2020 CPT Code Exam Ordering Guide

T 858 658 6500 F 866 558 4329 Everyone’s choice for imaging imaginghealthcare.com

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EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE M

MRI brain - post fossa • Bell’s Palsy • Hearing loss R 70553 w/ & w/o contrast (IAC w/ & w/o) • Vertigo I MRI brain (pituitary protocol) • Hormone abnormalities • Pituitary 70553 w/ & w/o contrast MRI brain (seizure protocol) • Seizures - multiple early onset 70553 w/ & w/o contrast

MRI brain and orbits • Loss of vision • Ocular mass or tumor H 70553, 70543 E w/ & w/o contrast • Optic neuritis • Visual disturbance A D / N

E • Brain tumor • Dizziness C

K & • Headaches (depends on • Meningitis MRI brain w/ & w/o contrast 70553 associated clinical history) • Metastatic brain disease N

E • Multiple sclerosis • Seizures U R O • Ataxia • CVA • Dementia • Headaches (depends on MRI brain w/o contrast 70551 • Traumatic brain injury associated clinical history) (chronic)

MRI brain w/o contrast • Personal or family history of aneurysm 70551, 70544 and MRA or MRV • Severe headache • Subarachnoid hemorrhage

MRI (facial bones, orbits, neck soft • Tumor, mass, swelling, or infection of the soft tissue neck 70543 tissue) w/ & w/o contrast 2020.v1_1 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE

MRI abdomen w/ & w/o contrast • Abdominal pain 74183 • Any complaint related to liver, spleen, pancreas or kidneys

MRA abdomen w/ or w/o contrast • Hypertension 74185 • Renal artery stenosis

• Gall stones • Cholangitis A MRI abdomen w/ & w/o contrast B • Biliary tumor or pancreatitis 74183, 76377 D w/ MRCP O • Common bile duct or gallbladder concerns M

E • Pancreatic duct N & P

E • Crohn’s disease 74183 Abdomen

L MRI abdomen and pelvis

V • Inflammatory bowel disease w/ & w/o

I w/ & w/o contrast S • Ischemic bowel disease 72197 Pelvis w/ & w/o

• Coccyx fracture • Pelvic fracture • Pubic arthralgia • Sacral fracture MRI pelvis w/o contrast 72195 • Sacroiliitis • Sports hernia • Stress fracture (Pelvis)

MRI pelvis and prostate gland • Prostate cancer screening, staging or follow up 72197 w/ & w/o contrast

2020.v1_2 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE

• Adenomyosis • Cervical cancer • Dermoid • Family history of uterine MRI pelvis female GYN • Fibroid or ovarian malignant tumor

P 72197

E w/ & w/o contrast • Infection or tumor • Ovarian disease L

V • Post menopausal bleeding • UFE planning I S • Uterine mass • Vaginal cancer

• Non-gynecological tumor or infection MRI pelvis w/ & w/o contrast 72197 • Non-specific pelvic pain

• Demyelination, Infection MRI cervical spine w/ & w/o contrast • MS 72156 • Suspected tumor of cervical spinal cord

• Benign cervical spine • Cervical neck pain SPI N MRI cervical spine w/o contrast • Compression fracture (Cervical Spine) 72141 • Degenerative disc disease E • Disk herniation radiculopathy

MRI lumbar spine w/ & w/o contrast • Malignancy *If prior lumbar surgery (within 10 years), r/o • Failed back syndrome 72158 infection, or bone mets then MRI lumbar spine • Pathologic compression fracture (Lumbar Spine) w/ & w/o contrast. 2020.v1_3 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE

• Compression fracture • Degenerative disk disease MRI lumbar spine • Disk herniation • Low back pain > 6 weeks 72148 w/o contrast • Radiculopathy • Sciatica

SPI N • Compression fracture benign (Thoracic Spine) MRI thoracic spine • Degenerative disk disease • Disk herniation 72146 E w/o contrast • Thoracic back pain

MRI thoracic spine • Demyelinating disease • Thoracic tumor 72157 w/o & w/contrast • Infection

73722 MRI joint LOWER • Knee pain with concern for unstable osteochondral lesion extremity w/ contrast MRI arthrogram, Knee A • Knee pain with prior arthroscopy 27369 Arthro injection R

T 77002 Fluoro guidance H R O G R A

M 73222 MRI joint UPPER • Shoulder pain after dislocation or concern for labral tear extremity w/ contrast MRI arthrogram, Shoulder • Shoulder pain after rotator cuff or labral repair 23350 Arthro injection 77002 Fluoro guidance

2020.v1_4 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE

MRI (joint) UPPER • Evaluate for bony or soft tissue pathology 73221 extremity w/o contrast • Internal derangement occult • Joint pain EX T R EM I • Fracture to non-joint extremity • Lipoma MRI (non joint) UPPER T • Myositis • Nonspecific pain 73218 Y extremity w/o contrast

U • Soft tissue injury • Stress response P P E R MRI (non joint) UPPER extremity w/ & w/o • Contrast indicated for tumor or infection of extremity only 73220 contrast

MRI (joint) LOWER • Evaluate for bony or soft tissue pathology 73721 extremity w/o contrast • Internal derangement occult • Joint pain EXT R

EMI T • Fracture to non-joint extremity • Lipoma MRI (non joint) LOWER • Myositis • Nonspecific pain 73718

Y extremity w/o contrast

• Soft tissue injury • Stress response L O W E R MRI (non joint) LOWER extremity w/ & w/o • Contrast indicated for tumor or infection of extremity only 73720 contrast

2020.v1_5 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE • Ataxia • Brain tumor • CVA • Dementia CT head, brain w/ & w/o contrast • Headaches 70470 (Contrast - depends on associated clinical history)

• Ataxia • CVA • Dementia • Headaches CT head, brain w/o contrast • Normal pressure • Traumatic brain injury 70450 hydrocephalus (NPH) (acute) H E

A (Contrast - depends on associated clinical history) D / N

E CT maxillofacial w/o contrast • Possible fracture • Trauma 70486 C K & • Fracture • Swelling CT orbit w/o contrast 70480 N • Trauma E U R

O CT sinus w/o contrast • Facial pain • Sinusitis 70486

• Lymphadenopathy • Mass CT soft tissue neck w/ contrast 70491 • Swelling

• Contraindication to iodine (consider MRI) CT soft tissue neck w/o contrast 70490 • Salivary gland stone

• Earache • Cholesteatoma CT temporal bones w/o contrast 70480 • Hearing loss 2020.v1_6 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE • Pulmonary embolism • Aneurysm • Chest pain • Dyspnea CT angiography chest 71275 • Elevated D-Dimer • Ascending aorta or aortic arch dissection CT chest high-resolution chest w/o • Interstitial lung disease 71250 contrast

• Low dose lung cancer screening • Minimum “30-Pack Year” smoker • Asymptomatic patients only • Requires completion of CT Low C CT low dose lung screening G0297 H • Patient age between 55-77 years Dose Screening Request Form C ES T • Less than 15 years since quit smoking T

Preferred • Abnormal chest x-ray • Adenopathy • Chest pain • Cough CT chest w/ contrast 71260 • Pleural effusion • Lung cancer • Dyspnea • Pneumonia • Follow up for known neoplasm • Pulmonary mass

• Nodule follow-up CT chest w/o contrast 71250 • Contraindication to iodine

CT abdomen w/ & w/o contrast • Adrenal mass • Hepatic mass (dedicated liver study) 74170 A

B • Pancreatic mass • Renal mass • Pancreatitis • Upper abdominal pain D O M E N CT abdomen w/o contrast • Contraindication to iodine (consider MRI) 74150

2020.v1_7 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE

Preferred • Abdominal distension • Abdominal pain (upper or lower) • Adenopathy • Appendicitis CT abdomen/pelvis w/ contrast • Bowel obstruction • Cancer 74177 (w/ oral contrast, unless specified) or perforation • Constipation • Diverticulitis • Lymph node enlargement • Mass • Pelvic pain

A CT abdomen/pelvis w/o contrast • Abdominal or pelvic pain B 74176 D (w/ oral contrast, unless specified) • Contraindication to iodine (consider MRI) O M E

N & CT abdomen/pelvis w/o contrast • Flank pain 74176 (w/o oral contrast) - renal stone study • Suspected renal stones or follow-up P E L

V • Failed or contraindication to traditional colonoscopy due to: I

S CT colonography diagnostic - Rectal bleeding, tortuous colon, or inability to 74261 tolerate sedation

CT colonography screening • Colon cancer screening 74263

• Anemia • Bowel obstruction CT small bowel w/ contrast • Chronic GI bleed • Crohn’s disease 74177 (w/ oral contrast) • Small bowel mass

• Dysuria • Flank pain CT urogram w/ & w/o contrast 74178 • Hematuria • UTIs 2020.v1_8 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE • Compression fracture • Neck pain SPI N CT cervical spine w/o contrast 72125 • Trauma (Cervical Spine)

E • Compression fracture (Lumbar Spine) CT lumbar spine w/o contrast 72131 • Low back pain • Trauma (Lumbar Spine)

• Fracture • Pain O CT extremity LOWER w/o contrast 73700 T

H • Swelling E R • Fracture • Pain CT extremity UPPER w/o contrast 73200 • Swelling

2020.v1_9 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE

US neck soft tissue • Palpable head, face or neck mass (describe area) 76536 NECK • Goiter • Palpable neck mass (describe on head, face, or neck) US thyroid or neck 76536 • Parotid, abnormal thyroid tests • Thyroidmegaly CHEST • Palpable mass, chest wall and upper back (describe location) US chest 76604 • Pleura - Fluid

• Abnormal liver tests • Ascites • Epigastric pain • Fatty liver • Hepatitis • Jaundice • Nausea • Pain US abdominal complete 76700

ABDOMEN Test includes the liver, pancreas, gallbladder, kidneys, aorta, and spleen. If abdominal and kidney (renal) are ordered together use abdomen and pelvic LTD (76857) to include bladder images.

• Inguinal hernia • Quadrant pain US abdominal LTD • Single organ evaluation such as liver or gallbladder 76705 • Palpable mass lower abdominal and lower back (describe location) 2020.v1_10 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE • Aorta screening US aorta Screening 76706 • Abdominal aortic aneurysm (AAA) • Abnormal kidney labs • Calculus of kidney stones • Dysuria includes bladder and • Flank pain pre & post void measurements • Hematuria • Hydronephrosis • Mass or cyst US renal retroperitoneal • CKB • UTI 76770 If clinical history suggests urinary tract pathology, then a complete evaluation of the kidneys and urinary bladder will be included in the exam. • Bleeding • Bloating PE L Patient or doctor may specifically • Endometriosis • Excessive or frequent VIS request no transvaginal due to patient • Female pelvis to view menstruation U

76856, 76830 L

age (under 18 years old), pregnancy uterus and ovaries • Fibroids T or comfort. R • Leiomyoma • Mass A S

• Lower abdominal and pelvic pain O U

• Pelvic pain • Mass N

US pelvic (female and male) • Irregular bleeding • Bloating D 76856 (No transvaginal included) • Fibroids • Abscess • Free fluid • Male pelvis bladder • Bladder • Urinary tract problems • Soft palpable mass, • To evaluate bladder in US pelvic LTD 76857 pelvic wall and buttocks addition to abdominal US (describe location) US scrotal • Mass • Pain • Swelling and tenderness 76870, 93976 2020.v1_11 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE

US arterial - lower extremity only • Cellulitis • Claudication 93925 Bilateral *Always includes bilateral extremity • Edema • Extremity pain 93926 Unilateral unless amputation. • PVD or PAD (Peripheral vascular/arterial disease)

• Bruit • Diplopia

V US carotid duplex arteries bilateral • Hypercholestremia • Hyperlipidemia 93880 ASCULAR • Trauma • Vertigo

• Edema • Numbness US extremity venous studies • Swelling in extremity • Warm limb duplex scan of veins, • Pain in extremity • Thrombosis 93971 UNILATERAL upper and lower Please indicate upper/lower extremity and right/left.

US extremity venous study • Pain • Redness duplex scan of veins, • Swelling • Tenderness in both legs 93970 BILATERAL upper and lower Please indicate upper/lower extremity and right/left.

US breast, unilateral, limited • Palpable mass to INCLUDE side and location on breast 76642 US breast, unilateral, complete (i.e. right breast palpable 10:00) 76641 O THER

• Lumps US non-vascular extremity LTD • Soft tissue masses on extremities and axilla 76882 (document specific area of concern)

2020.v1_12 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE B D • Evaluate bone loss O E DXA, Bone Density, one or more sites N N • Osteoporosis 77080 S E (hips, pelvis, spine) I

M T • Osteopenia O I N M E E R T R A Y L CT, Bone Density, QCT • Osteoporosis • Osteopenia 77078

EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE

• Pregnancy LESS than 14 weeks • Fetal demise US Obstetrical < 14 weeks 76801, 76817 US Transvaginal Please include last menstrual period or established estimated date of delivery on all exams (less than

PREG N 14 weeks). *Preferred exam to include EV for early OB.

• Pregnancy GREATER than 14 weeks ANCY • Evaluation of fetal growth B O US Obstetrical > 14 weeks Please include last menstrual period or established 76805, 76810 & P estimated date of delivery for OB ultrasound (more N R E D

than 14 weeks or for multiple fetus). E G E N A N S US Obstetrical w/ imaging 76801 (first) N C I

• Multiple fetus US obstetrical less than 14 weeks T Y

of additional fetus 76802 (additional) Y 2020.v1_13 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE I n • All asymptomatic women; Age 40 and older

c Screening: Bilateral Annual 77067 l u d e

s Compu t Diagnostic (Women): Bilateral Annual • Personal history breast cancer – asymptomatic 77066 MA M Diagnostic (Women): Unilateral Annual • Personal history breast cancer – asymptomatic 77065 M er A id e d O

G Diagnostic (Women): • Symptomatic patients; Age 30 and older 77066 R

A Bilateral - Symptomatic • Symptomatic Exam requires Breast Ultrasound Complete US, 76641 M

De t Limited US, 76642

e Diagnostic (Men): Bilateral • Palpable mass 77066 c t i o • Family history of breast cancer. n 98968 High Risk Breast Assessment Self or family carrying the BRCA 1/BRCA2. T O

M Screening: Bilateral Annual • All Asymptomatic Women; Age 40 and older 77063 O S Y N Diagnostic: Bilateral • Symptomatic Women; Age 40 and older 77062 T H E S I

S Diagnostic: Unilateral • Symptomatic Women; Age 40 and older 77061 U

L • Complete exam of all four quadrants of the breast and T

B Complete** 76641 R

R retroareolar region A EAS T S

O • Focused exam of the breast that is limited to one or U

N Limited** more quadrants of the breast and retroareolar region 76642 D • Palpable mass woman age 29 and younger

2020.v1_14 **Both code definitions include exam of the Axilla, if performed. MA M EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE M O

• High Risk Patients: Diagnostic: G R

- BRCA 1 or 2 carrier 77048* Unilateral with and A - History of chest radiation from ages 10-30 without contrast P H - Lifetime risk of breast cancer 20-25% or greater 77049* Bilateral with and Y

O without contrast MRI Breast (in addition to - - Untested patient w/ 1st degree relative positive THER - MRI not as a replacement for) for BRCA 1 or 2 For Breast Implant Integrity: Annual Screening • Dense Breast evaluation Mammography or • Evaluation suspected Breast Cancer 77046 Unilateral without contrast Tomosynthesis • Assessment of breast implants (Silicone/Saline) • Preoperative evaluation of newly diagnosed breast 77047 Bilateral without cancer contrast • Evaluation of inconclusive clinical or imaging findings (*Studies performed w/wo • Breast Implant Integrity. Without contrast only. contrast, including CAD- Computer Aided Detection.)

2020.v1_15 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE

Whole Body Bone Scan • Metastatic disease • Paget's disease • Bone lesions 78306 B

O Limited Bone Scan • Occult fracture, stress reaction, arthritis 78300 N E S • Known or suspected joint replacement loosening, C

A Three Phase Bone Scan 78315 Bone graft viability, vascular necrosis, Reflex N

S Sympathetic, Dystrophy (RSD)

• Occult Fracture, stress reaction, arthritis Limited Bone Scan with SPECT 78803 • Pars defect

W White Blood Cell (WBC) • Known or suspected infection/inflammation H

( 78800 I

W Indium-111 (IN-111) Limited T • Osteomyelitis E B

C B ) L

O

S White Blood Cell (WBC) Indium-111 C O • Known or suspected infection/inflammation areas 78801 A D (IN-111) Multiple N

C E S

LL White Blood Cell (WBC) • Known or suspected infection/inflammation Indium-111 (IN-111) Whole Body 78302 P A R A S T C H A • Evaluate for parathyroid adenomas and patients with Y N Parathyroid Scan 78071 (with SPECT)

R hyperparathyroidism and hypercalcemia. O I D

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r u h i u h e o o o s X I I S Mult I T Whole Bo T S i S W T p E THYROID I-131 WHOLE BODY SCANS THYROID SCANS THERAPY EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE S L C U A N N • Suspected pulmonary embolism

G Lung V/Q (Ventilation and Perfusion) 78582 S

H E

P • Evaluate for cystic duct obstruction and for A Hepatobiliary Scan 78226 S T

C acute cholecystitis O A B N I L S I

A Hepatobiliary Scan with gallbladder • Evaluate for gallbladder dysmotility or

R 78227

Y ejection fraction analysis biliary dyskinesia E M G A PT Y S T Gastric Emptying Study • Evaluate gastric motility and emptying. 78264 R I N O G

C S A C R A D N I Cardiac Blood Pool (MUGA) Scan • Evaluate cardiac function 78472 A S C L Y T M I G P R H A O

P Lymphoscintigraphy • Lymphatic Imaging 78195 SC I H Y N-

2020.v1_18 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE L I

V Liver Spleen Scan Without SPECT • Evaluate focal liver masses such as HCC, FNH, adenoma

E 78215

R (Planar) and hemangioma when MRI is indeterminate.

S C

A • Evaluate focal liver masses such as HCC, FNH, adenoma

N Liver Spleen Scan With SPECT

S and hemangioma when MRI is indeterminate. SPECT is 78205 (Tomography) preferred over planar study. H E MA N L I V • Evaluate liver mass for possible hemangioma when GI O E Liver Red Blood Cell Scan SPECT 78205 R MRI is indeterminate

M A

R Preferred E

N Renal Flow and Function • Evaluate for renal function, renal ureter obstruction, A 78709 L Without and With Lasix post surgical evaluation

S C A N S Renal Flow and Function • Evaluate renal function 78707 I M B R A G A • Evaluate for Parkinson’s Disease, MSA, CBD, and PSP I I Brain DaTScan 78803, A9584 N N

G • Tremors

2020.v1_19 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE T

U • Oncology staging, restaging, recurrence, and therapy MO R

WI T Skull Base to Mid-Thigh response (Please refer to the IHS PETCT coverage guide 78815, A9552 for more information)

H I M

F A D G G I

N • Oncology staging, restaging, recurrence, and therapy

G Whole Body 78816, A9552 response for melanoma or sarcoma of the long bones T U W MO R I T H

I G Ga-68 Dotatate Scan M • Staging and restaging neuroendocrine tumors 78815, A9587 A

A (Skull to Mid-Thigh) - G 6 I 8 N G B O S N O E D

I S U C M A

N • Detection and evaluation of skeletal metastatic F Whole Body Bone Scan

L WI T disease (more sensitive alternative than conventional 78816, A9580 U with F-18 Naf O bone scans) R H I F D E - 1 8

2020.v1_20 EXAM TO ORDER SYMPTOMS/CONCERNS CPT CODE

B • Evaluate Mild Cognitive Impairment and Dementia. R

A Brain Scan with FDG Help differentiate Alzheimer’s Disease from 78608, A9552 I N Fronto-Temporal Dementia (FTD)

I M A G I

N Brain Scan with Florbetapir F-18 • Evaluate for Alzheimer’s Disease and differentiate

G 78608, A9599 Amyloid Imaging (Amyvid) from FTD P ROST A

T Prostate Scan with Fluciclovine • Prostate cancer re-staging after patient has completed

E 78815, A9588 F-18 (Axumin) treatment and has a rising PSA S C A P N E T / C T

2020.v1_21 CT ANATOMY - CPT CODES

BRAIN / HEAD LUNG BONE DENSITY SCREENING wo 70450 Low Dose Lung QCT 77078 w/wo 70470 Screening G0297 CTA Brain/Head (w/) 70496 HEART CT COLONOGRAPHY CACS (wo) 75571 ORBITS Screening 74263 CCTA (w/) 75574 wo 70480 Diagnostic 74261 CACS & CCTA (wo/w) 75574 w/ 70481 w/wo 70482 PETROUS/TEMPORAL BONE (IAC) CHEST PELVIS wo 70480 w/ 71260 wo 72192 SELLA (PITUITARY) wo 71250 w/ 72193 w/wo 70482 Angio (w/) 71275 ABDOMEN AND PELVIS SINUSES ABDOMEN w/wo 74178 wo 70486 wo 74150 Renal Stone (wo) 74176 w/wo 70488 w/wo 74170 Urogram (w/wo) 74178 NECK, SOFT TISSUE Angio / AAA (w/) 74175 Small Bowel (w/wo) 74178 wo 70490 Angio Aorta Runoff (w/) 75635 w/ 70491 w/wo 70492 COMBINATION CODES 3-D RECONSTRUCTION Add to Any Exam 76377 NECK, CHEST, ABDOMEN, CHEST AND ABDOMEN PELVIS w/wo 71260, 74170 UPPER EXTREMITY w/wo 70491, 71260, 74178 ABDOMEN AND PELVIS wo 73200 CHEST, ABDOMEN, PELVIS (ANGIO) w/wo 73202 wo 71250, 74176 w/wo 74175, 72191 LOWER EXTREMITY w/wo 71260, 74178 wo 73700 w/wo 73702 Angio (w/wo) 73706 ABBREVIATION KEY *T hese CPT codes represent t he most wo = without IV contrast commonly ordered CT exams. For an SPINE w/ = with IV contrast coding inquiry not listed ple ase call for assistance 858 658 6500. Cervical wo 72125 w/wo = with & without IV contrast Thoracic wo 72128 CACS = Coronary Artery Calcium Score Lumbar wo 72131 2020.v1_22 CCTA = Coronary CT Angiogram MRI ANATOMY - CPT CODES

SPINE, CERVICAL BRAIN NECK, SOFT TISSUE wo 72141 wo 70551 wo 70540 w/wo 72156 w/wo 70553 w/wo 70543 SPINE, THORACIC Brain MRA (wo) 70544 MR Angio (w/) 70549 wo 72146 ORBITS/FACE (PITUITARY, IACS) COMBINATION CODES w/wo 72157 wo 70540 Brain MRI & MRA 70553, 70544 SPINE, LUMBAR w/wo 70543 Brain & Orbits w/wo 70553, 70543 wo 72148 TMJ (wo) 70336 w/wo 72158 PETROUS/TEMPORAL BONE (IAC) wo 70480 UPPER EXTREMITY NON JOINT CHEST PELVIS (HUMERUS, FOREARM, HAND) wo 71550 wo 72195 wo 73218 w/wo 71552 w/wo 72197 w/wo 73220 Chest MRA BREAST JOINT (for Brachial Plexus) 71555 w/wo (SHOULDER, ELBOW, WRIST) ABDOMEN Unilateral 77048 wo 73221 wo 74181 Bilateral 77049 w/wo 73223 w/wo 74183 MRI ARTHROGRAM Abdomen MRA (w/wo) 74185 Shoulder 23350, 77002, 73222 Elbow 24220, 77002, 73222 Wrist 25246, 77002, 73222 ABBREVIATION KEY wo = without IV contrast LOWER EXTREMITY w/ = with IV contrast NON JOINT(THIGH, CALF, FOOT) wo 73718 w/wo = with & without IV contrast C

w/wo 73720 M P R JOINT(HIP, KNEE, ANKLE) T C wo 73721 I & w/wo 73723 O D C E

MRI ARTHROGRAM T S

* These CPT codes represent the most commonly ordered CT exams. For any coding Hip 27093, 77002, 73722 inquiry not listed please call your Marketing Team Member at 858 658 6500. Knee 27370, 77002, 73722 Ankle 27648, 77002, 73722 2020.v1_23 Lab Requirements for IV S E Y

L L U

Contrast Exams NTH S E E N O I N N T S 0 D A A A NIN E B N 3 P P I ADI N T A Current Pre Medication Prescription: O M L A T C IN

IN 3 M U E S A / / O I T OAG OAG O • Prednisone 40mg by mouth taken 12 R W D C W C S C C EXAMS PATIENT INDICATIONS N hours before exam and 2 hours prior to exam. IHS recommends that the referring Age 70 and over physician order the prednisone for History of kidney/renal disease the patient. MRI with IV Contrast (any age)

Coag Panel: Dialysis patient* • PT, PTT, INR Age 70 and over • STAT COAG PANEL must be drawn the day prior to scheduled procedure, with results History of kidney/renal disease received to IHS no later than 9 a.m. on CT with IV Contrast the day of the exam. Dialysis patient*

Coumadin: Diabetic patient • Patient must discontinue Coumadin 5 days prior to any biopsy. Anti-coagulant Standard medications cannot be discontinued CT Guided Biopsy without notification of prescribing Patient on Coumadin physician. Lines (picc, ports) for Standard MISSING LABS may result in the replacement, changes, rescheduling of the patient exam or or removals Patient on Coumadin changed to a non-contrast exam. Tubes (G tubes, J tubes) Standard *Dialysis appointment must be scheduled for replacement, changes, or removals Patient on Coumadin within 24 hours af ter the examination. 2020.v1_24

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