Contrast Guidelines for Common CT/CTA MRI/MRA

Contrast Guidelines for Common CT/CTA & MRI/MRA

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

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 & 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

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

EXAM DESCRIPTION CT Abdomen w & wo CT Abdomen & Pelvis w CT Abdomen & Pelvis w CT Abdomen & Pelvis wo 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

Body Imaging

Gastrointestinal

CT

MRI

CT/CTA CPT CODES EXAM DESCRIPTION

74177

MRI Abdomen w & wo

74177

MRI Abdomen w & wo

74177

MRI Abdomen w & wo

74177

MRI Abdomen and Pelvis w & wo

74177

MRI Abdomen w & wo MRCP

74160

MRI Abdomen w & wo

74170

MRI Abdomen w & wo (attn liver)

74170

MRI Abdomen w & wo MRCP

74177

74177 & 76376

74177

74177

MRI Abdomen w & wo (attn liver)

74170

MRI Abdomen w & wo (attn liver)

74170

MRI Abdomen w & wo (attn liver)

74170

MRI Abdomen w & wo (attn liver)

74177

74177

74170

MRI Abdomen w & wo

74170

MRI Abdomen w & wo

74177

74177

Genitourinary

CT

MRI

CT/CTA CPT CODES EXAM DESCRIPTION

74170

MRI Abdomen w & wo

74177

74177

MRI Abdomen w & wo

74176

74178

MRI Abdomen and Pelvis w & wo

74178

MRI Abdomen w & wo (attn kidney)

74178

74178

74176

74170

MRI Abdomen w & wo (attn kidney)

74170

MRI Abdomen w & wo (attn kidney)

Updated 12/4/12

MRI/MRA CPT CODES 74183 74183 74183 74183 & 72197 74183 & 76376 74183 74183 74183 & 76376

74183 74183 74183 74183

74183 74183

MRI/MRA CPT CODES 74183 74183 74183 & 72197 74183

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.

Contrast Guidelines for Common CT/CTA & MRI/MRA

CLINICAL GUIDELINES Adenomyosis Cancer staging Complex adnexal cysts Cysts Dermoid Endometriosis Pelvic mass, origin uncertain Uterine fibroid

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

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

EXAM DESCRIPTION CT Abdomen & Pelvis w CT Pelvis w

EXAM DESCRIPTION CT Chest wo

Pelvis

CT

CT/CTA CPT CODES EXAM DESCRIPTION

MRI Pelvis w & wo

74177

MRI Pelvis w & wo

MRI Pelvis w & wo

MRI Pelvis w & wo

72193

MRI Pelvis w & wo

MRI Pelvis w & wo

MRI Pelvis w & wo

MRI Pelvis w & wo

Pulmonary

CT

CT/CTA CPT CODES EXAM DESCRIPTION

71250

Chest for Interstitial Lung Disease, High resolution (CT Chest wo) CT Chest w CT Chest w CT Chest w

71250 71260 71260 71260

MRI Chest w & wo

Chest for Interstitial Lung Disease, High resolution (CT Chest wo) CT Chest w

71250 71260

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)

Cardiac

CT EXAM DESCRIPTION CT Chest w & wo

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

71250 71260 71250 71260 71270

71260

CT/CTA CPT CODES 71270

75574 75574 75574 71260 75572

MRI Chest w & wo

EXAM DESCRIPTION MRI Chest w & wo MRI Chest wo

MRI Chest w & wo

Updated 12/4/12

MRI MRI/MRA CPT CODES 72197 72197 72197 72197 72197 72197 72197 72197

MRI MRI/MRA CPT CODES

71552

71552

MRI MRI/MRA CPT CODES 71552 71551

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.

Contrast Guidelines for Common CT/CTA & MRI/MRA

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

CT 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

Vascular

CT/CTA CPT CODES 74174 74174 71275 70498 70498 75635

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

CT Angiography Abdomen, Pelvis, Lower Ext w runoff

75635

MRA Abdomen w & wo and MRA Lower Ext w & wo

CT Angiography Abdomen, Pelvis, Lower Ext w runoff

75635

MRA Abdomen w & wo and MRA Lower Ext w & wo

CT Angiography Renal (Abdomen) w & wo Contrast CT Angiography Abdomen & Pelvis CT Angiography Abdomen, Pelvis, Lower Ext w runoff

74175 74174 75635

MRA Abdomen w or wo MRA Abdomen w & wo and MRA Lower Ext w & wo

AAA/Endograft CT Angiography Renal (Abdomen) w & wo Contrast CT Angiography Coronary CT Angiography Chest

74174 74175 75574 71275

MRA Abdomen w or wo MRA Chest w or wo

Updated 12/4/12

MRI/MRA CPT CODES 74185 74185 71555 70549* 70549* 74185 & 73725 * 74185 & 73725 * 74185 & 73725 * 74185 74185 & 73725 *

74185 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.

Contrast Guidelines for Common CT/CTA & MRI/MRA

Updated 12/4/12

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

EXAM DESCRIPTION

CT Soft tissue neck w CT Angiography Carotid/Neck CT Limited sinus wo CT Complete sinus wo CT Brain wo

CT Brain wo CT Brain w & wo

CT Angiography Brain/Head CT Maxillofacial Bones wo CT Temporal Bones wo

CT Soft tissue neck w CT Angiography Brain/Head CT Brain wo CT Temporal Bones w

Neurological Imaging

Head and Neck

CT CT/CTA CPT CODES

70491 70498 70486-52 70486 70450

MRI 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 Brain w & wo MRI Brain w & wo and MRI Orbit , Face, Neck w & wo

70450 70470

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

70496 70486

70480

MRI Brain w & wo MRI Brain w & wo MRI Brain w & wo (Attn to Internal Auditory Canal)

70491 70496 70450

70481

MRA Brain w

MRI Brain w & wo

MRI Brain w & wo MRI Brain w & wo MRI Brain w & wo MRI Brain w & wo MRI Brain w & wo MRI Brain w & wo

MRI/MRA CPT CODES 70553 70553 & 70545 70553 70553 70543 70549

70553

70553 & 70543 70551 70551 70553 70551 70553 70551 70553 70551

70553 & 70543 70553

70553

70553

70545

70553

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.

Contrast Guidelines for Common CT/CTA & MRI/MRA

Updated 12/4/12

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 Soft tissue neck w & wo

CT Brain wo CT Brain wo CT Brain wo CT Brain wo CT Temporal bones wo CT Brain wo CT Brain wo

Head and Neck

CT CT/CTA CPT CODES 70491 70491

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

70492

70450 70450 70450 70450 70480 70450 70450

MRI Brain w & wo MRI Pituitary (Brain w & wo) MRI Pituitary (Brain w & wo)

MRI Brain w & wo MRI Brain w & wo

MRI Brain w & wo MRI Brain w & wo MRI IACs (Brain w & wo)

MRI Brain w & wo MRI IACs (Brain w & wo) MRI Brain w & wo and 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

70553 70553 70553

70553 70553

70553 70553 70553

70553 70553 70553 & 70543

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.

Contrast Guidelines for Common CT/CTA & MRI/MRA

Updated 12/4/12

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

Leg weakness Low back pain Metastasis

Mid back pain

Multiple sclerosis, diagnosed

Multiple sclerosis, suspected

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

Spinal stenosis Syrinx

Transverse myelitis

EXAM DESCRIPTION CT Cervical spine wo

Spine

CT

CT Cervical, Thoracic or Lumbar spine wo CT Pelvis wo CT Lumbar spine wo

CT Lumbar spine wo

*If MRI contraindicated; CT Thoracic spine and Bone Scan

CT Cervical spine wo CT Lumbar spine wo

CT Lumbar spine wo

MRI

CT/CTA CPT CODES EXAM DESCRIPTION

MRI Lumbar spine w & wo

72125

MRI Cervical wo

MRI Cervical wo

MRI Lumbar spine w & wo

MRI Lumbar spine w & wo

MRI Lumbar spine w & wo

72125,72128 or 72131 MRI Cervical wo, Thoracic wo or Lumbar wo

72192

72131

MRI Cervical wo, Thoracic wo or MRI Lumbar wo

MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo

MRI/MRA CPT CODES 72158 72141 72141 72158 72158 72158 72141, 72146 or 72148

72141, 72146 or 72148 72156, 72157, or 72158

72131

MRI Cervical wo, Thoracic wo or Lumbar wo

72141, 72146 or 72148

MRI Lumbar spine wo

72148

MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72156, 72157, or 72158

MRI Thoracic spine wo

72146

MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72156, 72157, or 72158

MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72156, 72157, or 72158

72125 72131

72131

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

MRI Cervical wo, Thoracic wo or Lumbar wo

72141, 72146 or 72148

MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72156, 72157, or 72158

MRI Cervical w & wo, Thoracic w & wo or Lumbar w & wo 72156, 72157, or 72158

"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.

Contrast Guidelines for Common CT/CTA & MRI/MRA

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

EXAM DESCRIPTION

CT Lower or Upper Extremity wo CT Lower or Upper Extremity wo

Labral tear, shoulder Labral tear, shoulder, consider arthrogram if post surgery 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

Soft tissue mass or bony lesion, joint Soft tissue mass or bony lesion, non joint Tendon tear or injury Triangular fibrocartilage tear (wrist)

CT Lower or Upper Extremity w & wo CT Lower or Upper Extremity w & wo

Musculoskeletal

CT CT/CTA CPT CODES

(L)73700 (U)73200 (L)73700 (U)73200

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 Upper Ext JT wo MRI Upper Ext JT w

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

MRI Upper Ext JT wo MRI Upper Ext JT w

(L)73702 (U)73202 (L)73702 (U)73202

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

Updated 12/4/12

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

73221 73222

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

73221 73222

(L)73723 or (U)73223 (L)73720 or (U)73220 (L)73721 or (U)73221 73221

"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.

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