Process Easier

One of the subtle ways clinicians get stuck is by starting from scratch every time. You know the patient needs the MRI. You know why. But rewriting the rationale, remembering each insurer’s language, and keeping up with what documents are needed? That’s where the cracks show.

FightPaperwork.com streamlines this process by:

• Guiding you through the necessary information: The platform prompts you with questions to ensure all relevant details are captured.
• Generating appropriately formatted letters or medical notes: Based on your responses, it creates documents tailored to payer requirements.
• Reducing redundancy: By saving commonly used templates, it minimizes repetitive tasks.

This is more than shortcuts—it’s about streamlining and not wasting time doing the same thing five different ways when one efficient, clean format gets it done right the first time, saving you time and financial resources.

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Tips to Use BEFORE You Submit

• Know Your Payer’s Criteria: Some plans follow MCG or AIM guidelines. Others use internal ones.
• Be Specific With Diagnosis Codes: Use the most accurate, current, detailed ICD-10 code available. “Low back pain” is vague. “Lumbago with sciatica, left side” (M54.42) tells a clearer story so the reviewer has a clearer picture.
• Upload the Right Notes: A separate Letter of Medical Necessity isn’t always required—but including your visit note or an addendum that checks all five boxes above often avoids back-and-forth, saving you time and money.
• Don’t Rely on the Portal: If you’re submitting through a payer’s portal but can’t upload all your documentation, your request is going in incomplete. Always track what was sent, when, and how. (Yes, FightPaperwork does that too.)

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So You Got Denied. It Happens. What To Do Next.

Even well-documented requests can get denied. Remember, healthcare payers can be rigid. When/If it happens:

• Upload claims denial on FightPaperwork
• The appeal will use AI to synthesize the data into appeal options to choose and customize.
• FightPaperwork can submit a strong appeal immediately, including all data from the original documents restating the clinical need.
• And most importantly, don’t give up after one attempt. Not even at a second attempt. A lot of denials get reversed when additional documentation is submitted—especially when it’s succinct, clean, clear, and complete.

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Remember

Prior authorizations for imaging aren’t going away. Using the right resources will make the process easier and more efficient. When you standardize your approach and leverage the right tools and resources, you spend more time focusing and delivering excellent care to patients and less time justifying that care.

Fight smart. Fight with strategy. And let FightPaperwork.com do the heavy lifting—so your notes tell the story once, and tell it right the first time.

Danielle Miller, RN
Doctorate-Level Nursing Expert | Healthcare Consultant | Academic Advisor