Guidelines for Ordering Common CT/CTA & MRI/MRA
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Guidelines for Ordering Common CT/CTA & MRI/MRA Body Imaging Gastrointestinal CT CLINICAL GUIDELINES Abdominal mass Abdominal pain Abscess Appendicitis Biliary ductal dilatation Cancer staging Cirrhosis Common bile duct stone Constipation Crohn's disease, inflammatory bowel disease Diarrhea Diverticulitis, LLQ pain Hemochromatosis Hepatitis Liver function test elevation Liver hemangioma, cyst Lymphoma Lymphadenopathy Pancreatic mass Pancreatitis Small bowel obstruction Weight loss EXAM DESCRIPTION CT Abdomen & Pelvis w CT Abdomen & Pelvis w CT Abdomen & Pelvis w CT Abdomen & Pelvis w CT Abdomen & Pelvis w CT Abdomen w CT Abdomen w & wo CT Abdomen w & wo CT Abdomen & Pelvis w CT Enterography/Small Bowel CT Abdomen & Pelvis w CT Abdomen & Pelvis w CLINICAL GUIDELINES Adrenal adenoma /mass/cyst Bladder cancer, suspected Cancer staging Flank pain, renal colic Hematuria (CT Urogram, CT IVP) Hematuria (suspect mass) Hematuria (suspect stone) Hydronephrosis, work up Renal calculus Renal cyst Renal mass or complex cyst EXAM DESCRIPTION CT Abdomen w & wo CT Abdomen & Pelvis w CT Abdomen & Pelvis w CT Abdomen & Pelvis wo MRI CT/CTA CPT CODES 74177 74177 74177 74177 74177 74160 74170 74170 74177 74177 & 76376 74177 74177 CT Abdomen w & wo CT Abdomen w & wo CT Abdomen w & wo CT Abdomen & Pelvis w CT Abdomen & Pelvis w CT Abdomen w & wo CT Abdomen w & wo CT Abdomen & Pelvis w CT Abdomen & Pelvis w 74170 74170 74170 74177 74177 74170 74170 74177 74177 Genitourinary EXAM DESCRIPTION MRI Abdomen w & wo MRI Abdomen w & wo MRI Abdomen w & wo MRI Abdomen and Pelvis w & wo MRI Abdomen w & wo MRCP MRI Abdomen w & wo MRI Abdomen w & wo (attn liver) MRI Abdomen w & wo MRCP MRI/MRA CPT CODES 74183 74183 74183 74183 & 72197 74183 & 76376 74183 74183 74183 & 76376 MRI Abdomen w & wo (attn liver) MRI Abdomen w & wo (attn liver) MRI Abdomen w & wo (attn liver) MRI Abdomen w & wo (attn liver) 74183 74183 74183 74183 MRI Abdomen w & wo MRI Abdomen w & wo 74183 74183 CT CT Hematuria Protocol - CT/IVP w & wo CT Hematuria Protocol - CT/IVP w & wo CT Hematuria Protocol - CT/IVP w & wo CT Abdomen & Pelvis w and/or wo CT Abdomen & Pelvis wo CT Abdomen w & wo CT Abdomen w & wo MRI CT/CTA CPT CODES 74170 74177 74177 74176 74178 74178 74178 74178 74176 74170 74170 EXAM DESCRIPTION MRI Abdomen w & wo MRI/MRA CPT CODES 74183 MRI Abdomen w & wo 74183 MRI Abdomen and Pelvis w & wo MRI Abdomen w & wo (attn kidney) 74183 & 72197 74183 MRI Abdomen w & wo (attn kidney) MRI Abdomen w & wo (attn kidney) 74183 74183 "w" indicates with IV contrast, "wo" indicates without IV contrast These are general guidelines to assist in requesting exams by common diagnoses. Please consult with ARA radiologists as needed for clarification or further assistance @ 512-454-5641. Guidelines for Ordering Common CT/CTA & MRI/MRA Pelvis CT CLINICAL GUIDELINES Adenomyosis Cancer staging Complex adnexal cysts Cysts Dermoid Endometriosis Pelvic mass, origin uncertain Uterine fibroid MRI EXAM DESCRIPTION CT/CTA CPT CODES CT Abdomen & Pelvis w 74177 CT Pelvis w 72193 EXAM DESCRIPTION MRI Pelvis w & wo MRI Pelvis w & wo MRI Pelvis w & wo MRI Pelvis w & wo MRI Pelvis w & wo MRI Pelvis w & wo MRI Pelvis w & wo MRI Pelvis w & wo MRI/MRA CPT CODES 72197 72197 72197 72197 72197 72197 72197 72197 Pulmonary CT CLINICAL GUIDELINES Asbestosis Bronchiectasis Cancer staging Chest wall mass Compex pleural effusion COPD Hilar fullness Intersitial lung disease Lung mass, suspected Lung nodules Mediastinal adenopathy Mediastinal mass Sarcoidosis EXAM DESCRIPTION CT Chest wo Chest for Interstitial Lung Disease, High resolution (CT Chest wo) CT Chest w CT Chest w CT Chest w Chest for Interstitial Lung Disease, High resolution (CT Chest wo) CT Chest w Chest for Interstitial Lung Disease, High resolution (CT Chest wo) CT Chest w CT Chest wo CT Chest w CT Chest w & wo Chest for Interstitial Lung Disease with contrast, High resolution (CT Chest w) MRI CT/CTA CPT CODES 71250 71250 71260 71260 71260 EXAM DESCRIPTION MRI/MRA CPT CODES MRI Chest w & wo 71552 MRI Chest w & wo 71552 71250 71260 71250 71260 71250 71260 71270 71260 Cardiac CT CLINICAL GUIDELINES Aortic dissection Cardiac anomalies Coronary artery anomalies Coronary artery disease Coronary artery disease + LV/RV cardiac function Pericardial disease Pulmonary vein mapping, pre ablation MRI EXAM DESCRIPTION CT Chest w & wo CT/CTA CPT CODES 71270 CTA Coronary w & wo Include 3 D CTA Coronary w & wo Include 3 D CTA Coronary w & wo Include 3 D CT Chest w CTA Heart Morphology 75574 75574 75574 71260 75572 EXAM DESCRIPTION MRI Chest w & wo MRI Chest wo MRI/MRA CPT CODES 71552 71551 MRI Chest w & wo 71552 "w" indicates with IV contrast, "wo" indicates without IV contrast These are general guidelines to assist in requesting exams by common diagnoses. Please consult with ARA radiologists as needed for clarification or further assistance @ 512-454-5641. Guidelines for Ordering Common CT/CTA & MRI/MRA Vascular CT CLINICAL GUIDELINES Abdominal aortic aneurysm (AAA), suspected Abdominal aortic aneurysm (AAA), known Aortic dissection, Thoracic Carotid bruit Carotid stenosis/occlusion Claudication Cold feet Foot ulcer Hypertension, malignant Leg edema Peripheral vascular disease legs Pre-op or post-op stent graft Renal artery stenosis Coronary Artery Disease Thoracic aortic aneurysm EXAM DESCRIPTION CT Angiography Abdomen & Pelvis CT Angiography Abdomen & Pelvis CT Angiography Chest CT Angiography Carotid/Neck CT Angiography Carotid/Neck CT Angiography Abdomen, Pelvis, Lower Ext w runoff CT Angiography Abdomen, Pelvis, Lower Ext w runoff CT Angiography Abdomen, Pelvis, Lower Ext w runoff CT Angiography Renal (Abdomen) w & wo Contrast CT Angiography Abdomen & Pelvis CT Angiography Abdomen, Pelvis, Lower Ext w runoff AAA/Endograft CT Angiography Renal (Abdomen) w & wo Contrast CT Angiography Coronary CT Angiography Chest CT/CTA CPT CODES 74174 74174 71275 70498 70498 75635 75635 75635 74175 74174 75635 74174 74175 75574 71275 MRI EXAM DESCRIPTION MRA Abdomen w or wo MRA Abdomen w or wo MRA Chest w or wo MRA Neck w & wo MRA Neck w & wo MRA Abdomen w & wo and MRA Lower Ext w & wo MRA Abdomen w & wo and MRA Lower Ext w & wo MRA Abdomen w & wo and MRA Lower Ext w & wo MRA Abdomen w or wo MRI/MRA CPT CODES 74185 74185 71555 70549* 70549* 74185 & 73725 * 74185 & 73725 * 74185 & 73725 * 74185 MRA Abdomen w & wo and MRA Lower Ext w & wo 74185 & 73725 * MRA Abdomen w or wo 74185 MRA Chest w or wo 71555 "w" indicates with IV contrast, "wo" indicates without IV contrast These are general guidelines to assist in requesting exams by common diagnoses. Please consult with ARA radiologists as needed for clarification or further assistance @ 512-454-5641. Guidelines for Ordering Common CT/CTA & MRI/MRA Neurological Imaging Head and Neck CT CLINICAL GUIDELINES Abscess AVM, vascular malformation Breast discharge Cancer staging, Brain Cancer staging, Neck Carotid stenosis/occlusion Sinus congestion/drainage Chronic sinusitis Change in mental status Cranial neuropathy Dementia Dizziness, syncope Dizziness, syncope with cancer history Headache, acute onset Headache, acute onset with cancer history Migraines Migraines with cancer history Headaches, subacute or chronic Diplopia Family history intracranial aneurysm Fracture - facial, orbital Glioma Hearing loss, conductive Hearing loss, sensorineural Hoarseness Intracerebral artery stenosis/occlusion Intracranial hemorrhage, acute Lyme disease Mastoiditis Meningeal disease Meningioma Metastasis Multiinfarct state Multiple sclerosis, diagnosed Multiple sclerosis, suspected MRI EXAM DESCRIPTION CT/CTA CPT CODES CT Soft tissue neck w CT Angiography Carotid/Neck CT Limited sinus wo CT Complete sinus wo CT Brain wo 70491 70498 70486-52 70486 70450 CT Brain wo CT Brain w & wo 70450 70470 CT Angiography Brain/Head CT Maxillofacial Bones wo 70496 70486 CT Temporal Bones wo 70480 CT Soft tissue neck w CT Angiography Brain/Head CT Brain wo 70491 70496 70450 CT Temporal Bones w 70481 EXAM DESCRIPTION MRI Brain w & wo MRI Brain w & wo and MRA Head w MRI Brain w & wo (Attention to Pituitary) MRI Brain w & wo MRI Orbit, Face, & Neck w & wo MRA Neck w & wo MRI/MRA CPT CODES 70553 70553 & 70545 70553 70553 70543 70549 MRI Brain w & wo MRI Brain w & wo and MRI Orbit , Face, Neck w & wo 70553 MRI Brain wo MRI Brain wo MRI Brain w & wo MRI Brain wo MRI Brain w & wo MRI Brain wo MRI Brain w & wo MRI Brain wo MRI Brain w & wo and MRI Orbit , Face, Neck w & wo 70553 & 70543 70551 70551 70553 70551 70553 70551 70553 70551 MRI Brain w & wo 70553 & 70543 70553 MRI Brain w & wo 70553 MRI Brain w & wo (Attn to Internal Auditory Canal) 70553 MRA Brain w 70545 MRI Brain w & wo 70553 MRI Brain w & wo MRI Brain w & wo MRI Brain w & wo MRI Brain w & wo MRI Brain w & wo MRI Brain w & wo 70553 70553 70553 70553 70553 70553 "w" indicates with IV contrast, "wo" indicates without IV contrast These are general guidelines to assist in requesting exams by common diagnoses. Please consult with ARA radiologists as needed for clarification or further assistance @ 512-454-5641. Guidelines for Ordering Common CT/CTA & MRI/MRA Head and Neck CT CLINICAL GUIDELINES Neck lymphadenopathy Neck mass or cyst Optic neuritis Parkinson's disease Pituitary adenoma/microadenoma Prolactin, increased Salivary gland stone or mass Seizures Stroke, acute Subarachnoid hemorrhage Subdural hematoma TIA Tinnitus (ringing in ears) Trauma, acute Trauma, subacute or chronic Vertigo Visual disturbance Visual field defect EXAM DESCRIPTION CT Soft tissue neck w CT Soft tissue neck w CT/CTA CPT CODES 70491 70491 CT Soft tissue neck w & wo 70492 CT Brain wo CT Brain wo CT Brain wo CT Brain wo CT Temporal bones wo CT Brain wo CT Brain wo 70450 70450 70450 70450 70480 70450 70450 MRI EXAM DESCRIPTION MRI Orbit, Face, & Neck w & wo MRI Orbit, Face, & Neck w & wo MRI Brain w & wo and MRI Orbit , Face, Neck w & wo MRI/MRA CPT CODES 70543 70543 70553 & 70543 MRI Brain w & wo MRI Pituitary (Brain w & wo) MRI Pituitary (Brain w & wo) 70553 70553 70553 MRI Brain w & wo MRI Brain w & wo 70553 70553 MRI Brain w & wo MRI Brain w & wo MRI IACs (Brain w & wo) 70553 70553 70553 MRI Brain w & wo MRI IACs (Brain w & wo) MRI Brain w & wo and MRI Orbit , Face, Neck w & wo 70553 70553 70553 & 70543 MRI Brain w & wo and MRI Orbit , Face, Neck w & wo 70553 & 70543 "w" indicates with IV contrast, "wo" indicates without IV contrast These are general guidelines to assist in requesting exams by common diagnoses. Please consult with ARA radiologists as needed for clarification or further assistance @ 512-454-5641. Guidelines for Ordering Common CT/CTA & MRI/MRA Spine CT MRI EXAM DESCRIPTION MRI Lumbar spine w & wo MRI Cervical wo MRI Cervical wo MRI Lumbar spine w & wo MRI Lumbar spine w & wo MRI Lumbar spine w & wo MRI Cervical wo, Thoracic wo or Lumbar wo MRI/MRA CPT CODES 72158 72141 72141 72158 72158 72158 72141, 72146 or 72148 MRI Cervical wo, Thoracic wo or MRI Lumbar wo MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72141, 72146 or 72148 72156, 72157, or 72158 MRI Cervical wo, Thoracic wo or Lumbar wo MRI Lumbar spine wo MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72141, 72146 or 72148 72148 72156, 72157, or 72158 MRI Thoracic spine wo 72146 Multiple sclerosis, diagnosed MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72156, 72157, or 72158 Multiple sclerosis, suspected MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72156, 72157, or 72158 MRI Cervical wo, Thoracic wo or Lumbar wo MRI Cervical spine wo MRI Lumbar spine wo MRI Cervical spine wo MRI Lumbar spine wo MRI Cervical spine wo MRI Cervical spine wo MRI Lumbar spine w & wo MRI Lumbar spine wo MRI Thoracic spine w & wo MRI Thoracic spine wo MRI Cervical wo, Thoracic wo or Lumbar wo MRI Cervical w & wo or Thoracic spine w & wo MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72141, 72146 or 72148 72141 72148 72141 72148 72141 72141 72158 72148 72157 72146 72141, 72146 or 72148 72156 or 72157 72156, 72157, or 72158 Spinal stenosis Syrinx MRI Cervical wo, Thoracic wo or Lumbar wo MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72141, 72146 or 72148 72156, 72157, or 72158 Transverse myelitis MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72156, 72157, or 72158 CLINICAL GUIDELINES Cauda equina lesion Cervical rotation, decreased Chiari malformation Disc vs scar (epidural fibrosis) Discitis, lumbar Epidural abscess Fracture Fracture, sacrum or coccyx Herniated disc Intradural extramedullary lesion EXAM DESCRIPTION CT/CTA CPT CODES CT Cervical spine wo 72125 CT Cervical, Thoracic or Lumbar spine wo CT Pelvis wo CT Lumbar spine wo 72125,72128 or 72131 72192 72131 Leg weakness Low back pain Metastasis CT Lumbar spine wo 72131 Mid back pain *If MRI contraindicated; CT Thoracic spine and Bone Scan Myelopathy Neck pain Numbness, leg Numbness, shoulder or arm Pain, leg Pain, shoulder or arm Prior surgery, cervical Prior surgery, lumbar (less than 10 years) Prior surgery, lumbar (greater than 10 years) Prior surgery, thoracic (less than 10 years) Prior surgery, thoracic (greater than 10 years) Radiculopathy Spinal cord ischemia Spinal cord lesion CT Cervical spine wo CT Lumbar spine wo 72125 72131 CT Lumbar spine wo 72131 "w" indicates with IV contrast, "wo" indicates without IV contrast These are general guidelines to assist in requesting exams by common diagnoses. Please consult with ARA radiologists as needed for clarification or further assistance @ 512-454-5641. Guidelines for Ordering Common CT/CTA & MRI/MRA Musculoskeletal CT MRI EXAM DESCRIPTION MRI Lower Ext JT wo or MRI Upper Ext JT wo MRI Lower or Upper Ext other than JT wo MRI Lower Ext JT wo or MRI Upper Ext JT wo MRI Lower Ext JT wo or MRI Upper Ext JT wo MRI Lower Ext JT wo or MRI Upper Ext JT wo MRI Lower or Upper Ext other than JT wo MRI Lower Ext JT wo or MRI Upper Ext JT wo MRI Lower Ext JT wo MRI Lower Ext JT w MRI/MRA CPT CODES (L)73721 or (U)73221 (L)73718 or (U)73218 (L)73721 or (U)73221 (L)73721 or (U)73221 (L)73721 or (U)73221 (L)73718 or (U)73218 (L)73721 or (U)73221 73721 73722 Labral tear, shoulder Labral tear, shoulder, consider arthrogram if post surgery MRI Upper Ext JT wo MRI Upper Ext JT w 73221 73222 Ligamentous tear, wrist, consider arthrogram Meniscal, ligamentous tear knee Muscle injury, joint Muscle injury, non joint Osteoarthritis Osteochondral defect, joint Osteomyelitis, joint Osteomyelitis, non joint Rheumatoid arthritis, Inflammatory arthritis, Inflammatory arthropathy, Synovitis Rotator cuff tear Rotator cuff tear, consider arthrogram if post surgery MRI Upper Ext JT w MRI Lower Ext JT wo MRI Lower Ext JT wo or MRI Upper Ext JT wo MRI Lower or Upper Ext other than JT wo MRI Lower Ext JT wo or MRI Upper Ext JT wo MRI Lower Ext JT wo or MRI Upper Ext JT wo MRI Lower or Upper Ext JT w & wo MRI Lower or Upper Ext other than JT w & wo MRI Lower or Upper Ext JT w & wo 73222 73721 (L)73721 or (U)73221 (L)73718 or (U)73218 (L)73721 or (U)73221 (L)73721 or (U)73221 (L)73723 or (U)73223 (L)73720 or (U)73220 (L)73723 or (U)73223 MRI Upper Ext JT wo MRI Upper Ext JT w 73221 73222 MRI Lower or Upper Ext JT w & wo MRI Lower or Upper Ext other than JT w & wo MRI Lower Ext JT wo or MRI Upper Ext JT wo MRI Upper Ext JT wo (L)73723 or (U)73223 (L)73720 or (U)73220 (L)73721 or (U)73221 73221 CLINICAL GUIDELINES Bone contusion, joint Bone contusion, non joint Bursitis DJD Fracture, joint Fracture, non joint Joint effusion Labral tear, hip Labral tear, hip, consider arthrogram if post surgery Soft tissue mass or bony lesion, joint Soft tissue mass or bony lesion, non joint Tendon tear or injury Triangular fibrocartilage tear (wrist) EXAM DESCRIPTION CT/CTA CPT CODES CT Lower or Upper Extremity wo CT Lower or Upper Extremity wo (L)73700 (U)73200 (L)73700 (U)73200 CT Lower or Upper Extremity w & wo CT Lower or Upper Extremity w & wo (L)73702 (U)73202 (L)73702 (U)73202 "w" indicates with IV contrast, "wo" indicates without IV contrast These are general guidelines to assist in requesting exams by common diagnoses. Please consult with ARA radiologists as needed for clarification or further assistance @ 512-454-5641.
