University Radiology To MRI & MRA Ordering Guide

[Pages:7]University Radiology MRI & MRA Ordering Guide

To Order an MRI study call 305-8080 If you are unsure what MRI to order call 305-8656

For more Information visit

Body Part

MRI Brain

MRA Brain

(Arterial or Venous Circulation or Circle

of Willis)

MRA Brain

(Venous Circulation)

MRA Neck

(Arch and Great Vessels)

MRI Orbits

Please use this guide to determine the correct MRI or MRA exam to Order and Precert

Reason for Exam or Exam Indications

Procedure to Order & Precert

Alzheimers

Mental Status Change

Confusion

Dementia

Memory Loss

Stroke / CVA

TIA

Headaches

Dizziness / Vertigo

Cranial Nerve Lesions

HIV / AIDS

Hearing Loss

IAC Mass

Infection

Suspected MS

Neurofibromatosis

Pituitary Lesion

Elevated Prolactin

Seizures

Tumor/Mass/Cancer

Visual Changes

Vascular Lesions

AVM

Bell's Palsy

Facial Weakness

Acoustic Neuroma

Metastases

Aneurysm or Family History of Aneurysm

TIA

Stroke / CVA* (Order with MRI Brain W/Out 70551)

Venous Thrombosis

AVM* (Order with MRI Brain W/WOut 70553)

Sinus Thrombosis

Venous Circulatory Symptoms

Alzheimers

Mental Status Changes

Stroke/CVA

TIA

Bruit

Trauma

MRI Brain Without Contrast

MRI Brain With and Without Contrast

MRA Brain Without Contrast MRA Brain With and Without Contrast MRA Neck With and Without Contrast MRI Orbits (Face/Neck) Without Contrast

Grave's Disease

CPT Code(s) to Precert 70551

70553

70544 70546 70549 70540 70543

? Association of University Radiologists, PC

Page 1

University Radiology MRI & MRA Ordering Guide

To Order an MRI study call 305-8080 If you are unsure what MRI to order call 305-8656

For more Information visit

Body Part MRI Orbits

MRI Neck

MRI Spine Cervical

MRI Spine ? Thoracic

MRI Spine ? Lumbar

Please use this guide to determine the correct MRI or MRA exam to Order and Precert

Reason for Exam or Exam Indications

Procedure to Order & Precert

Exopthalmos / Proptosis Pseudotumor

Tumor/Mass/Cancer/Mets Vascular Lesions (Hemangioma)

MRI Orbits (Face/Neck) Without and With Contrast

Infection

Pain

Tumor / Mass / Cancer / Mets

Vocal Cord Paralysis

Arm/Shoulder Pain Degenerative Disease

Neck Pain

Disc Herniation

Radiculopathy

Numbness

Syrinx

Post Op Fusion

Discitis

Osteomyelitis

Myelopathy

Tumor/Mass/Cancer

Back Pain

Degenerative Disease

Disc Herniation

Radiculopathy

Trauma

Compression Fracture

Discitis

Post Op Fusion

Osteomyelitis

Multiple Sclerosis

Myelopathy

Syrinx

Tumor/Mass/Cancer

Back / Leg Pain Degenerative Disease

Disc Herniation

Radiculopathy

Trauma

Compression Fracture

Sciatica

Spinal Stenosis

Spondylolithesis

Scoliosis

Discitis

Osteomyelitis

MRI Orbits (Face/Neck) Without and With Contrast

MRI Cervical Spine Without Contrast MRI Cervical Spine Without and With

Contrast MRI Thoracic Spine Without Contrast

MRI Thoracic Spine With and Without Contrast

MRI Lumbar Spine Without Contrast

MRI Lumbar Spine Without and With Contrast

CPT Code(s) to Precert

70543 72141 72156 72146 72157

72148 72158

? Association of University Radiologists, PC

Page 2

University Radiology MRI & MRA Ordering Guide

To Order an MRI study call 305-8080 If you are unsure what MRI to order call 305-8656

For more Information visit

Body Part

MRI Abdomen

(General, Liver, Renal, Adrenal, Biliary, Pancreas)

MRA Abdomen MRI Pelvis (Hip)

MRI Pelvis

(Soft Tissue, Uterus, Ovaries)

MRI Pelvis

Continued

Please use this guide to determine the correct MRI or MRA exam to Order and Precert

Reason for Exam or Exam Indications

Procedure to Order & Precert

Post Op HX of Back Surgery

Tumor / Mass / Cancer / Mets

Tumor/Mass/Cancer Abdominal Pain

Post Embolization

Hepatitis

Hemangioma

Cirrhosis

HCC

Renal Mass or Cyst

Transitional Cell

Increased Liver

Carcinoma of Kidney

Function Tests

Adrenal Mass / Lesion

Hematuria

Pheochromocytoma

Hypertension

Jaundice

Abnormal Enzymes

Stones

Biliary Obstruction

Pancreatitis

Pancreas Mass

Painless Jaundice Ampulla Evaluation

Cholangiocarcinoma

PSC ? Primary Sclerosing Cholangitis

Renal Artery Stenosis

Mesenteric Arterial Hypertension

Ischemia

Fracture

Trauma

Hip/Pelvis Pain Muscle /Tendon Tear

Pain

Abscess

Fibroid

Adenomysis

Infertility

Ovarian Mass

Osteomyelitis

Septic Arthritis

Tumor/Mass/Cancer

Pre/Post Uterine Fibroid Embolization

Endometrioma

Decubitis Ulcer

MRI Abdomen With and Without Contrast

MRA Abdomen With and Without Contrast MRI Pelvis Without Contrast

MRI Pelvis With and Without Contrast

? Association of University Radiologists, PC

CPT Code(s) to Precert

74183

74185 72195 72197

Page 3

University Radiology MRI & MRA Ordering Guide

To Order an MRI study call 305-8080 If you are unsure what MRI to order call 305-8656

For more Information visit

Body Part

MRA Pelvis (Iliac Vessels)

MR Enterography

MRI Extremity NON JOINT:

Forearms Humerus Lower Leg/Calf Femur/Thigh

MRI Extremity JOINT:

Upper:

Hand Wrist Elbow Shoulder SC Joint Lower: Foot Ankle Knee Hip (Whole Pelvis) MRA Upper Extremity

Please use this guide to determine the correct MRI or MRA exam to Order and Precert

Reason for Exam or Exam Indications

Procedure to Order & Precert

Pelvic Venous Thrombosis

Crohn's Disease

Celiac Disease

Small Bowel Tumor

Crohn's Fistulous Disease

Fracture

Stress Fracture

Muscle or Tendon Tear

Plantar Fasciitis

Abscess

Myositis

Ulcer

Osteomyelitis

Tumor/Mass/Mets Morton's Neuroma

Soft Tissue Mass

Arthritis

Meniscal Tear

Avascular Necrosis

Muscle Tear

Stress Fracture

Ligament Tear

Joint Pain

Cartilage Tear

Internal Derangement

Ostochondritis (OCD)

Plantar Fasciitis

Labral Tear

Abscess Ulcer

Cellulitis Myositis

Osteomyelitis Inflamed Arthritis

Septic Arthritis Tumor/Mets/Mass

Subclavian Tenderness, Redness, Swelling

MRA Pelvis With and Without Contrast

MRI Abdomen With and Without Contrast MRI Pelvis With and Without Contrast

MRI Non-Joint Without Contrast: Upper Extremity Lower Extremity

MRI Non-Joint With and Without Contrast: Upper Extremity Lower Extremity

MRI Joint Without Contrast: Upper Extremity Lower Extremity

MRI Joint Without and With Contrast: Upper Extremity Lower Extremity

MRA Upper Extremity With and Without Contrast

CPT Code(s) to Precert 72198 74183 72197

73218 (Upper) 73718 (Lower)

73220 (Upper) 73720 (Lower)

73221 (Upper) 73721 (Lower)

73223 (Upper) 73723 (Lower)

73225

? Association of University Radiologists, PC

Page 4

University Radiology MRI & MRA Ordering Guide

To Order an MRI study call 305-8080 If you are unsure what MRI to order call 305-8656

For more Information visit

Body Part MRA Lower Extremity

MR Arthogram

(Upper Extremity, Shoulder, Elbow,

Wrist)

MR Arthogram

(Lower Extremity, Hip, Knee, Ankle)

MRI Lumbosacral Plexus

MRI Brachial Plexus

MRI Chest (Mediastinum)

MRA Aorta MRA Aorta With Peripheral

Run-Off

Please use this guide to determine the correct MRI or MRA exam to Order and Precert

Reason for Exam or Exam Indications

Procedure to Order & Precert

Peripheral Vascular Disease

Shoulder Instability Labral Tear Loose Body

Ligament Injury TFCC Tear

Labral Tear

Loose Body

Post Surgical Meniscus Retear

OCD Lesion (Osteochondritis Dissecans)

Leg Pain/Sciatica

Lumbar Plexopathy

Radiculopathy

Sacral/Coccyx Pain

Shoulder Injury

Nerve Avulsion

Brachial Plexopathy

Tumor/Mass/Cancer/Mets

Abdominal Aortic Dissection

MRA Lower Extremity With or Without Contrast

MRI Upper Extremity Joint With and Without Contrast

Shoulder Injection Elbow Injection Wrist Injection

MRI Lower Extremity Joint With and Without Contrast

Hip Injection Knee Injection Ankle Injection

MRI Pelvis Without Contrast

MRI Upper Extremity Non-Joint With and Without Contrast

MRI Chest/Mediastinum With and Without Contrast

MRA Abdomen With and Without Contrast

Peripheral Vascular Disease Claudication

MRA Abdomen With and Without Contrast MRA Lower Extremity With and Without Contrast

CPT Code(s) to Precert 73725 73222

23350 24220 25246 73722

27093 27370 27093 72195

73220

71552 74185

74185 73725

? Association of University Radiologists, PC

Page 5

Body Part MRI Breast

Cardiac MRI

STROKE PROTOCOL

University Radiology MRI & MRA Ordering Guide

To Order an MRI study call 305-8080 If you are unsure what MRI to order call 305-8656

For more Information visit

Please use this guide to determine the correct MRI or MRA exam to Order and Precert

Reason for Exam or Exam Indications

Procedure to Order & Precert

Newly Diagnosed Breast Cancer Family History of Breast Cancer / 20% Lifetime

Risk of Breast Cancer BRCA 1 and BRCA 2 Genes Implant Integrity Issue or Rupture

MRI Breast Bi-Lateral With and Without Contrast

Sarcoidosis, Amyloidosis, Hypertrophic Cardiomyopathy, Mass

Cardiac MRI with and Without Contrast

Common MRI Protocols

Stroke Suspected Stroke

TIA

MRI Brain With and Without Contrast MRA Head Without Contrast

MRA Neck With and Without Contrast

CPT Code(s) to Precert 77059

75561

Precert All: 70553 70544 70549

CAROTID PROTOCOL

MRA Neck With and Without Contrast

70549

LIVER (HEPATIC) PROTOCOL

MR ENTEROGRAPHY

Crohn's Disease Celiac Disease Small Bowel Tumor Crohn's Fistulous Disease

? Association of University Radiologists, PC

MRI Abdomen With and Without Contrast

MRI Abdomen With and Without Contrast MRI Pelvis With and Without Contrast

74183

74183 72197

Page 6

University Radiology MRI & MRA Ordering Guide

To Order an MRI study call 305-8080 If you are unsure what MRI to order call 305-8656

For more Information visit

? Association of University Radiologists, PC

Page 7

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