Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 ● Web Site: www.MRIGroup.com

EPIC Ordering Reference Sheet – Head/Neck

Body Part RAD Code Procedure to Pre-Cert CPT Code Brain RAD07060 MRI Brain without Contrast 70551 Brain RAD07058 MRI Brain without and with Contrast 70553 Circle of Willis (COW) RAD07018 MRA Head without Contrast 70544 Carotid RAD07024 MRA Neck without Contrast 70547 Carotid RAD07023 MRA Neck without and with Contrast 70549 Intracranial Venous Sinus RAD09111 MRV Head without and with Contrast 70546 Orbits RAD07188 MRI Orbits/Face/Neck without and with Contrast 70543 Neck-Soft Tissue RAD07188 MRI Orbits/Face/Neck without and with Contrast 70543 TMJ RAD07225 MRI Temporomandibular Joint 70336

EPIC Ordering Reference Sheet – Spine

Body Part RAD Code Procedure to Pre-Cert CPT Code Spine: Cervical RAD07075 MRI Cervical Spine without Contrast 72141 Spine: Cervical RAD07074 MRI Cervical Spine without and with Contrast 72156 Spine: Thoracic RAD07228 MRI Thoracic Spine without Contrast 72146 Spine: Thoracic RAD07227 MRI Thoracic Spine without and with Contrast 72157 Spine: Lumbar RAD07178 MRI Lumbar Spine without Contrast 72148 Spine: Lumbar RAD07177 MRI Lumbar Spine without and with Contrast 72158 SI Joints RAD09118 MRI Pelvis without Contrast 72195 SI Joints RAD09120 MRI Pelvis without and with Contrast 72197 Sacrum RAD07208 MRI Pelvis without Contrast 72195 Sacrum RAD07207 MRI Pelvis without and with Contrast 72197

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Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 ● Web Site: www.MRIGroup.com

EPIC Ordering Reference Sheet – Body

Body Part RAD Code Procedure to Pre-Cert CPT Code Abdomen - Adrenals RAD07005 MRI Abdomen without Contrast 74181 Abdomen - MRCP RAD07249 MRI Abdomen without Contrast 74181 Abdomen – RAD07003 MRI Abdomen without and with Contrast 74183 Liver *Note in comment section Kidneys area you are looking at Mass (Liver, Kidneys, etc.) Abdomen - MRE RAD09135 MRI Abdomen without and with Contrast 74183 Abdomen - MRA RAD07011 MRA Abdomen without and with Contrast 74185 Brachial Plexus BILAT – RAD07268 MRI Chest without Contrast 71550 LEFT – RAD07052 RIGHT – RAD07266 Brachial Plexus BILAT – RAD07051 MRI Chest without and with Contrast 71552 LEFT – RAD07053 RIGHT – RAD07264 Chest – MRA RAD07014 MRA Chest without and with Contrast 71555 Chest Mediastinum RAD07078 MRI Chest without Contrast 71550 Chest Mediastinum RAD07077 MRI Chest without and with Contrast 71552 Pelvis - Female RAD07196 MRI Pelvis without Contrast 72195 Pelvis - Female RAD07195 MRI Pelvis without and with Contrast 72197 Pelvis - Angiography RAD07026 Pelvic Angiography with or without Contrast 72198 Peripherals (must LEFT – RAD07020 Lower Extremity Angiography with or 73725 choose Left and Right RIGHT – RAD07021 without Contrast – not Bilateral; also need to order Pelvis Pelvis – RAD07020 Pelvic Angiography with or without Contrast 72198 MRA at same time)

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Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 ● Web Site: www.MRIGroup.com

EPIC Ordering Reference Sheet – MSK Upper Extremity

Body Part RAD Code Procedure to Pre-Cert CPT Code Hand/Finger LEFT – RAD07120 MRI Non-Joint Upper Extremity without 73218 RIGHT – RAD07123 Contrast Hand/Finger LEFT – RAD07119 MRI Non-Joint Upper Extremity without 73220 RIGHT – RAD07122 and with Contrast Wrist LEFT – RAD07241 MRI Joint Upper Extremity without 73221 RIGHT – RAD07247 Contrast Wrist LEFT – RAD07240 MRI Joint Upper Extremity without and 73223 RIGHT – RAD07246 with Contrast Wrist Arthrogram LEFT – RAD07236 MRI Upper Extremity Joint with Contrast 73222 RIGHT – RAD07242 Forearm LEFT – RAD07113 MRI Non-Joint Upper Extremity without 73218 RIGHT – RAD07277 Contrast Forearm LEFT – RAD07112 MRI Non-Joint Upper Extremity without 73220 RIGHT – RAD07276 and with Contrast Elbow LEFT – RAD07086 MRI Joint Upper Extremity without 73221 RIGHT – RAD07092 Contrast Elbow LEFT – RAD07085 MRI Joint Upper Extremity without and 73223 RIGHT – RAD07091 with Contrast Elbow Arthrogram LEFT – RAD07081 MRI Upper Extremity Joint with Contrast 73222 RIGHT – RAD07087 Humerus LEFT – RAD07148 MRI Non-Joint Upper Extremity without 73218 RIGHT – RAD07151 Contrast Humerus LEFT – RAD07147 MRI Non-Joint Upper Extremity without 73220 RIGHT – RAD07150 and with Contrast Shoulder LEFT – RAD07214 MRI Joint Upper Extremity without 73221 RIGHT – RAD07220 Contrast Shoulder LEFT – RAD07213 MRI Joint Upper Extremity without and 73223 RIGHT – RAD07219 with Contrast Shoulder LEFT – RAD07209 MRI Upper Extremity Joint with Contrast 73222 Arthrogram RIGHT – RAD07215

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Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 ● Web Site: www.MRIGroup.com

EPIC Ordering Reference Sheet – MSK Lower Extremity

Body Part RAD Code Procedure to Pre-Cert CPT Code Foot/Toes LEFT – RAD07107 MRI Non-Joint Lower Extremity without 73718 RIGHT – RAD07110 Contrast Foot/Toes LEFT – RAD07106 MRI Non-Joint Lower Extremity without 73720 RIGHT – RAD07109 and with Contrast Ankle LEFT – RAD07035 MRI Joint Lower Extremity without 73721 RIGHT – RAD07041 Contrast Ankle LEFT – RAD07040 MRI Joint Lower Extremity without and 73723 RIGHT – RAD07046 with Contrast Ankle Arthrogram LEFT – RAD07036 MRI Joint Lower Extremity with Contrast 73722 RIGHT – RAD07042 Lower Leg (Tib/Fib LEFT – RAD07231 MRI Non-Joint Lower Extremity without 73718 or Calf) RIGHT – RAD07234 Contrast Lower Leg (Tib/Fib LEFT – RAD07230 MRI Non-Joint Lower Extremity without 73720 or Calf) RIGHT – RAD07233 and with Contrast Knee LEFT – RAD07160 MRI Joint Lower Extremity without 73721 RIGHT – RAD07166 Contrast Knee LEFT – RAD07165 MRI Joint Lower Extremity without and 73723 RIGHT – RAD07171 with Contrast Knee Arthrogram LEFT – RAD07161 MRI Joint Lower Extremity with Contrast 73722 RIGHT – RAD07167 Thigh/Femur LEFT – RAD07098 MRI Non-Joint Lower Extremity without 73718 RIGHT – RAD07101 Contrast Thigh/Femur LEFT – RAD07097 MRI Non-Joint Lower Extremity without 73720 RIGHT – RAD07100 and with Contrast Hip LEFT – RAD07136 MRI Joint Lower Extremity without 73721 RIGHT – RAD07142 Contrast Hip LEFT – RAD07135 MRI Joint Lower Extremity without and 73723 RIGHT – RAD07141 with Contrast Hip Arthrogram LEFT – RAD07131 MRI Joint Lower Extremity with Contrast 73722 RIGHT – RAD07137 Pelvis - MSK RAD07196 MRI Pelvis without Contrast 72195 Pelvis – MSK RAD07195 MRI Pelvis without and with Contrast 72197

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