Contrast CT MRI Guidelines 2012 For Print.xls

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1 12/4/12 CODES CODES 7 6 6 7 Updated CPT CPT 7637 7637 7219 7219 & & & & 5641. ‐ 454 74183 74183 MRI/MRA 74183 74183 74183 MRI/MRA 74183 74183 74183 74183 74183 74183 74183 74183 74183 74183 74183 74183 74183 74183 74183 ‐ 512 @ assistance MRI MRI further wo wo or kidney) liver) liver) liver) kidney) liver) kidney) liver) & & w w (attn (attn (attn (attn (attn (attn (attn MRCP (attn MRCP wo wo wo wo wo wo wo wo wo wo wo wo wo wo wo wo wo wo Pelvis Pelvis & & & & & & & & & & & & & & & & & & w w w w w w w w w w w w and w w w and w w w clarification for DESCRIPTION DESCRIPTION Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen needed MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI EXAM MRI EXAM MRI MRI MRI MRI MRI MRI MRI MRI MRI as contrast IV 6 CODES CODES 7637 radiologists CPT CPT without & ARA 74177 74170 74177 74170 74177 74177 74177 74170 74177 74177 CT/CTA 74177 74177 74177 74177 74177 74177 74177 74170 74170 74170 74170 74176 CT/CTA 74170 74176 74178 74178 74178 74178 74160 74170 74170 74177 with MRI/MRA indicates & "wo" consult Imaging Genitourinary Please Gastrointestinal contrast, Body IV CT/CTA CT CT with diagnoses. wo wo wo indicates & & & wo common w w w Common "w" by Bowel and/or CT/IVP CT/IVP CT/IVP w w w w w wo w w w w wo w w w w w ‐ ‐ ‐ w for wo wo wo wo wo wo wo wo wo wo exams & & & & & & & & & & Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis w & w w & & & & & w w w w & & & w & & & & & & & w w w Protocol Protocol Protocol & DESCRIPTION DESCRIPTION requesting Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Enterography/Small Abdomen Abdomen Abdomen Abdomen Abdomen Abdomen Hematuria Abdomen Hematuria Hematuria in CT CT CT CT CT EXAM CT CT CT CT CT CT CT CT EXAM CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT CT Guidelines assist to disease guidelines Contrast bowel IVP) general CT cyst are up stone) mass) cyst stone elevation /mass/cyst pain colic work inflammatory These suspected Urogram, complex test duct LLQ dilatation obstruction or mass pain renal (suspect (CT (suspect mass bile GUIDELINES GUIDELINES adenoma cancer, disease, loss staging staging ductal mass calculus cyst bowel pain, hemangioma, function Bladder Cancer Adrenal Liver Appendicitis Renal Abdominal CLINICAL Abdominal Hepatitis Abscess Liver Pancreatitis Hematuria Hematuria Hemochromatosis Weight Lymphadenopathy Lymphoma Pancreatic Renal Renal Hydronephrosis, Flank Cancer Biliary Small Diarrhea Hematuria Constipation CLINICAL Crohn's Diverticulitis, Cirrhosis Common

2 12/4/12 CODES CODES CODES Updated CPT CPT CPT 5641. ‐ 454 71552 MRI/MRA 72197 72197 MRI/MRA 72197 72197 72197 72197 MRI/MRA 71552 71551 72197 72197 71552 71552 ‐ 512 @ assistance MRI MRI MRI further or wo wo wo wo wo wo wo wo wo wo wo wo clarification & & & & & & & & & & & & for w w w w w w w w w w wo w w DESCRIPTION DESCRIPTION DESCRIPTION Chest Pelvis Pelvis Pelvis Pelvis Pelvis Pelvis Chest Chest Pelvis Pelvis Chest Chest needed MRI MRI EXAM MRI MRI MRI EXAM MRI MRI MRI EXAM MRI MRI MRI MRI MRI as contrast IV CODES CODES CODES radiologists CPT CPT CPT without 4 4 4 ARA 71270 71260 71250 74177 71250 CT/CTA 71260 75572 72193 71270 71250 CT/CTA 71260 71250 CT/CTA 71260 71250 71260 71260 71260 71260 7557 7557 7557 with MRI/MRA indicates & "wo" wo) wo) wo) consult Pelvis Cardiac Chest Chest Chest Pulmonary resolution Please (CT (CT (CT contrast, High IV CT/CTA CT CT CT with resolution resolution resolution diagnoses. contrast, High High High with D D D indicates 3 3 3 common Common "w" Disease Disease, Disease, Disease, by Include Include Include w Lung Lung Lung Lung for wo wo wo exams & & & Pelvis w w w wo wo & & & Morphology w) Interstitial Interstitial Interstitial Interstitial w w w wo wo w w w w w w w DESCRIPTION DESCRIPTION DESCRIPTION for for for for requesting Coronary Coronary Heart Coronary Chest Chest Chest Chest Chest Chest Abdomen Pelvis Chest Chest Chest Chest Chest Chest in Chest CT CT Chest CT CT EXAM CT CT CT Chest CT CTA EXAM CTA CTA CT EXAM CT CTA CT CT Chest CT (CT Guidelines assist to function guidelines Contrast cardiac ablation general LV/RV pre + are uncertain cysts anomalies disease disease effusion mapping, These disease origin mass adenopathy suspected vein disease mass lung artery artery artery GUIDELINES GUIDELINES GUIDELINES adnexal pleural fibroid anomalies staging staging dissection mass, wall nodules mass, fullness Sarcoidosis Mediastinal Bronchiectasis Asbestosis Mediastinal Lung Uterine CLINICAL Adenomyosis Cancer Complex Cysts Dermoid Aortic Cardiac Coronary Lung Hilar Intersitial Endometriosis Pelvic Coronary Coronary Pericardial CLINICAL Pulmonary Chest Cancer Compex COPD CLINICAL

3 12/4/12 * * * * CODES Updated CPT 73725 73725 73725 73725 & & & & 5641. ‐ 454 70549* 70549* 74185 74185 74185 MRI/MRA 74185 74185 74185 74185 74185 71555 71555 ‐ 512 @ wo wo wo wo & & & & w w w w Ext Ext Ext Ext assistance MRI Lower Lower Lower Lower further or MRA MRA MRA MRA and and and and wo wo wo wo wo wo wo wo & or & & or or or & wo wo w w w w w w w w wo wo clarification or or & & w w for w w DESCRIPTION Abdomen Neck Neck Abdomen Abdomen Chest Abdomen Chest Abdomen Abdomen Abdomen Abdomen needed MRA MRA MRA MRA MRA MRA MRA EXAM MRA MRA MRA MRA MRA as contrast IV CODES radiologists CPT without 4 4 4 4 4 ARA 70498 70498 7417 7417 7417 7417 7557 CT/CTA 71275 71275 74175 74175 75635 75635 75635 75635 with MRI/MRA indicates & "wo" consult Vascular Please contrast, IV CT/CTA runoff runoff runoff runoff CT w w w w Contrast Contrast with Ext Ext Ext Ext diagnoses. wo wo & & w w Lower Lower Lower Lower indicates Pelvis Pelvis Pelvis common Pelvis, Pelvis, Pelvis, Pelvis, Common & & & "w" by (Abdomen) (Abdomen) for exams Abdomen Abdomen, Abdomen Carotid/Neck Abdomen, Carotid/Neck Abdomen Chest Coronary Renal Abdomen, Abdomen, Chest Renal DESCRIPTION requesting Angiography Angiography Angiography Angiography Angiography Angiography Angiography Angiography Angiography Angiography Angiography Angiography Angiography Angiography in AAA/Endograft CT CT CT CT CT CT CT CT CT CT CT CT CT EXAM CT Guidelines assist to guidelines suspected known Contrast (AAA), (AAA), general legs graft are disease stent Thoracic aneurysm aneurysm Disease These aneurysm op malignant ‐ stenosis aortic aortic vascular post Artery GUIDELINES aortic stenosis/occlusion bruit or dissection, artery ulcer feet op edema ‐ Leg Foot Carotid Carotid Claudication Pre Abdominal Coronary Hypertension, Cold Abdominal Aortic CLINICAL Thoracic Renal Peripheral

4 12/4/12 CODES 5 Updated CPT 70543 7054 70543 & & & 5641. ‐ 454 70553 70551 70551 70553 70551 70553 70553 70553 70553 70545 70553 70553 70549 70553 70543 70553 70551 70553 70553 70553 70553 70553 70553 70553 MRI/MRA 70553 70553 70551 70553 ‐ 512 @ wo wo & & w w Canal) assistance Neck Neck MRI Auditory Face, Face, w , , Pituitary) further to wo or Head Orbit Orbit Internal & w to MRI MRA MRI Neck and and and (Attn (Attention & wo wo wo wo wo wo wo wo wo wo wo wo wo wo wo wo wo wo wo wo wo clarification & & & & & & & & & & & & & & & & & & & & & w for Face, w w wo wo w wo w w w w w w w w wo w w w w w w w w wo w w DESCRIPTION Neck Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Orbit, Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain Brain needed MRA MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRA MRI MRI MRI MRI MRI MRI MRI MRI EXAM MRI MRI MRI MRI MRI MRI as contrast IV CODES radiologists CPT without 52 ‐ ARA 70481 70498 70470 70450 70486 70491 70450 70450 70491 CT/CTA 70480 70486 70486 70496 70496 with MRI/MRA indicates Imaging Neck & "wo" consult and Please Head contrast, IV CT/CTA CT Neurological with diagnoses. indicates common Common "w" by wo for w wo w w wo exams wo Carotid/Neck Brain/Head Brain/Head Bones neck neck wo sinus Bones Bones & sinus w wo wo wo tissue tissue DESCRIPTION requesting Soft Soft Temporal Temporal Limited Brain Brain Maxillofacial Angiography Angiography Angiography Brain Brain Complete in CT CT CT CT CT CT CT CT CT CT CT CT CT CT EXAM Guidelines assist to guidelines history Contrast history cancer general aneurysm acute chronic cancer with are history or stenosis/occlusion with suspected diagnosed status onset onset orbital These Neck Brain cancer malformation intracranial artery conductive sensorineural state subacute hemorrhage, disease acute acute with mental facial, syncope syncope GUIDELINES sclerosis, sclerosis, ‐ loss, loss, sinusitis in stenosis/occlusion neuropathy staging, staging, history discharge vascular disease congestion/drainage Headaches, Dizziness, Migraines Meningeal Dizziness, Migraines Mastoiditis Hearing Dementia Lyme Glioma Multiple Sinus Fracture Carotid Cranial Headache, Intracranial Multiple AVM, Cancer Family Multiinfarct Hoarseness Intracerebral Metastasis Abscess Cancer Change Headache, Diplopia Meningioma Chronic Hearing CLINICAL Breast

5 12/4/12 CODES Updated CPT 70543 70543 70543 & & & 5641. ‐ 454 70553 70553 70553 70553 70543 70553 70553 70553 70553 70543 70553 70553 MRI/MRA 70553 70553 70553 ‐ 512 @ wo wo wo & & & w w w assistance Neck Neck Neck MRI Face, Face, Face, , , , further wo wo or Orbit Orbit Orbit & & wo) wo) w w MRI MRI MRI & & wo) wo) w w Neck Neck and and and & & & & w w wo wo wo wo wo wo wo wo wo clarification (Brain (Brain & & & & & & & & & for Face, Face, w w w w w w w w w (Brain (Brain DESCRIPTION Brain Brain IACs Brain Brain Brain Pituitary Orbit, Pituitary Brain Brain Orbit, Brain IACs Brain needed MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI EXAM MRI MRI as contrast IV CODES radiologists CPT without ARA 70492 70450 70450 70450 70491 70450 70450 70450 70491 CT/CTA 70480 with MRI/MRA indicates Neck & "wo" consult and Please Head contrast, IV CT/CTA CT with diagnoses. indicates common Common "w" by wo & for wo w w w exams neck neck neck bones wo wo wo wo wo wo tissue tissue tissue DESCRIPTION requesting Soft Soft Soft Brain Brain Brain Brain Brain Brain Temporal in CT CT CT CT CT CT CT CT CT CT EXAM Guidelines assist to guidelines Contrast general are mass chronic or ears) or in These stone hemorrhage cyst disease defect or increased GUIDELINES hematoma adenoma/microadenoma subacute acute (ringing gland acute disturbance field neuritis mass lymphadenopathy Tinnitus Visual TIA Vertigo Salivary Optic Subdural Prolactin, Subarachnoid Trauma, Pituitary Neck Parkinson's Neck Trauma, Stroke, Visual CLINICAL Seizures

6 12/4/12 72158 72158 72158 72158 72158 72158 72158 72148 72148 72148 72148 72148 72148 or or or or or or or CODES or or or or or or Updated CPT 72157 72146 72157, 72146 72157, 72146 72157, 72157, 72157, 72157, 72146 72146 72146 72157, or 5641. ‐ 454 72141, 72156, 72141, 72156, 72158 72146 72141 72146 72141, 72148 72157 72156, 72156, 72156, 72156 72141 72148 72158 72141 72141 72156, 72141, 72141, 72148 72141, 72156, MRI/MRA 72158 72148 72158 72158 72141 72141 ‐ 512 wo wo wo wo wo wo wo @ & & & & & & & w w w w w w w wo wo Lumbar Lumbar Lumbar Lumbar Lumbar Lumbar Lumbar & wo wo wo wo wo assistance MRI or or or or or or or w Lumbar wo wo wo wo wo wo wo & & & & & & & spine Lumbar Lumbar Lumbar Lumbar Lumbar MRI further w w w w w w w or or or or or or or wo wo wo wo wo wo wo Thoracic wo wo wo wo wo & Thoracic Thoracic Thoracic Thoracic Thoracic Thoracic Thoracic or & & & & & wo wo w wo wo wo wo w wo wo w wo w wo w w wo, wo, wo, wo, wo, wo wo, wo, Thoracic Thoracic Thoracic Thoracic Thoracic Thoracic & & & & & & & & clarification spine spine spine w wo, w spine wo, w wo wo w w wo, w w spine w wo, wo, spine spine wo, spine spine spine spine spine spine spine spine spine for DESCRIPTION Cervical Lumbar Cervical Thoracic Cervical Cervical Lumbar Cervical Thoracic Cervical Cervical Lumbar Thoracic Cervical Cervical Cervical Cervical Cervical Cervical Cervical Cervical Lumbar Lumbar Lumbar Cervical Lumbar Lumbar Cervical Lumbar Cervical Cervical Cervical needed MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI EXAM MRI MRI MRI MRI MRI MRI MRI MRI MRI as contrast IV 72131 or CODES radiologists CPT without ARA 72192 72131 72131 72125,72128 72125 72131 CT/CTA 72131 72125 with MRI/MRA indicates & "wo" consult Spine Scan Please contrast, IV Bone CT/CTA CT and with diagnoses. wo spine spine indicates common Thoracic Common "w" by CT Lumbar or for exams wo wo wo wo wo wo Thoracic spine spine spine spine spine spine wo contraindicated; DESCRIPTION requesting MRI Pelvis Lumbar Cervical Lumbar Cervical, Lumbar Cervical Lumbar in CT CT CT *If CT CT CT EXAM CT CT Guidelines assist to years) years) guidelines 10 years) 10 years) Contrast 10 10 than than than general than lesion arm are (greater (less (greater (less fibrosis) or coccyx diagnosed suspected decreased arm or These or lesion cervical thoracic thoracic lumbar lumbar (epidural shoulder leg lesion ischemia myelitis disc extramedullary pain pain sacrum GUIDELINES sclerosis, sclerosis, abscess rotation, lumbar scar equina cord cord stenosis malformation pain shoulder leg surgery, surgery, surgery, surgery, surgery, back vs back weakness Low Neck Spinal Discitis, Radiculopathy Multiple Herniated Fracture, Prior Leg Transverse Myelopathy Spinal Pain, Prior Disc Chiari Prior Mid Syrinx Spinal Cervical Pain, Intradural Multiple Numbness, Cauda Prior Metastasis Fracture Epidural CLINICAL Numbness, Prior

7 12/4/12 0 CODES (U)73223 (U)73220 (U)73221 (U)73221 (U)73218 (U)73221 (U)73221 (U)73218 (U)73221 (U)7322 (U)73223 (U)73221 (U)73221 (U)73223 (U)73221 (U)73221 (U)73218 Updated CPT or or or or or or or or or or or or or or or or or 5641. ‐ 454 (L)73723 73222 (L)73720 (L)73721 (L)73721 (L)73718 (L)73721 73222 73721 (L)73721 73721 73221 (L)73721 73221 (L)73723 73222 (L)73721 (L)73721 (L)73723 MRI/MRA 73722 (L)73721 (L)73718 (L)73721 (L)73718 (L)73720 73221 ‐ 512 @ wo wo wo wo wo wo wo wo wo wo wo & & assistance MRI JT JT JT JT JT JT JT JT JT w wo wo wo w JT JT JT JT JT Ext Ext Ext Ext Ext Ext Ext Ext Ext further wo wo wo than than than than than & & & or Upper Upper Upper Upper Upper Upper Upper Upper Upper w w w other other other JT other other JT JT MRI MRI MRI MRI MRI MRI MRI MRI MRI Ext Ext Ext or or or or or or or or or Ext Ext Ext Ext Ext w wo w wo wo w wo wo wo wo wo wo wo wo wo wo w wo JT JT JT JT JT JT JT JT JT JT JT JT JT JT JT JT JT JT clarification Upper Upper Upper Upper Upper Upper Upper Upper or or or Ext Ext Ext Ext Ext Ext Ext Ext Ext Ext Ext or Ext Ext Ext Ext Ext or Ext Ext or or or for DESCRIPTION Lower Lower Lower Lower Lower Lower Lower Lower Upper Lower Lower Lower Lower Lower Upper Upper Upper Lower Lower Lower Upper Lower Lower Lower Upper Lower needed MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI MRI EXAM MRI MRI MRI MRI MRI MRI MRI as contrast IV CODES (U)73202 (U)73202 (U)73200 (U)73200 radiologists CPT without ARA (L)73702 (L)73702 (L)73700 (L)73700 CT/CTA with MRI/MRA indicates & "wo" consult Please contrast, IV CT/CTA Musculoskeletal CT with diagnoses. wo wo & & indicates w w wo wo common Common "w" by for Extremity Extremity Extremity Extremity exams Upper Upper Upper Upper or or or or DESCRIPTION requesting Lower Lower Lower Lower in CT CT EXAM CT CT Guidelines assist to surgery post surgery if post post if if guidelines joint arthritis, Contrast arthrogram joint non arthrogram novitis (wrist) y knee general S arthrogram , arthrogram y lesion, lesion, consider tear are tear joint Inflammatory consider ath joint p joint bony bony joint wrist, consider non joint or or consider These injury defect, non joint non joint arthro joint tear, arthritis, or tear, tear y hip, hip shoulder, shoulder mass mass fibrocartilage ligamentous non joint GUIDELINES cuff cuff tear injury, injury, tear, tear, tear, tear, y contusion, contusion, effusion tissue tissue er g Osteomyelitis, Tendon Muscle Soft Labral Fracture, Bursitis Labral Muscle Osteomyelitis, Rotator Joint Meniscal, Bone Soft Fracture, sur Osteochondral Rotator Bone Labral Triangular Ligamentous DJD Osteoarthritis CLINICAL Rheumatoid Inflammator Labral

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