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Shetty. Plast Aesthet Res 2022;9:47 https://dx.doi.org/10.20517/2347-9264.2022.41 Page 3 of 9

Figure 1. Key radiology stakeholders in establishing a peripheral MR lymphangiography program. MRI: Magnetic resonance imaging;
HIMS: health information management system; PACS: picture archival and communication system.

contrast to take place before the patient’s MR exam, but this workflow should be familiar to musculoskeletal
radiologists who perform MR arthrograms with a similar workflow. Extensive discussions were undertaken
with the coding and billing department to ensure that these exams would be coded and billed appropriately
to minimize issues with insurance preauthorization and payment. The injection portion of the exam, which
is performed without imaging guidance, may also be billable as a separate procedure. The design of this
process must take into account the institutional, local, and national healthcare environment and guidelines,
and will vary from site to site.

We achieved the following milestones during the development phase of establishing a new MRL service line:

- 4 months out - initial meetings to establish goal and vision

- 3 months out - configure HIMS ordering, scheduling, protocoling, and billing

- 2 months out - build protocol, plastic surgery begins seeing lymphedema patients in clinic and ordering
exams

- 1 month out - establish a clinical workflow for injection, MR protocol, scheduling patients

- “Go Live”: first exam