BWC15-460 (04/15) BWC15-460

Washington University’s Mallinckrodt Institute of Radiology. of Institute Mallinckrodt University’s Washington

All exams are read by subspecialized radiologists from from radiologists subspecialized by read are exams All

Outpatient CT appointments are available 7 a.m. - 6:30 p.m. Monday-Friday and 8 a.m. - 1 p.m. on Saturdays. on p.m. 1 - a.m. 8 and Monday-Friday p.m. 6:30 - a.m. 7 available are appointments CT Outpatient

For questions regarding how to order any of the CT scans, please call radiologist at 314-996-8514 or CT Department 314-996-8428. Department CT or 314-996-8514 at radiologist call please scans, CT the of any order to how regarding questions For

• Tumor (if contraindication to MRI) to contraindication (if Tumor •

gadolinium allergy or extreme claustrophobia extreme or allergy gadolinium

50 mg PO to be taken 1 hour prior to exam. to prior hour 1 taken be to PO mg 50

• Arthrogram for labral or chondral injuries in patients with adjacent metal, metal, adjacent with patients in injuries chondral or labral for Arthrogram •

(optional): (optional): • Diphenhydramine (Benadryl) Diphenhydramine

• Infection (if concern for septic joint should be aspirated prior to CT) to prior aspirated be should joint septic for concern (if Infection •

50 mg PO (four doses total) to be taken 19 hours, 13 hours, 7 hours and 1 hour prior to appointment. to prior hour 1 and hours 7 hours, 13 hours, 19 taken be to total) doses (four PO mg 50

Hip CT W Contrast ...... CPT Code 73701 Code CPT ...... Contrast W CT Hip

: : • Prednisone

Premedication Protocol Premedication • Hip fracture Hip •

• Hip pain Hip •

and/or premedication is ordered. ordered. is premedication and/or

Hip CT W/O Contrast ...... CPT Code 73700 Code CPT ...... Contrast W/O CT Hip

• Patients with anaphylaxis or laryngeal edema should be discussed with radiologist before the exam exam the before radiologist with discussed be should edema laryngeal or anaphylaxis with Patients •

• Tumor (if contraindication to MRI) to contraindication (if Tumor •

• Patients with vomiting or dizziness with IV contrast, or shell fi sh allergy do not require premedication. premedication. require not do allergy sh fi shell or contrast, IV with dizziness or vomiting with Patients •

gadolinium allergy or extreme claustrophobia extreme or allergy gadolinium

• Patients with hives or rash must be pre-medicated for an IV contrast CT scan (not oral contrast). contrast). oral (not scan CT contrast IV an for pre-medicated be must rash or hives with Patients •

• Arthrogram for meniscus and chondral injuries in patients with adjacent metal, metal, adjacent with patients in injuries chondral and meniscus for Arthrogram •

Premedication for Contrast Allergy Contrast for Premedication

• Infection (if concern for septic joint should be aspirated prior to CT) to prior aspirated be should joint septic for concern (if Infection •

Knee CT W Contrast ...... CPT Code 73701 Code CPT ...... Contrast W CT Knee

Fracture •

• Pelvic ring fractures/acetabular fractures fractures/acetabular ring Pelvic •

Knee CT W/O Contrast ...... CPT Code 73700 Code CPT ...... Contrast W/O CT Knee

Pelvis CT W/O Contrast W/3D Reconstruction ...... CPT Code 72192 & 76377 & 72192 Code .CPT ...... Reconstruction W/3D Contrast W/O CT Pelvis

• Tumor (if contraindication to MRI) to contraindication (if Tumor •

• Tumor (if contraindication to MRI) to contraindication (if Tumor • gadolinium allergy or extreme claustrophobia extreme or allergy gadolinium

• Infection (if concern for septic joint should be aspirated prior to CT) to prior aspirated be should joint septic for concern (if Infection • • Arthrogram to evaluate for osteochondral lesions in patients with adjacent metal, metal, adjacent with patients in lesions osteochondral for evaluate to Arthrogram •

Pelvis CT W Contrast ...... CPT Code 72193 Code CPT ...... Contrast W CT Pelvis • Infection (if concern for septic joint should be aspirated prior to CT) to prior aspirated be should joint septic for concern (if Infection •

Ankle CT W Contrast...... CPT Code 73701 Code CPT ...... Contrast. W CT Ankle

• Pelvic fractures Pelvic •

• Arthrodesis evaluation Arthrodesis •

• Bone stock following bone graft harvest graft bone following stock Bone •

• Arthroplasty evaluation Arthroplasty •

Pelvis CT W/O Contrast ...... CPT Code 72192 Code CPT ...... Contrast W/O CT Pelvis

Arthritis •

Fracture • • Impingement protocol Impingement •

Ankle CT W/O Contrast...... CPT Code 73700 Code CPT ...... Contrast. W/O CT Ankle Hip CT W/O Contrast W/3D Reconstruction ...... CPT Code 73700 & 76377 & 73700 Code .CPT ...... Reconstruction W/3D Contrast W/O CT Hip

Prep: NPO 2 hours for all studies W Contrast W studies all for hours 2 NPO Prep:

MUSCULOSKELETAL MUSCULOSKELETAL (continued)

Updated 2015 CT Ordering Guide

BODY Coronary CT W and W/O Contrast ...... CPT Code 75574 Prep: NPO 2 hours for all studies W Contrast • Coronary artery disease/Bypass graft evaluation • Chest pain suspected cardiac Chest CT W/O Contrast ...... CPT Code 71250 Heart CT W Contrast (Morphology) ...... CPT Code 75572 • Lung Nodules (may be done W Contrast if ordering MD desires) • Pulmonary venous mapping • Pneumonia (may be done W Contrast if ordering MD desires) • Pulmonary vein evaluation • Pleural effusion (may be done W Contrast if ordering MD desires) • Gated TAVI (if in conjunction with Angiography Abd and Pel CT • Interstitial Lung Disease (Hi Res Chest) W and W/O Contrast W/ 3D Reconstruction, CPT Code 74174) • COPD Abdomen CT W/O Contrast ...... CPT Code 74150 Chest CT W Contrast ...... CPT Code 71260 • Adrenal mass detection • Lung Cancer (may be done W/O Contrast if ordering MD desires) • Chest Wall Mass Abdomen CT W Contrast ...... CPT Code 74160 • Mediastinal Mass/Abnormality • Empyema • Liver Mass Characterization/Surgical Planning • Hilar Mass/Abnormality • Pulmonary embolism (PE) • Hepatitis/Cirrhosis/Cholangiocarcinoma • Aneurysm Follow-Up (size only) • Chest Pain • Post treatment HCC (not for metastatic surveillance) (may be done W Contrast if ordering MD desires) • Coarctation of the aorta • Dissection (chest only, no 3D) Abdomen CT W and W/O Contrast ...... CPT Code 74170 • Renal Mass or Pancreatic Mass Characterization/Surgical Planning Chest CT W and W/O Contrast ...... CPT Code 71270 • Liver chemo embolization or RFA • Dissection (if in conjunction with Abdomen and Pelvis CT W Contrast, CPT Code 74177) • Adrenal Mass characterization Angiography, Chest CT W and W/O Contrast W/ 3D Reconstruction . . . . CPT Code 71275 Abdomen and Pelvis CT W/O Contrast ...... CPT Code 74176 • Chronic PE • Renal Stone/RP bleed • Pulmonary AVM • Abdomen and pelvis patient who cannot have contrast (will give oral contrast) • Pre and Post Operative sternal anatomy (redo sternotomy; Damiano protocol) Abdomen and Pelvis CT W Contrast ...... CPT Code 74177 Chest CT W/O Contrast W/ 3D Reconstruction ...... CPT Code 71250 & 76377 • Abdominal Pain/Abdominal mass/Malignancy • Nausea and vomiting/Weight loss/Fever • Airway imaging (inc. TBM), Tracheal stenosis, Tracheal malacia (Tracheal Tree) • Diverticulitis/Appendicitis/Abscess/Acute pancreatitis • CT Enterography • Redo sternotomy for patients who cannot have contrast • Dissection • Trauma/Bowel perforation • Aortic or mitral valve for patients who cannot have contrast • Any other indication that is not already listed (BODY – continued inside) Chest CT W Contrast W/ 3D Reconstruction ...... CPT Code 71260 & 76377 • Aortic or mitral valve • Dissection (chest only)

To schedule any radiology exam, call 314-996-8080 BODY (continued) NEURO Prep: NPO 2 hours for all studies W Contrast Prep: NPO 2 hours for all studies W Contrast Abdomen and Pelvis CT W and W/O Contrast ...... CPT Code 74178 Head CT W/O Contrast ...... CPT Code 70450 •Ischemic Bowel •Headache/Trauma/Stroke/TIA •GI bleeding •Dizziness/Intracranial bleed

Angiography Abdomen CT W and W/O Contrast Head CT W and W/O Contrast ...... CPT Code 70470 W/ 3D Reconstruction ...... CPT Code 74175 •Mass/Metastatic disease •Pre Liver transplant/Portal vein embolization •Hepatic resection candidates Neck CT W Contrast ...... CPT Code 70491 •Living Liver Donor •Neck Mass/Malignancy Staging/Malignancy follow

Angiography Abd and Pel CT Sinus CT W/O Contrast ...... CPT Code 70486 W and W/O Contrast W/ 3D Reconstruction...... CPT Code 74174 •Acute or chronic Sinusitis/Nasal cavity polyps •Pre and Post endoluminal grafting/TAVI •TRAM fl ap surgical planning Orbits CT W/O Contrast ...... CPT Code 70480 •Living Renal Donor •Trauma/black eye/visual defects •Gated TAVI (if in conjunction with Heart CT W Contrast (Morphology), CPT Code 75572) Abdomen and Pelvis CT Maxillofacial CT W/O Contrast ...... CPT Code 70486 W/O Contrast W/ 3D Reconstruction ...... CPT Code 74176 & 76377 •Trauma/ black eye/facial contusion/jaw injury •Pre and post endoluminal grafting-for patients who cannot have contrast Maxillofacial CT W Contrast ...... CPT Code 70487 Chest, Abdomen and Pelvis CT W Contrast ...... CPT Code 71260 &74177 •Facial weakness/Neoplasm/Malignancy/Cellulitis/Abscess •Malignancy Staging/Malignancy follow-up Temporal Bones CT W/O Contrast ...... CPT Code 70480 Angiography Chest, Abdomen and Pelvis CT •Ear Disorder/Deafness/Acute Mastoiditis W and W/O Contrast W/ 3D Reconstruction...... CPT Code 71275 & 74174 •Trauma/ear injury •Pre and Post endoluminal grafting/Aortic stenosis/TAVI •Intraparenchymal hematoma Chest, Abdomen, and Pelvis CT Head CTA...... CPT Code 70496 W/O Contrast W/ 3D Reconstruction ...... CPT Code 71250, 74176 & 73677 •Intracranial Aneurysm/Stenosis/Dissection •Pre and post endoluminal grafting for patients who cannot have contrast •Subarachnoid hemorrhage (SAH)/Arteriovenous malformation (AVM) Virtual Colonoscopy Diagnostic CT W/O Contrast ...... CPT Code 74261 •Failed colonoscopy Head and Neck CTA ...... CPT Code 70496 and 70498 •Patients that cannot be sedated or cannot stop blood thinners for conventional colonoscopy •Extracranial Aneurysm/Stenosis/Dissection •Subarachnoid hemorrhage (SAH)/Arteriovenous malformation (AVM) Urogram CT Abdomen and Pelvis •Penetrating neck injury W and W/O Contrast W/ 3D Reconstruction...... CPT Code 74178 & 76377 •Cervical Spine fracture •Hematuria Angiography, Abdominal Aorta CT Spine CT W/O Contrast. . . .CPT Code 72125 (C-Spine) or 72128 (T-Spine) or 72131(L-Spine) with Lower Extremity Runoff, W Contrast W/ 3D Reconstruction ...... CPT Code 75635 •Radiculopathy/Trauma/Pain •CT AIF / Bypass evaluation/Cold leg/Leg ischemia

To schedule any radiology exam, call 314-996-8080

MYELOGRAPHY MUSCULOSKELETAL Prep: NPO 4 hours; may drink clear liquids up to 30 minutes prior to exam Prep: NPO 2 hours for all studies W Contrast

Myelogram with CT, Cervical Spine...... CPT Code 72240 Wrist CT W/O Contrast ...... CPT Code 73200 (Precert CPT Code 72240 & 72126) • Acute fracture • Problem cases unresolved by non-invasive imaging • Fracture healing (most commonly scaphoid) • Patients with contraindications for MR • Distal radioulnar joint instability • Cervical myelopathy or radiculopathy in which fi ne bone detail is desired • Arthrodesis evaluation • Presurgical planning and mapping Wrist CT W Contrast ...... CPT Code 73201 Myelogram with CT, Thoracic Spine ...... CPT Code 72255 • Infection (if concern for septic joint should be aspirated prior to CT) (Precert CPT Code 72255 & 72129) • Arthrogram to evaluate for ligamentous or chondral injuries in patients • Problem cases unresolved by non-invasive imaging with adjacent metal, gadolinium allergy or extreme claustrophobia • Patients with contraindications for MR • Tumor (if contraindication to MRI) • Thoracic myelopathy or radiculopathy in which fi ne bone detail is desired Elbow CT W/O Contrast ...... CPT Code 73200 • Presurgical planning and mapping • Fracture • Arthritis Myelogram with CT, Lumbosacral Spine ...... CPT Code 72265 (Precert CPT Code 72265 & 72132) Elbow CT W Contrast ...... CPT Code 73201 • Problem cases unresolved by non-invasive imaging • Infection (if concern for septic joint should be aspirated prior to CT) • Patients with contraindications for MR • Arthrogram to evaluate for ligamentous or chondral injuries in patients • Lumbar radiculopathy in which fi ne bone detail is desired with adjacent metal, gadolinium allergy or extreme claustrophobia • Presurgical planning and mapping • Tumor (if contraindication to MRI)

Myelogram with CT, 2-3 Regions ...... CPT Code 72270 Shoulder CT W/O Contrast ...... CPT Code 73200 (Precert CPT Code 72270 & depending on the desired level(s) 72126, 72129, and/or 72132) • Fracture • Arthritis prior to replacement • Problem cases unresolved by non-invasive imaging • Patients with contraindications for MR Shoulder CT W Contrast...... CPT Code 73201 • Complex or nonfocal myelopathy or radiculopathy in which fi ne bone detail is desired • Infection (if concern for septic joint should be aspirated prior to CT) • Presurgical planning and mapping • Arthrogram to evaluate for glenoid labrum or chondral injuries in patients with adjacent metal, gadolinium allergy or extreme claustrophobia • Arthrogram for patient with arthroplasty glenoid component loosening • Tumor (if contraindication to MRI) Shoulder CT W/O Contrast W/3D Reconstruction ...... CPT Code 73200 & 76377 • Shoulder arthritis prior to replacement • Glenoid fracture Forefoot/Hindfoot CT W/O Contrast ...... CPT Code 73700 • Fracture • Evaluation of arthrodesis • Arthritis Forefoot/Hindfoot CT W Contrast ...... CPT Code 73701 • Infection (if concern for septic joint should be aspirated prior to CT) • Tumor (if contraindication to MRI) (MUSCULOSKELETAL – continued on back) To schedule any radiology exam, call 314-996-8080