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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