ORDERING GUIDE - Radiology Ltd
←
→
Page content transcription
If your browser does not render page correctly, please read the page content below
ORDERING GUIDE
00
MISSION, VISION, AND CORE VALUES
Mission
To provide compassionate care
and superior medical imaging
services to patients, providers,
and healthcare organizations.
Vision
Enhance the wellness of
our community through
the delivery of high-quality,
innovative healthcare.
CoRE Values
• Compassion...for everyone
• Respect...in every interaction
• Excellence...in everything we do
01
WHY THIS GUIDE IS IMPORTANT
TO YOU AND YOUR PATIENTS
This ordering guide is meant to assist you when ordering a study with
Radiology Ltd. The guide includes common indications as well as
recommendations for the most appropriate examination.
Our goal is to provide you and your patients with the most appropriate
and complete imaging examination. After the correct order is placed,
examinations are further tailored to each patient’s specific condition.
Thus, it is very important for the radiologist to be aware of the clinical
question or specific condition in question so that the appropriate
imaging can be performed.
When ordering an examination please include pertinent history as
well as signs or symptoms. Please refrain from ordering “r/o” exams
such as “rule out tumor” or “rule out anomaly” unless history and signs/
symptoms are included as well. Feel free to specify a particular entity
or condition you would like the Radiologist to comment upon in the
report.
In the back of the guide, you will find a list of our contracted insurance
and network plans as well as our imaging centers, addresses and
phone numbers.
Radiology Ltd. has a Professional
Relations Department with field
representatives dedicated to serving
your needs. If you have any questions
or concerns, please contact the
Professional Relations Department at
(520) 901-6614 or at pr@radltd.com.
Thank you,
The Physicians and Staff of Radiology Ltd.
02
IMPORTANT CONTACT INFORMATION
CENTRALIZED SCHEDULING NEED HELP OR HAVE QUESTIONS
Tel: (520) 733-7226 ABOUT WHAT TO ORDER?
Fax: (520) 290-8377 CLINICAL REVIEW
STAT Hotline: (520) 545-1919 Tel: (520) 545-1819
Toll Free: (866) 565-2220 Fax: (520) 545-1844
Toll Free Fax: (866) 707-0750
SPECIALTY SCHEDULING
BREAST BIOPSY INTERVENTIONAL COORDINATION
Tel: (520) 901-6792 Tel: (520) 545-1906
Fax: (520) 545-1848 Fax: (520) 545-1898
BREAST MRI PET / CT
Tel: (520) 901-6631 Tel: (520) 545-1906, opt. 3
Fax: (520) 901-6746 Fax: (520) 545-1898
OTHER IMPORTANT NUMBERS
AUTHORIZATION VERIFICATION For Supplies:
Tel: (520) 901-6767 Tel: (520) 733-4104
Fax: (520) 545-1981 Email: supplies@radltd.com
CODING & PRICING HOTLINE RADVISION
Tel: (520) 545-1818 Tel: (520) 901-6747
Online Requests: Fax: (520) 901-6634
radltd.com/request-exam-pricing Toll Free Tel: (866) 386-9459
HIPAA HOTLINE Website: radltd.com/for-providers
Tel: (520) 545-1969 After Hours Tech Support:
Toll Free Tel: (866) 683-2199 Tel: (520) 545-1720
MEDICAL RECORDS TAX ID AND NPI INFORMATION
Tel: (520) 545-1822 Radiology Ltd. Tax ID
Fax: (520) 326-7989 86-0423896
Online Requests:
radltd.com/medical-record-request Radiology Ltd. - Carondelet Tax ID
26-2750704
PATIENT BILLING (for CT, Ultrasound and X-ray only; for MRI use
Tel: (520) 296-0278 Radiology Ltd. Tax ID listed above)
Secure Online Bill Pay:
radltd.com/online-bill-pay Radiology Ltd. Group NPI#
1841261989
PROFESSIONAL RELATIONS
Tel: (520) 901-6614 Radiology Ltd. - Carondelet NPI#
Fax: (520) 545-1726 1528224904
03
Email: pr@radltd.com
TABLE OF CONTENTS
BREAST IMAGING ULTRASOUND
High Risk Screening.............................................. 5 General....................................................................... 33
Mammo Ordering Decision Tree...................... 6 Vascular...................................................................... 36
CPT Codes for Women’s Imaging...................... 7 MSK/Extremity......................................................... 37
Screening & Diagnostic Mammography........ 8
Additional Imaging & Procedures..................... 9 X-RAY
Breast MRI Scheduling Checklist...................... 10 General....................................................................... 38
Breast MRI.................................................................. 11
INTERVENTIONAL
CT / CTA Minimally Invasive Diagnostic Procedures........ 40
CPT Codes for CT Scans........................................ 12 Pain Management........................................................ 43
Lung Screening Ordering..................................... 13 Vascular Services........................................................... 45
General....................................................................... 14
Head and Spine...................................................... 17 ICD-10 CODES
Musculoskeletal...................................................... 19 ICD-10 Codes Notes................................................. 46
Specialty.................................................................... 20
PREFERRED PROVIDER INFORMATION
DEXA Major Insurance Plans............................................. 49
Bone Densitometry................................................ 22 Major Network Plans................................................ 49
MRI / MRA IMAGING CENTERS
CPT Codes for MRI Scans...................................... 23 Locations..................................................................... 50
Brain............................................................................ 24 Modality by Location.............................................. 51
Spine........................................................................... 25 Weekend MRI............................................................. 52
Breast.......................................................................... 26
Chest, Abdomen, and Pelvis............................... 27 MISC.
Musculoskeletal...................................................... 29 RadVision..................................................................... 53
ACR Appropriateness Criteria.............................. 54
PET / CT Notes............................................................................. 55
PET/CT Scheduling Checklist............................ 31
General....................................................................... 32
Bone Scan................................................................. 32
04
HIGH RISK SCREENING
BREAST IMAGING
New American College of Radiology (ACR) Recommendations
for High Risk Screening
The ACR recommends all women, especially black women and those of Ashkenazi
Jewish descent, should be evaluated for breast cancer risk no later than age 30, so
that those at higher risk can be identified and can benefit from high risk screening.
GROUP ONE
Tyrer-Cuzick calculated lifetime risk of 20% or greater
Patients with a known high risk gene and their untreated first-degree relatives
• Digital mammography with or without 3D mammography annually from age 30
• Annual breast MRI from age 25-30
GROUP TWO
Women with a history of chest radiotherapy before age 30
• Digital mammography with or without 3D mammography annually from age
25 or 8 years after radiotherapy, whichever is later
• Annual breast MRI from age 25-30
GROUP THREE
Personal history of breast cancer diagnosed before age 50
Personal history of breast cancer and dense breasts
• Digital mammography with or without 3D mammography annually from diagnosis
• Annual breast MRI from diagnosis
GROUP FOUR
For women with personal histories of breast cancer not included in the above
• Annual breast MRI should be considered in addition to digital mammography
with or without 3D mammography, especially if other risk factors are present
05 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377.
BREAST IMAGING
MAMMOGRAPHY ORDERING DECISION TREE
Does the patient have a problem?
YES NO
SCREENING MAMMOGRAPHY
DIAGNOSTIC STUDY
(beginning at age 40)
(see below)
± 3D Tomosynthesis
www.radltd.com
Extra views needed (call back)
Nipple discharge
Palpable per radiologist recommendation:
(reproducible, single Negative
lesion / focal pain Diagnostic order required
duct, bloody or serous)
(see below)
Diagnostic Cyst aspiration
CPT CODES for WOMEN’S IMAGING
BREAST IMAGING
This is for reference only. This does not imply protocol standards for all radiology
facilities. Information is subject to change.
SCREENING MAMMOGRAPHY BIOPSY
77067 - BILATERAL DIGITAL MAMMOGRAPHY, CODING VARIES DEPENDING
INCLUDING CAD ON THE PROCEDURE. PLEASE
77063 - SCREENING BREAST 3D CONTACT OUR CODING
TOMOSYNTHESIS DEPARTMENT FOR A DETAILED
EXPLANATION.
DIAGNOSTIC MAMMOGRAPHY
UNILATERAL
77065 - UNILATERAL DIGITAL MAMMOGRAPHY,
INCLUDING CAD
77061 - UNILATERAL BREAST 3D
TOMOSYNTHESIS BREAST MRI
77059 - BILATERAL BREAST MRI
DIAGNOSTIC MAMMOGRAPHY
BILATERAL
77066 - BILATERAL DIGITAL MAMMOGRAPHY,
INCLUDING CAD BONE DENSITY SCAN
77062 - BILATERAL BREAST 3D 77080 - DEXA SCAN
TOMOSYNTHESIS 77085 - DEXA WITH VERTEBRAL
FRACTURE ASSESSMENT
76499 - DEXA BODY COMPOSITION
STUDY
ULTRASOUND UTERINE FIBROID EMBOLIZATION (UFE)
76641 - UNILATERAL COMPLETE CODING VARIES DEPENDING ON
76642 - UNILATERAL LIMITED THE PROCEDURE. PLEASE CONTACT
76882 - AXILLA ALONE OUR CODING DEPARTMENT FOR A
DETAILED EXPLANATION.
For more information on exam codes
and pricing, please contact the Radiology Ltd.
*CMS determined Coding and
that for several Pricing
reasons related toHotline at (520)
claims processing systems,545-1818.
Medicare claims systems will be
unable to process claims using CPT codes 77065, 77066, and 77067 for calendar year 2017. They will continue to
use the existing G-codes G0206, G0204 and G0202 and anticipate adopting the 2017 codes for calendar year 2018.
07 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377.
BREAST IMAGING: Screening and
BREAST IMAGING
Diagnostic Mammography
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
TYPE OF EXAM PARAMETERS PROCEDURE CODE
Screening Mammography, • Annual after age 40 • Screening 77067
Bilateral, Including CAD (12 months and 1 day mammogram
Preps: See below for standard since last screening (specify baseline or
mammo preps. exam) annual exam)
Screening Mammography 77063
Tomosynthesis (3D)
Preps: See below for standard
mammo preps.
Adjunctive Imaging 3D is requested after full-field digital mammography to evaluate
Preps: See below for standard dense breasts. Please call for further information if required: (520)
mammo preps. 901-6668.
Mastectomy Annual Screening, • Annual screening of • Unilateral screening 77067-52
Including CAD untreated breast (12 mammogram
Preps: See below for standard months and 1 day
www.radltd.com
mammo preps. since last exam)
History of Breast Cancer • Lumpectomy • Diagnostic 77066 - bilateral
Preps: See below for standard • 6 months post surgery mammogram: 77065 - unilateral
mammo preps. • ≤ 3 years post personal history
Unilateral Mammography treatment of breast cancer - 77061
Tomosynthesis (3D) lumpectomy
Preps: See below for standard
mammo preps.
Bilateral Mammography 77062
Tomosynthesis (3D)
Preps: See below for standard
mammo preps.
Clinical Findings - Symptoms • Mass • Diagnostic 77066 - bilateral
Preps: See below for standard mammogram: 77065 - unilateral
mammo preps. with ultrasound
(identify area of mass)
• Pain - localized • Diagnostic
mammogram: pain
*CMS determined that for several reasons related to claims processing systems, Medicare claims systems will be unable to process claims
using CPT codes 77065, 77066, and 77067 for calendar year 2017. They will continue to(identify area ofG-codes
use the existing pain)G0206, G0204 and G0202
and anticipate adopting the 2017 codes for calendar year 2018. with ultrasound
(localized pain)
Under 30 Years of Age - Order • Mass, discharge - • Diagnostic Breast 76641 - unilateral,
Ultrasound localized pain Ultrasound with complete
Preps: See below for standard Mammogram 76642 - unilateral,
mammo preps. (if needed) limited
Standard Mammo Preps: Arrive 15 mins prior to exam. No fasting required. No deodorant, lotions,
powder or perfumes. Bring insurance cards along with doctors order to appointment.
08
BREAST IMAGING: Additional Imaging
BREAST IMAGING
and Procedures
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
TYPE OF EXAM PARAMETERS PROCEDURE CODE
Recommendation of • Mammography (call • Mammogram 77065 - unilateral
Additional Imaging back) ±Ultrasound additional exam 76642 - unilateral
(callback or recall exam) ±ultrasound 77066 - bilateral
Short Term Follow-Up Exam 76642 - RT
Preps: See below for standard 76642 - LT
mammo preps. • Recommendation of • Diagnostic 77065 - unilateral
previous exam (3-6 mammogram: 77066 - bilateral
months) short-term follow-up
• Post biopsy exam • Diagnostic 77065 - unilateral
(6 months after previous mammogram: 77066 - bilateral
mammogram) post biopsy
Nipple Discharge • Unilateral • Diagnostic 77665 - unilateral
Preps: See below for standard • Reproducible mammogram 76642 - unilateral
mammo preps. • Single duct discharge +ultrasound: discharge 77066 - bilateral
(patient must be able to (identify breast and 76642 - RT
express discharge at time of describe discharge) 76642 - LT
ductogram)
Nipple Discharge • Ductogram • Ductogram for nipple Singular Duct
Preps: See below for standard (preferably after discharge 19030
breast preps. surgical consultation) 77053
Multiple Ducts
19030 - x number of ducts
77054
Cystic Mass / Lesion • Previous ultrasound • Left / right cystic Ultrasound Guided Singular
Found on Previous Breast report indicating need aspiration 76942
Ultrasound for aspiration 19000
Preps: See below for standard Ultrasound Guided Multiple
breast preps. Same Side
19000
19001 x number of add’l cysts
76942
Indeterminate Lesion • Biopsy indicated on prior • Left / right Stereotactic Guided
Preps: See below for standard imaging indeterminate Biopsy - 19081
breast preps. lesion / mass Additional Lesion - 19082
Ultrasound Guided
Biopsy - 19083
Additional Lesion - 19084
Magnetic Resonance
Guided Biopsy - 19085
Additional Lesion - 19086
Standard Mammo Preps: No fasting required. No deodorant, lotions, powder or perfumes. Arrive
15 mins prior to exam. Bring insurance cards along with doctors order to appointment.
Standard Breast Preps: No fasting required. No deodorant or talcum powder under arms or breast
area. Arrive 30 mins prior to exam. Bring insurance cards along with doctors order to appointment.
3D mammography may be ordered as an adjunct to screening
or diagnostic mammography, if the patient has dense breasts
09 or it is deemed appropriate for other reasons.BREAST IMAGING:
BREAST IMAGING
Breast MRI Scheduling Checklist
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
Please include the following with ALL Breast
MRI orders:
Order for Breast MRI (all are performed
Bilateral, please do not indicate Rt or Lt)
Clinical history / progress notes
Copy of patients insurance card(s)
Patient demographics
www.radltd.com
If prior imaging studies were not performed at
Radiology Ltd., please include any additional
reports listed below:
Last mammogram reports (past 5 years)
Breast ultrasound reports (past 5 years)
Breast MRI reports (past 5 years)
Breast biopsy and breast pathology
reports (past 5 years)
Please fax any additional notes to:
Breast MRI Dept. at (520) 545-1848
10BREAST IMAGING: Breast MRI
BREAST IMAGING
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
TYPE OF EXAM PARAMETERS PROCEDURE CODE
Breast (pre-operative • Recent diagnosis of breast • Bilateral breast MRI 77059
staging) cancer (and chest MRI, if (71552)
necessary)
Preps: See below for standard
breast MRI preps.
Breast (high risk screening) • High risk breast cancer • Bilateral breast MRI 77059
screening
Preps: See below for standard
breast MRI preps.
Breast (silicone implants) • Suspected silicone implant • Bilateral breast 77059
leak MRI in addition to
Preps: See below for standard • Palpable lump “implant protocol”
breast MRI preps. • Pain
Breast (indeterminate • Further evaluation of • Bilateral breast MRI 77059
clinical or imaging results) indeterminate clinical or
imaging results (radiologist
Preps: See below for standard recommendation)
breast MRI preps.
Follow-up for • Follow-up for neo-adjuvant • Bilateral breast MRI 77059
Chemotherapy Treatment chemotherapy
Preps: See below for standard
breast MRI preps.
Please note: Breast MRI does not replace screening mammography.
Standard Breast MRI Preps: Drink plenty of fluids day before exam, nothing to eat two hours
prior to exam. Do not wear hairspray, deodorant, jewelry, metal or eye makeup. Arrive 30 mins
before exam. Bring insurance card to appointment.
11 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377.CPT CODES for CT SCANS
CT / CTA
This is for reference only. This does not imply protocol standards for all radiology
facilities. Information is subject to change.
ORBIT
70480 - W/O CONTRAST BRAIN
70481 - W/CONTRAST 70450 - W/O CONTRAST
70482 - W/O & W/CONTRAST 70460 - W/CONTRAST
70470 - W/O & W/CONTRAST
MAXILLOFACIAL CERVICAL SPINE
70486 - W/O CONTRAST 72125 - W/O CONTRAST
70487 - W/CONTRAST 72126 - W/CONTRAST
70488 - W/O & W/CONTRAST 72127 - W/O & W/CONTRAST
www.radltd.com
CHEST
SOFT TISSUE NECK 71250 - W/O CONTRAST
70490 - W/O CONTRAST 71260 - W/CONTRAST
70491 - W/CONTRAST 71270 - W/O & W/CONTRAST
70492 - W/O & W/CONTRAST
UPPER EXTREMITY
73200 - W/O CONTRAST
73201 - W/CONTRAST
73202 - W/O & W/CONTRAST
THORACIC SPINE
72128 - W/O CONTRAST
72129 - W/CONTRAST
72130 - W/O & W/CONTRAST
LOWER EXTREMITY
73700 - W/O CONTRAST
ABDOMEN PELVIS
73701 - W/CONTRAST
COMBINATION
73702 - W/O & W/CONTRAST
74176 - W/O CONTRAST
74177 - W/CONTRAST
74178 - W/O & W/CONTRAST
LUMBAR SPINE
72131 - W/O CONTRAST
72132 - W/CONTRAST
72133 - W/O & W/CONTRAST
To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 12Eligibility not verified.
Reasons for ineligibility
reported to your office.
If your patient does not meet these
requirements, but needs a chest CT
scan for another clinical indication,
you can order a standard diagnostic
chest CT.
.
13CT / CTA: General
CT / CTA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Chest • Lung nodules (1 exam)
st • CT chest without and 71270
Preps: See below for standard with contrast
CT Contrast Preps. • Lung nodules (follow-up) • CT chest without 71250
contrast
• Abnormal chest X-ray • CT chest with contrast 71260
• COPD
• Cough
• Esophageal CA
• Hemoptysis
• Lung CA
• Lymphoma
• Mass
• Pain
• Pneumonia
• Shortness of breath
www.radltd.com
• Tracheal stenosis
Chest, High Resolution • Asbestosis • CT chest without 71250
Preps: See below for standard • Bronchiectasis contrast, high-
CT Preps. • Fibrosis resolution
• Interstitial lung disease
• Pleural plaques
• Sarcoidosis
CTA Chest (PE Study) • Pulmonary embolism • CTA chest 71275
Preps: See below for standard • Shortness of breath
CT Contrast Preps. • Vascular evaluation
CTA Chest • Aortic dissection • CTA chest 71275
Preps: See below for standard • Thoracic aortic aneurysm
CT Contrast Preps.
CTA Chest & Abdomen • Aortic dissection • CTA chest and 71275
Preps: See below for standard • Thoracic aortic aneurysm abdomen 74175
CT Preps.
Neck • Cancer workups • CT neck with contrast 70491
Preps: See below for standard • Dysphagia
CT Contrast Preps. • Infection
• Infection of parotid gland
• Infection of submandibular
gland
• Lymphadenopathy
• Mass
• Parotid mass
• Parotid stone
• Submandibular stone
Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty
of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment.
Standard CT Contrast Preps: Nothing to eat two hours prior to exam. Drink plenty of water. Bring 14
insurance cards to appointment. Arrive 30 mins before exam.CT / CTA: General
CT / CTA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Pelvis (soft tissue) • Cancer staging • CT pelvis with 72193
Preps: See below for standard CT • Cysts contrast
Oral Contrast Preps. • Hernia
• Infection
• Mass
• Pain
Pelvis (bone) • Fracture, arthritis • CT pelvis without 72192
Preps: See below for standard contrast
CT Preps.
• Bone Infection, Illiac joints • CT pelvis with 72193
• Cancer / mass / mets / tumor contrast
Adrenal • Adrenal mass • CT abdomen with 74170
Preps: See below for standard and without contrast
CT Preps.
Abdomen / Pelvis • Stone (stone protocol) • CT abdomen and 74176
Preps: See below for standard pelvis without
CT Preps. contrast (stone
protocol)
Abdomen / Pelvis • Abdominal pain Area of concern:
Preps: See below for standard CT • Abscess Above iliac crest
Oral Contrast Preps. • Hernia (ie, ventral, umbilical, (hip bone)
inguinal) • CT abdomen with 74160
• Mass contrast
Below iliac crest
(hip bone)
• CT pelvis with 72193
contrast
Location unknown or
both areas apply
• CT abdomen and 74177
pelvis with contrast
Abdomen / Pelvis • Any cancer staging • CT abdomen and 74177
Preps: See below for standard CT • Appendicitis pelvis with contrast
Oral Contrast Preps. • Crohns / ulcerative colitis
• Diarrhea
• Diverticulitis
• IBD
Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty
of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment.
Standard CT Oral Contrast Preps: At least one day prior to exam, patient needs pick up oral contrast at
any one of our locations. Further instructions will be given.
15CT / CTA: General
CT / CTA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Liver • Hepatoma, Hepatitis, Cirrhosis • CT abdomen with 74170
Preps: See below for standard CT • Liver hemangioma and without contrast
Oral Contrast Preps. (MR preferred) (liver protocol)
Pancreas • Pancreatic mass • CT abdomen 74170
Preps: See below for standard CT • Pancreatitis without and with
Oral Contrast Preps. • Pseudocyst contrast (pancreatic
protocol 1st time)
• CT abdomen with 74160
contrast
Kidneys • Any renal pathology • CT abdomen 74170
Preps: See below for standard CT without and with
Oral Contrast Preps. contrast (kidney
www.radltd.com
protocol)
Note: Diagnosis for renal calculi-no
oral contrast needed, see below for
standard CT prep.
CT Urogram / CT IVP • Transitional cell carcinoma of • CT IVP or CT urogram 74178
Preps: See below for standard kidney and/or bladder
CT Preps. • Hematuria
CTA Abdomen & Run Off • Claudication • CTA abdomen and 75635
Preps: See below for standard • Peripheral Artery Disease (PAD) Run off
CT Preps.
Abdominal Aorta • Mesenteric ischemia • CTA abdomen 74175
Mesenteric Vessels • Renal artery stenosis
Renal Arteries • AAA • CTA abdomen and 74174
Stent • Crossing vessels pelvis
Preps: See below for standard • Stent obstruction / leak /
CT Preps.
malfunction
Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty
of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment.
Standard CT Oral Contrast Preps: At least one day prior to exam, patient needs pick up oral contrast at
any one of our locations. Further instructions will be given.
To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 16CT / CTA: Head and Spine
CT / CTA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Head / Brain • Alzheimer’s • CT head / brain without 70450
Preps: See below for standard • CVA contrast
CT preps. • Headache less than 7 days
• Hydrocephalus
• Memory loss, confusion
• Shunt check
• Stroke / bleed
• Trauma
Head / Brain • Headache more than 7 days • CT head / brain with 70460
Preps: See below for standard • HIV contrast
CT contrast preps. • Infection
• Mass / tumor
• Meningioma
• Meningitis
• Metastatic staging
• Seizures
• Toxoplasmosis
• Vertigo / dizziness / mastoiditis
CTA Brain • Aneurysm • CTA head / brain 70496
Preps: See below for standard • AVM (Arteriovenous Malformation) (reconstruction)
CT contrast preps. • Bruit
• CVA
• Stroke and/or
• TIA (If both ordered, please
• Vascular tumor authorize both codes)
CTA Neck, Carotid Artery • AVM (Arteriovenous Malformation) • CTA neck 70498
Preps: See below for standard • Bruit
CT contrast preps. • Carotid stenosis
• CVA
• Stroke
• TIA
• Vascular tumor
• Vertebrobasilar Insufficiency • CTA head, neck (please 70498,
authorize with both) 70496
Orbit • Foreign body • CT orbit without contrast 70480
Preps: See below for standard • Fracture
CT preps. • Trauma
Orbit • Cellulitis • CT orbit with contrast 70481
Preps: See below for standard • Exophthalmos
CT contrast preps. • Graves’ disease
• Mass
• Pain
• Pseudotumor
Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty
of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment.
17 Standard CT Contrast Preps: Nothing to eat two hours prior to exam. Drink plenty of water. Bring
insurance cards to appointment. Arrive 30 mins before exam.CT / CTA: Head and Spine
CT / CTA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Sinus / Face • Functional endoscopic sinus • CT sinus without 70486
Preps: See below for surgery contrast
standard CT preps. • Ostiomeatal complex
• Sinusitis
Sinus / Face • Mass or infection • CT sinus with contrast 70487
Preps: See below for
standard CT contrast preps.
Spine: Cervical • MR recommended for disc • CT cervical spine 72125
Preps: See below for herniation, mets, infection without contrast
standard CT preps. • Trauma, fracture, fusion
Spine: Cervical • Abscess or infection • CT cervical spine with 72126
Preps: See below for contrast
standard CT contrast preps.
Spine: Thoracic • MR recommended for disc • CT thoracic spine 72128
www.radltd.com
Preps: See below for herniation, mets, infection without contrast
standard CT preps. • Assess bony degenerative
changes
Spine: Thoracic • Abscess or infection • CT thoracic spine with 72129
Preps: See below for contrast
standard CT contrast preps.
Spine: Lumbar / Sacral • MR Recommended for disc • CT lumbar spine 72131
Preps: See below for herniation, mets, infection without contrast
standard CT preps. • Trauma, fracture, fusion, pars defect
Spine: Lumbar / Sacral • Abscess or infection • CT lumbar spine with 72132
Preps: See below for contrast
standard CT contrast preps.
Temporal Bone / IAC’s • Cholesteotoma • CT inner ears, temporal 70480
Preps: See below for • Trauma bones without contrast
standard CT preps.
Pituitary • MRI unless contraindicated • CT brain without and 70470
Preps: See below for with contrast
standard CT contrast preps.
Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty
of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment.
Standard CT Contrast Preps: Nothing to eat two hours prior to exam. Drink plenty of water. Bring
insurance cards to appointment. Arrive 30 mins before exam.
To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 18CT / CTA: Musculoskeletal
CT / CTA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Upper Extremity • All bone exams ordered • CT without contrast 73200
–Arm without contrast except upper extremity
–Forearm for tumor evaluations (mention part)
–Wrist Note: MRI preferred
–Hand
–Finger
Preps: See below for standard
CT preps.
Lower Extremity • All bone exams ordered • CT without contrast 73700
–Hip without contrast except lower extremity
–Thigh when evaluating for mass (mention part)
–Knee or infection Note: MRI preferred
–Calf
–Ankle/Foot
Preps: See below for standard
CT preps.
Extremities • Tumor / mass / cancer / • CT with contrast - upper 73201
Preps: See below for mets / infection • CT with contrast - lower 73701
standard CT contrast preps.
Ischemia • Peripheral artery disease • CTA upper extremity 73206
(lower extremity) • CTA lower extremity 73706
Arterial Stenosis
(lower extremity)
Preps: See below for
standard CT contrast preps.
Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty
of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment.
Standard CT Contrast Preps: Nothing to eat two hours prior to exam. Drink plenty of water. Bring
insurance cards to appointment. Arrive 30 mins before exam.
CT Chest Screening
for Lung Cancer
Early detection matters. The goal
of the CT lung cancer screening
program is to detect lung cancer
early, when it is easier to treat.
19 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377.CT / CTA: Specialty
CT / CTA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Colon • Failed colonoscopy • CT colonography 74263
Preps: At least three days • Patients taking blood thinners with 3D rendering Screening
prior to exam, patient needs who are not candidates for (virtual colonoscopy)
pick up cleanings prep at our routine colonoscopy 74261
Camp Lowell location. Further • Screening Diagnostic
Instructions will be given.
Renal smallArtery • Hypertension • CTA abdomen for 74175
(or Mesenteric Artery) • Renal artery stenosis renal arteries
Preps: See below for standard
CT Preps.
Small Intestine (bowel) • Crohn’s disease • CT enterography 74177
Preps: Arrive 90 mins before • Small bowel related issues
exam for oral prep given in –Abscess
office. Nothing to eat two –Bleeding sources
hours prior to arrival. Patient –Bowel obstruction
www.radltd.com
needs to stay near a restroom –Fistula
after completion of exam for –Inflammation
the remainder of the day. This –Tumor
exam causes a laxative effect.
Drink plenty of water.
Urinary Bladder • Bladder cancer • CT cystogram 72192
Preps: See below for standard • Bladder polyps (please authorize 51600
CT Preps. • Bleeding BOTH codes)
• Hydronephrosis
• Vesicoureteral reflux
CT Heart • Screening, hyperlipidemia • CT calcium score 75571
Preps: See below for standard without contrast
CT Preps.
CTA Heart • Abnormal echo • CTA coronary artery 75574
Preps: Must have a • Chest pain, sub tachycardia without and with
responsible driver to drive contrast
home. Nothing to eat or drink
four hours before exam. No
caffeine the day of the exam.
Arrival time provided at the
time of scheduling.
CT Chest Lung Cancer • Lung cancer screening • CT chest, low-dose, 71250
Screening lung cancer screening G0297
Preps: See below for standard must meet criteria (medicare)
CT Preps.
Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty
of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment.
To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 20CT / CTA: Specialty
CT / CTA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
Additional Information Required for
CT Lung Cancer Screening:
• Smokers age 55-80 who have smoked 30 pack years
• Former smokers 55-80 who quit less than 15 years ago and
smoked 30 pack years also
Packs/day (20 cigarettes/pack) x Years smoked = Pack Years*
*Pack year calculator: http://www.shouldiscreen.com/pack-year-calculator/
For Medicare patients, the following G code should be
used by provider for the shared decision-making visit:
• G0296 - Counseling visit to discuss need for lung cancer
screening (LDCT) using low-dose CT scan (service is for
eligibility determination and shared decision-making)
• Medicare will deny G0296 and G0297 for claims that do not
contain ICD-10 Z87.891, personal history of tobacco use/
personal history of nicotine dependence
21 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 20DEXA: Bone Densitometry
DEXA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
CLINICAL INDICATIONS PROCEDURE CODE
Post Menopause DEXA 77080 - hips,
Early Surgical Menopause spine (axial
Long-Term Current Use of Other Medication skeleton)
Long-Term Current Use of Steroid Treatment
Vertebral Abnormalities
Follow-Up Treatment for Prevention /
Monitoring of Osteoporosis
Preps: See below for standard DEXA preps.
DEXA with Vertebral Fracture Assessment DEXA + VFA 77085
Preps: See below for standard DEXA preps.
www.radltd.com
Vertebral Fracture Assessment DEXA (VFA) 77086
Preps: See below for standard DEXA preps.
DEXA Body Composition Study DEXA (BCS) 76499
Preps: See below for standard DEXA preps.
Standard DEXA Preps: No vitamins, calcium or mineral supplements the day of the exam.
Prescribed medications are permitted. No IV or oral contrast given prior to study. Avoid
clothing with metal. Arrive 30 mins prior to exam. Bring insurance cards along with doctors
order to appointment.
#StartAt40
Radiology Ltd. stands firmly
behind its recommendation
that women should receive yearly
mammograms starting at age 40 in
order to receive the maximum benefit
from breast cancer screening.
21 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 22CPT CODES for MRI SCANS
MRI / MRA
This is for reference only. This does not imply protocol standards for all radiology
facilities. Information is subject to change.
BRAIN
ORBIT, FACE & NECK
70551 - W/O CONTRAST
70540 - W/O CONTRAST
70552 - W/CONTRAST
70542 - W/CONTRAST
70553 - W/O & W/CONTRAST
70543 - W/O & W/CONTRAST
CERVICAL SPINE
72141 - W/O CONTRAST
TMJ 72142 - W/CONTRAST
70336 72156 - W/O & W/CONTRAST
CHEST
SHOULDER, ELBOW OR WRIST 71550 - W/O CONTRAST
(UPPER EXTREMITY, JOINT) 71551 - W/CONTRAST
73221 - W/O CONTRAST 71552 - W/O & W/CONTRAST
73222 - W/CONTRAST
73223 - W/O & W/CONTRAST BREAST
77059 - W/O & W/CONTRAST
HUMERUS, FOREARM OR NON-JOINT THORACIC SPINE
(UPPER EXTREMITY, NON-JOINT) 72146 - W/O CONTRAST
73218 - W/O CONTRAST 72147 - W/CONTRAST
73219 - W/CONTRAST 72157 - W/O & W/CONTRAST
73220 - W/O & W/CONTRAST
ABDOMEN
74181 - W/O CONTRAST
HIP, KNEE OR ANKLE 74182 - W/CONTRAST
(LOWER EXTREMITY, JOINT) 74183 - W/O & W/CONTRAST
73721 - W/O CONTRAST
73722 - W/CONTRAST
73723 - W/O & W/CONTRAST LUMBAR SPINE
72148 - W/O CONTRAST
72149 - W/CONTRAST
72158 - W/O & W/CONTRAST
THIGH, LOWER LEG OR FOOT
(LOWER EXTREMITY, NON-JOINT)
73718 - W/O CONTRAST PELVIS
73719 - W/CONTRAST 72195 - W/O CONTRAST
73720 - W/O & W/CONTRAST 72196 - W/CONTRAST
72197 - W/O & W/CONTRAST
23 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377.MRI / MRA: Brain
MRI / MRA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Brain • Alzheimer’s, confusion, dementia, • MRI brain without contrast 70551
Preps: See below for hydrocephalus, memory loss,
standard MRI Brain Preps. mental status changes
Brain • Headache • MRI brain without and with 70553
Preps: See below for standard • Pseudotumor contrast
MRI Brain Contrast Preps. • Seizures
• Tumor / mass / cancer / mets
• Vascular lesions
• All other reasons
Brain • Mass / tumor • MRI brain without and with 70553,
Preps: See below for standard • Metabolic abnormality contrast, with spectroscopy 76390
MRI Brain Contrast Preps. • Demyelinating disease
Brain NeuroQuant • Dementia • MRI Brain without contrast 70551,
Preps: See below for standard • Memory loss to include NeuroQuant 76377
MRI Brain Contrast Preps. • Seizures (3D volumetric analysis)
Brain / Orbits / Face • Exophthalmos, proptosis • MRI brain and orbits without and 70553
Preps: See below for standard • Graves’ disease with contrast (if patient has not 70543
MRI Brain Contrast Preps. had recent MRI brain, please add
www.radltd.com
MRI brain without & with contrast)
(please authorize BOTH codes)
Pituitary • Elevated prolactin • MRI brain without and with 70553
Preps: See below for contrast
standard MRI Brain Preps. Att: pituitary
Ear (IAC) Brain • Hearing loss • MRI brain without and with 70553
Preps: See below for standard contrast
MRI Brain Contrast Preps.
Cranial Nerve Series • Bell’s palsy • MRI brain without and 70553
Preps: See below for • Trigeminal neuralgia with contrast
standard MRI Brain Preps. Att: cranial nerves
MRV • Venous thrombosis • MRV without contrast 70544
–Brain
Preps: See below for
standard MRI Brain Preps.
TMJ • Internal derangement • MRI TMJ without contrast 70336
Preps: See below for standard • Joint dysfunction
MRI Brain Contrast Preps.
MRA • Stroke / CVA • MRA brain without contrast 70544
–Arch & Great Vessels • TIA
–Brain • Vertebrobasilar insufficiency
–Neck
Preps: See below for
standard MRI Brain Preps.
MRA • Stroke / CVA • MRA neck with contrast 70548
–Arch & Great Vessels • TIA (please authorize BOTH codes)
–Brain • Vertebrobasilar insufficiency
–Neck
Preps: See below for
standard MRI Brain Preps.
Standard MRI Brain Preps: Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam,
may be asked to change into gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment.
24
Standard MRI Brain Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup,
hairspray, jewelry, or metal. Depending on the exam, may be asked to change into gown or scrubs. Arrive 30 mins
before exam. Bring insurance card to appointment.MRI / MRA: Spine
MRI / MRA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Neck (soft tissue) • Infection • MRI neck without 70543
Preps: See below for • Pain and with contrast
standard MRI Contrast • Tumor / mass / cancer / mets
Preps. • Vocal cord paralysis
Spine: Cervical • Arm / shoulder pain and/or weakness • MRI cervical spine 72141
Preps: See below for • Chiari malformation without contrast
standard MRI Preps. • Degenerative disease
• Disc herniation
• Neck pain
• Post-op fusion radiculopathy
Spine: Cervical • Discitis • MRI cervical spine 72156
Preps: See below for • Multiple sclerosis without and with
standard MRI Contrast • Myelopathy contrast
Preps. • Osteomyelitis
• Syrinx
• Tumor / mass / cancer / mets
• Vascular lesions, AVM
Spine: Thoracic • Back pain • MRI thoracic 72146
Preps: See below for • Compression fx (with hx of malig / mets) spine without
standard MRI Preps. • Degenerative disease contrast
• Disc herniation
• Radiculopathy
• Trauma
• Vertebroplasty planning (with hx of no malig)
Spine: Thoracic • AVM • MRI thoracic 72157
Preps: See below for • Compression fx (with hx of malig / mets) spine without
standard MRI Contrast • Discitis and with contrast
Preps. • Multiple sclerosis
• Myelopathy
• Osteomyelitis
• Syrinx
• Tumor / mass / cancer / mets
• Vascular lesions
• Vertebroplasty planning (with hx of malig)
Standard MRI Preps: Depending on the exam, may be asked to change into gown or scrubs.
Arrive 30 mins before exam. Bring insurance card to appointment.
MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye
makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a
gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment.
25 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 24MRI / MRA: Spine
MRI / MRA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Spine: Lumbar • Back pain • MRI lumbar spine 72148
Preps: See pg. 32 for • Compression fx (with hx of no malig / mets) without contrast
standard MRI Preps. • Degenerative disease
• Disc herniation
• Radiculopathy
• Sacrum / SI joints
• Sciatica
• Spondylolisthesis
• Stenosis
• Trauma
• Vertebroplasty planning (with hx of no malig) 72195
Sacrum / SI joints • When including sacurm/SI joints • MRI lumbar spine 72148,
Preps: See pg. 32 for to Include sacrum/SI 72195
standard MRI Preps. joints (please authorize
BOTH codes)
Spine: Lumbar • Compression fx (with hx of malig / mets) • MRI lumbar spine 72158
Preps: See pg. 32 • Discitis without and with
• Osteomyelitis
www.radltd.com
for standard MRI contrast
Contrast Preps. • Post-op
• Tumor / mass / cancer / mets
• Vertebroplasty (with hx of malig)
MRI: Breast
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Breast (pre-operative • Recent diagnosis of breast cancer • Bilateral breast MRI 77059
staging) (and chest MRI, if (71552)
Preps: See below for standard necessary)
MRI Breast Preps.
Breast (high risk screening) • High risk breast cancer screening • Bilateral breast MRI 77059
Preps: See below for standard
MRI Breast Preps.
Breast (silicone implants) • Suspected silicone implant leak • Bilateral breast 77059
Preps: See below for standard • Palpable lump MRI in addition to
MRI Breast Preps. • Pain “implant protocol”
Breast (indeterminate • Further evaluation of • Bilateral breast MRI 77059
clinical or imaging results) indeterminate clinical or
Preps: See below for standard imaging results (radiologist
MRI Breast Preps. recommendation)
Follow-up for • Follow-up for neo-adjuvant • Bilateral breast MRI 77059
Chemotherapy Treatment chemotherapy
Preps: See below for standard
MRI Breast Preps.
Please note: Breast MRI does not replace screening mammography.
25 Standard BREAST MRI Preps: Drink plenty of fluids day before exam, nothing to eat two hours prior to exam. Do not wear 26
hairspray, deodorant, jewelry, metal or eye makeup. Arrive 30 mins before exam. Bring insurance card to appointment.MRI / MRA: Chest, Abdomen, and Pelvis
MRI / MRA
This is for reference only. This does not imply protocol standards for all radiology
facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Chest Mediastinum • Tumor / mass / cancer / mets • MRI chest without 71552
Preps: See below for standard and with contrast
MRI Contrast Preps.
Heart • Congenital defect and heart • MRI heart 75557
Preps: See below for standard valve issues &
MRI Contrast Preps. • Past MI - other cardiac issues 75561
Brachial Plexus • Brachial plexus injury • MRI chest / 71552
Preps: See below for standard • Nerve avulsion mediastinum
MRI Contrast Preps. • Tumor / mass / cancer / mets without and with
contrast (specify
brachial plexus)
Abdomen • Adrenal • MRI abdomen 74181
Preps: Nothing to eat six hours • MRCP (biliary / pancreatic ducts) without contrast
prior to exam, fluid will interfere (MRCP)
with the exam. Avoid wearing • Kidney eval • MRI abdomen 74183
jewelry or metal. Will be asked to • Liver eval without and with
change into a gown or scrubs. • Pancreas eval contrast
Arrive 30 min before exam. Bring • All other reasons
insurance card to appointment.
Abdomen • AAA (Abdominal Aortic Aneurysm) • MRA abdomen 74185
Preps: Nothing to eat six hours • Abdominal aorta dissection
prior to exam, fluid will interfere • Mesenteric ischemia
with the exam. Avoid wearing • Renal artery stenosis
jewelry or metal. Will be asked to • Pre liver transplant • Order 2 exams:
change into a gown or scrubs. • Pre kidney transplant –MRA 74185
Arrive 30 min before exam. Bring • Renal mass-evaluation / pre-op abdomen
insurance card to appointment. AND
–MRI abdomen 74183
without and
with contrast
(please authorize
BOTH codes)
Standard MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup,
hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30
mins before exam. Bring insurance card to appointment.
Radiology Ltd. Offers 3T MRI!
This technology provides clinical advantages for certain exams like
prostate, abdominal imaging, small joints, and research studies.
This machine is centrally located at our Camp Lowell site.
27 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 26MRI / MRA: Chest, Abdomen, and Pelvis
MRI / MRA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Enterography • Crohn’s disease • MRI enterography 74183
Preps: Arrive 90 minutes • Inflammatory bowel disease without and with 72197
before exam. Nothing to eat contrast
six hours prior to exam. Avoid
wearing jewelry or metal. Will
be asked to change into a
gown or scrubs. Stay near a
restroom after completion of
exam for remainder of the day.
This exam causes a laxative
affect. Bring insurance card to
appointment.
Pelvis • Adenomyosis • MRI pelvis without 72195
Preps: See below for standard • Fracture contrast
MRI Contrast Preps. • Muscle / tendon tear
• Pelvic organ prolapse • MRI dynamic pelvis 72195
www.radltd.com
• Pelvic floor dysfunction
• Outlet obstruction
• Incontinence
• Abscess • MRI pelvis without 72197
• Fibroid and with contrast
• Osteomyelitis
• Pre / post fibroid embolization
• Septic arthritis
• Tumor / mass / cancer / mets
• Urethral diverticulum
Urogram • Hematuria - congenital • MRI urogram 74183
Preps: Nothing to eat four abnormalities &
hours prior to exam. Avoid • Urinary tract obstruction 72197
wearing jewelry or metal. Will
be asked to change into a
gown or scrubs. Arrive 30 mins
before exam. Bring insurance
card to appointment.
Prostate • Benign prostatic hyperplasia (BPH) • MRI prostate 72197
Preps: See below for standard • Enlarged prostate (best on 3T scanner)
MRI Contrast Preps. • Evaluation of prostate cancer • MRI prostate with 76377
• Infection (prostatitis) multiparmetric
• Prostate abscess reconstructions
Standard MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup,
hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30
mins before exam. Bring insurance card to appointment.
27 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 28MRI: Musculoskeletal
MRI / MRA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Arm • Fracture • MRI - non joint
Hand • Muscle / tendon tear without contrast
Leg • Stress Fracture –Upper extremity 73218
Foot –Lower extremity 73718
Preps: See below for
standard MRI Preps.
Arm • Abscess • MRI - non joint
Hand • Arthritis (special protocol - please specify) without
Leg • Bone tumor / mass / cancer / mets and with contrast 73220
Foot • Cellulitis –Upper extremity 73720
Preps: See below • Fasciitis –Lower extremity
for standard MRI • Myositis
Contrast Preps. • Morton’s neuroma
• Osteomyelitis
• Soft tissue tumor / mass / cancer / mets
• Ulcer
Shoulder • Joint pain (specify joint) • MRI - joint without
Elbow • Internal derangement, labral tear, ligament contrast
Wrist tear, meniscal tear –Upper extremity 73221
Finger • Articular cartilage injury –Lower extremity 73721
Hip • Osteochondritis dissecans (OCD)
Knee • Stress fracture / fracture
Ankle • Avascular necrosis (AVN)
Toe • Tendinosis / tendon tear
Preps: See below for • Plantar fasciitis
standard MRI Preps. • Muscle strain
Shoulder • Infection • MRI lower extremity
Elbow • Tumor / mass / cancer / mets - joint without and
Wrist • Inflammatory arthritis with contrast
Finger • Myositis –Upper extremity 73223
Hip –Lower extremity 73723
Knee
Ankle
Toe
Preps: See below
for standard MRI
Contrast Preps.
Standard MRI Preps: Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30
mins before exam. Bring insurance card to appointment.
Standard MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup,
hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30
mins before exam. Bring insurance card to appointment.
29 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 28MRI: Musculoskeletal (including Arthrography)
MRI / MRA
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART COMMON REASON FOR EXAM PROCEDURE CODE
Scapula (not included • Pain • MRI chest without and 71552
in shoulder) • Mass with contrast
Preps: See below for
standard MRI Contrast
Preps.
MRI Arthrography • Labral tear • MRI joint with contrast
–Shoulder • TFCC/tear scapholunate - order with 3 codes:
–Elbow ligament 1–Upper extremity 73222
–Wrist • Loose bodies with contrast OR
–Hip • OCD lower extremity 73722
–Knee • Post-op meniscus evaluation with contrast
–Ankle 2–Fluoro guided 77002
Preps: See below for arthrogram
standard MRI Contrast 3–Choose body part:
Preps. –Shoulder 23350 & 73040
–Elbow 24220 & 73085
www.radltd.com
–Wrist 25246 & 73115
–Hip 27093 & 73525
–Knee 27370 & 73580
–Ankle 27648 & 73615
Standard MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup,
hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30
mins before exam. Bring insurance card to appointment.
Radiology Ltd. offers a better choice in
open MRI called Espree X-Large MRI.
The open design of the Magnetom Espree accommodates
29 patients of all sizes and helps eliminate anxiety and claustrophobia. 30PET / CT: Scheduling Checklist
PET / CT
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
Please include the following with ALL PET/CT orders:
Order for exam requested:
PET/CT Whole Body (78816) PET/CT Bone Scan
(Diagnosis: Melanoma, Myeloma, w/Sodium Fluoride
Sarcoma & Merkel Cell Carcinoma (78816)
Cutaneous Lymphoma)
PET/CT Brain (78608)
PET/CT Skull Base to Mid-Thigh PET/CT Myocardium
(78815) (All other diagnosis) (78459)
Indicate if for:
q Staging
q Re-staging
q History of
Diagnosis
Clinical history / progress notes
Copy of patients insurance card(s)
Patient demographics
If prior imaging studies were not performed at Radiology Ltd.,
please include any additional reports listed below:
Biopsy
CT
MR
PET
Pathology
Please fax any additional notes to:
Interventional Scheduling Department at (520) 545-1898
31 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377.PET / CT: General
PET/CT
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
BODY PART REQUESTED TEXT CODE
Skull Base to Mid-Thigh • PET / CT skull base to mid-thigh (all other diagnoses) 78815
Whole Body • PET / CT whole body (diagnosis: Melanoma, Myeloma, 78816
Sarcoma, & Merkel Cell Carcinoma, Cutaneous Lymphoma)
Brain • PET / CT brain 78608
Myocardium • PET / CT myocardium 78459
(cannot be done if patient is diabetic)
PET / CT: Bone Scan
This is for reference only. This does not imply protocol standards
www.radltd.com
for all radiology facilities. Information is subject to change.
BODY PART REQUESTED TEXT CODE
Breast • PET / CT bone scan with sodium fluoride 78816
Lung (Sodium fluoride PET bone scans are not covered by Medicare.)
Prostate
Thyroid
PET/CT Imaging
Our PET services are centrally
located at our Camp Lowell site.
To schedule a PET exam, please
call (520) 545-1906, opt. 3.
To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 32ULTRASOUND: General
ULTRASOUND
This is for reference only. This does not imply protocol standards
for all radiology facilities. Information is subject to change.
TYPE OF EXAM COMMON INDICATIONS PROCEDURE CODE
Ultrasound of the Abdomen is • Abdominal pain (specify right • Abdominal 76700
imaging using sound waves to or left upper quadrant or ultrasound
produce pictures of the structures epigastric region)
within the abdomen (belly button • Abnormal LFT’s
up). It is used to help evaluate the • Cirrhosis
liver, kidneys, gallbladder, pancreas, • Hepatitis C
spleen and aorta. • Hepatomegaly
• Polycystic disease
Preps: Eat a low fat meal the • Splenomegaly
evening before, nothing to eat
or drink anything after midnight.
Prescribed medications are
permitted. Arrive 30 mins before
exam. Bring insurance card and
doctor’s orders.
Pelvis Ultrasound is imaging • Endometriosis • Transabdominal 76856
using sound waves to produce • Fibroids / enlarged uterus only
pictures of structures and organs • Groin (MSK/extremity)
in the pelvis (belly button down). • IUD • Pelvic 76856
It is used to evaluate the uterus • Menstrual disorders ultrasound Trans
and ovaries. Radiology Ltd.’s • Ovarian cysts complete Abdominal
preferred protocol is to perform • PCOS (transabdominal
both the Transabdominal and • Pelvic pain (relating specifically and transvaginal 76830
Transvaginal scans as these to uterus or ovaries; ultrasound - preferred) Trans
will give the most detailed is not the exam of choice for
information. If only one study is intestinal disorders) • Transvaginal Vaginal
perferred, our recommendation is only 76830
to order a transvaginal scan. Note • Examples of single organ • Pelvic limited 76857
that Transvaginal scans are not
performed on virgins.
Preps: 1.5 hours before
appointment, empty bladder. Next
30 minutes, drink 32oz of water.
Finish drinking one hour before
appointment. A full bladder is
required. If bladder is not full, may
delay exam. Arrive 30 mins before
exam. Bring insurance card, and
doctor’s orders.
Child Preps:
Ages 3-5: 8oz of water
Ages 6-10: 16oz of water
Ages 11+: 32oz of water
33 To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377.You can also read
