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CT Standard Operating ProceduresBody PartReason For ExamIV ContrastProcedure to Pre-CertCPT CodeHead/Brain Alzheimer’sBleed, HemorrhageCVA, Stroke Headaches HydrocephalusMemory Loss, ConfusionShunt CheckTraumaVertigo, Dizziness*Infection*Mass/Tumor*Metastatic Staging* Headache w/Associated Neurologic Signs* HIVMelanomaToxoplasmosis *MRI PREFERREDNo YesYes CT Head, Brain Without Contrast CT Head, Brain With Contrast CT Head, Brain Without and With Contrast704507046070470CTA Brain (Head) AneurysmAVM (Arterio/Venous MalformationCVATIA Vascular MalformationVasculitisYesCTA Brain 75671Orbit Foreign BodyFracture Graves Disease TraumaAbscessExopthalmusMassPainPseudo TumorRetinoblastomaNoYesYesCT Orbit Without Contrast CT Orbit With Contrast CT Orbit without & with Contrast704807048170482Sinus ( Limited study)Sinusitis AllergiesFrontal pressure(billing will apply modifier 52) *This is for limited exam ONLY*NoCT Sinus (same CPT code as sinus complete, but billed with modifier -52) 70486Body PartReason For ExamIV ContrastProcedure to Pre-CertCPT CodeSinus Full Osteomeatal ComplexAt Physician’s request, specifically ENT group.No CT Sinus Complete70486Sinus Stealth ProtocolSurgical Planning – Sinus surgeryNoCT Sinus Stealth Protocol70486Facial BonesTraumaNo CT Facial Bones w/o70486Temporal Bone CholesteotomaHearing Loss, Conductive*Trauma (remove)*Sensory neuro hearing loss, order MRI with and without contrastNoCT Inner Ears, Temporal Bones 70480CTA Carotid Aneurysm/DissectionBruitCarotid Stenosis CVATIAYesCTA Carotid 75662Spine Cervical/ThoracicTrauma, Fracture, FusionAssess Bony Degenerative Changes*MRI recommended for disc herniation, mets or infection NoCT Cervical Spine Without Contrast CT Thoracic Spine Without Contrast 7212572128SpineLumbar/Sacral Trauma, Fracture, Fusion, Pars Defect - *MRI recommended for disc herniation, mets, infection. NoCT Lumbar Spine Without Contrast 72131Neck/Parotid All necks should be ordered with contrast unless there is renal failure Parotid MassGland Infection of ParotidParotid StoneYesYesCT Neck, Parotid With Contrast CT Neck, Parotid Without and With Contrast 7049170492Neck/Parotid/NasopharynxIf elevated creatinine, or ordered without contrast. NoCT Neck Without Contrast 70490Body PartReason For ExamIV ContrastProcedure to Pre-CertCPT CodeChestAll chest CTs are ordered with contrast except for those patients with a contraindication to contrast or those referred for pulmonary nodule follow-upAsbestosisCOPDCoughEsophageal CA HemoptysisLymphomaLung CA Lung Nodule MassPneumoniaSarcoidosisNoYesCT Chest Without Contrast CT Chest With Contrast 7125071260CT Lung Cancer ScreeningCategory 1a: 55-74 years old, 30+ pack years, stopped smoking less than 15 years ago.Category 2b: 50-74 years old, 20+ pack years, have one additional risk factor* including second hand smoke.Risk Factors* Tobacco smokingContact with radonContact with asbestos or other cancer-causing agents such as chromium, arsenic, beryllium, cadmium, nickel, coal smoke, soot, silica or diesel fumes. Having had certain other cancersFamily member with lung cancer Having had other lung disease such as COPD or pulmonary fibrosisNoCT Lung Cancer Screening71250Chest, High Resolution BronchiectasisFibrosis Interstitial DiseasePleural PlaquesNoCT Chest Without High Resolution 71250Body PartReason For ExamIV ContrastProcedure to Pre-CertCPT CodeCTA Chest & AbdThoracic Aortic Dissection Aneurysm Aortic Dissection Thoracic AorticStenosisArterial occlusive diseaseTraumaYesCTA Chest and Abdomen (Please authorize BOTH codes) 7127575635CTA Chest ( PE Study)Chest Pain / Dyspnea+ D DimersDVTHemoptysisPulmonary HypertensionShortness of BreathTachypneaYes CT with contrast 71260Abdomen Adrenal MassCirrhosisEmbolization Hepatoma, HepatitisLiver Hemangioma- (MR preferred) Radiofrequency AblationYesCT Abdomen Without and With Contrast 74170Abdomen and/or Kidney and Pelvis (if ordering pelvis, both codes must be authorized) CarcinoidKidney Cyst vs. Mass - (MRI Preferred)Painless Hematuria YesCT Abdomen Without and With Contrast CT Pelvis With Contrast 7417072193Abdomen/PelvisHematuria Stone (Stone Study) Abdominal Pain (upper & lower quardrants) AbscessAppendicitis Cancer Staging (except melanoma & carcinoid)*Colitis/ IBDCrohns / UlcerativeDiverticulitisHematuriaHernia (i.e. ventral, umbilical, inguinal)**Mass *For certain CA’s, some insurance companies will not cover CT pelvis (i.e. breast & lung CA) ** Non covered indication for upper quadrant. NoYes CT Abdomen Without Contrast ANDCT Pelvis Without Contrast CT Abdomen With Contrast ANDCT Pelvis With Contrast 7417674177Body PartReason For ExamIV ContrastProcedure to Pre-CertCPT CodePelvis (Routine) Cancer Staging CystsInfectionMassPain YesCT Pelvis With Contrast Note: Symptoms must be in pelvis or lower abdomen to be covered by Medicare. 72193Pelvis Bone Infection Infection*Tumor/Mass/Cancer/Mets*Recommend MRIYesCT Pelvis Without and With Contrast Note: Must be in pelvic region (lower abdomen) to be a covered service of Medicare. 72194CT Urogram Carcinoma Kidney and/or Bladder Transitional CellYesCT Abdomen and Pelvis With and Without Contrast 74170CTA Abdomen & Run Off Peripheral Artery Disease (PAD)YesCT Abdomen and Run Off (Please authorize BOTH codes.) 7563573706CT Colonography, ScreeningOrdered per age guidelinesNoCT Colonography, screening including post-processing74263CT Colonography, DiagnosticOrdered due to positive finding or indicationNoCT Colonography, diagnostic, including post-processing74261Pubic Arch Study Protocol Prostate Treatment Planning NoCT Pelvis Without Contrast72192Pelvis HipsAcetabulumFracture Non Union Arthritis NoCT Pelvis Without Contrast72192ExtremityFoot ToeAnkleCalfKneeThighFemurLower LegFingerHandWristForearmElbowHumerusArthritisFemoral Anteversion Fracture FusionLoose bodyMalunionMalignment Knee (indicate Lt, Rt, or Bil) Non UnionOsteochondral lesionNoCT Without Contrast Lower Extremity Upper Extremity 7370073200ExtremitiesInfection* Tumor/Mass/Cancer/Mets*Recommend MRIYesCT Without and With Contrast –LowerCT Without and With Contrast –Upper7370273202Body PartReason For ExamIV ContrastProcedure to Pre-CertCPT CodeCT Angiography - ExtremitiesArterial Stenosis – LowerClaudication -extremityIschemia - extremityPeripheral Artery DiseaseYesCT Angiography Lower Extremity Upper Extremity 7370673206 CT Arthrography Cartilage Abnormally Labrum Abnormality Loose Bodies Meniscus Abnormally YesCT With Contrast Lower Extremity with Contrast Upper Extremity with Contrast Fluoro Guided Joint Injection*Please state which joint in comments737017320176000CT Cardiac Calcium scoring screeing Risk-stratification? Atypical chest pain??Intermediate risk of significant CAD??Risk stratification in equivocal work-up??Pre EP-ablation planning??Severe pulmonary hypertension??Anomalous coronary and assessment of myocardial bridges??Known or suspected coronary fistula??Congenital heart or vascular disease??Bicuspid aortic valve??Anomalous Pulmonary Venous Connections? ASDs/VSDsNoYesCT Cardiac without ContrastCardiac CT with Contrast7557175572 (75574?)If in the setting of congenital heart disease - 75573Gated CTA Chest??Sudden onset of tearing back pain??Suspected dissection, aneurysm, and follow-up??Evaluate intra-cardiac mass or thrombus??Cardiac diverticulum, aneurism or pseudoaneurism??Bicuspid aortic valve (aortopathy)??Marfans and other connective tissue disorders (precise measurements)??Infectious Endocarditis??Aortic or Cardiac abscess??Post-operative such as CABG and AV-replacement??Post-repaired aorta aneurism/dissection??Pre-operative and pre-procedural (pre-TAVR/TAVI and re-do CABG or AVR)??Pericardiac mass??Pericarditis??Mediastinitis??Mediastinal Mass??Surgical and procedural complications??Tracheal/bronchial injury/fistulas??Post-operative congenital heart disease? Consult DCVI radiology!YesCTA Chest71275Contrast ExamsMedical contraindications to contrastCan change to non-contrast exam ................
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