EPIC Ordering Reference Sheet Head/Neck - MRI Group

Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 Web Site:

EPIC Ordering Reference Sheet ? Head/Neck

Body Part

RAD Code Procedure to Pre-Cert

Brain Brain Circle of Willis (COW) Carotid Carotid Intracranial Venous Sinus Orbits Neck-Soft Tissue TMJ

RAD07060 RAD07058 RAD07018 RAD07024 RAD07023 RAD09111 RAD07188 RAD07188 RAD07225

MRI Brain without Contrast MRI Brain without and with Contrast MRA Head without Contrast MRA Neck without Contrast MRA Neck without and with Contrast MRV Head without and with Contrast MRI Orbits/Face/Neck without and with Contrast MRI Orbits/Face/Neck without and with Contrast MRI Temporomandibular Joint

CPT Code

70551 70553 70544 70547 70549 70546 70543 70543 70336

EPIC Ordering Reference Sheet ? Spine

Body Part

RAD Code Procedure to Pre-Cert

Spine: Cervical Spine: Cervical Spine: Thoracic Spine: Thoracic Spine: Lumbar Spine: Lumbar SI Joints SI Joints Sacrum Sacrum

RAD07075 RAD07074 RAD07228 RAD07227 RAD07178 RAD07177 RAD09118 RAD09120 RAD07208 RAD07207

MRI Cervical Spine without Contrast MRI Cervical Spine without and with Contrast MRI Thoracic Spine without Contrast MRI Thoracic Spine without and with Contrast MRI Lumbar Spine without Contrast MRI Lumbar Spine without and with Contrast MRI Pelvis without Contrast MRI Pelvis without and with Contrast MRI Pelvis without Contrast MRI Pelvis without and with Contrast

CPT Code

72141 72156 72146 72157 72148 72158 72195 72197 72195 72197

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Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 Web Site:

EPIC Ordering Reference Sheet ? Body

Body Part

Abdomen - Adrenals Abdomen - MRCP Abdomen ? Liver Kidneys Mass Abdomen - MRE Abdomen - MRA Brachial Plexus

Brachial Plexus

Chest ? MRA Chest Mediastinum Chest Mediastinum Pelvis - Female Pelvis - Female Pelvis - Angiography Peripherals (must choose Left and Right ? not Bilateral; also need to order Pelvis MRA at same time)

RAD Code

RAD07005 RAD07249 RAD07003 *Note in comment section area you are looking at (Liver, Kidneys, etc.) RAD09135 RAD07011 BILAT ? RAD07268 LEFT ? RAD07052 RIGHT ? RAD07266 BILAT ? RAD07051 LEFT ? RAD07053 RIGHT ? RAD07264 RAD07014 RAD07078 RAD07077 RAD07196 RAD07195 RAD07026 LEFT ? RAD07020 RIGHT ? RAD07021

Pelvis ? RAD07020

Procedure to Pre-Cert

MRI Abdomen without Contrast MRI Abdomen without Contrast MRI Abdomen without and with Contrast

CPT Code

74181 74181 74183

MRI Abdomen without and with Contrast MRA Abdomen without and with Contrast MRI Chest without Contrast

74183 74185 71550

MRI Chest without and with Contrast

71552

MRA Chest without and with Contrast MRI Chest without Contrast MRI Chest without and with Contrast MRI Pelvis without Contrast MRI Pelvis without and with Contrast Pelvic Angiography with or without Contrast Lower Extremity Angiography with or without Contrast

71555 71550 71552 72195 72197 72198 73725

Pelvic Angiography with or without Contrast 72198

6/14

Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 Web Site:

EPIC Ordering Reference Sheet ? MSK Upper Extremity

Body Part

RAD Code

Hand/Finger Hand/Finger Wrist Wrist Wrist Arthrogram Forearm Forearm Elbow Elbow Elbow Arthrogram Humerus Humerus Shoulder Shoulder Shoulder Arthrogram

LEFT ? RAD07120 RIGHT ? RAD07123 LEFT ? RAD07119 RIGHT ? RAD07122 LEFT ? RAD07241 RIGHT ? RAD07247 LEFT ? RAD07240 RIGHT ? RAD07246 LEFT ? RAD07236 RIGHT ? RAD07242 LEFT ? RAD07113 RIGHT ? RAD07277 LEFT ? RAD07112 RIGHT ? RAD07276 LEFT ? RAD07086 RIGHT ? RAD07092 LEFT ? RAD07085 RIGHT ? RAD07091 LEFT ? RAD07081 RIGHT ? RAD07087 LEFT ? RAD07148 RIGHT ? RAD07151 LEFT ? RAD07147 RIGHT ? RAD07150 LEFT ? RAD07214 RIGHT ? RAD07220 LEFT ? RAD07213 RIGHT ? RAD07219 LEFT ? RAD07209 RIGHT ? RAD07215

Procedure to Pre-Cert

MRI Non-Joint Upper Extremity without Contrast MRI Non-Joint Upper Extremity without and with Contrast MRI Joint Upper Extremity without Contrast MRI Joint Upper Extremity without and with Contrast MRI Upper Extremity Joint with Contrast

CPT Code

73218

73220

73221

73223

73222

MRI Non-Joint Upper Extremity without Contrast MRI Non-Joint Upper Extremity without and with Contrast MRI Joint Upper Extremity without Contrast MRI Joint Upper Extremity without and with Contrast MRI Upper Extremity Joint with Contrast

73218 73220 73221 73223 73222

MRI Non-Joint Upper Extremity without Contrast MRI Non-Joint Upper Extremity without and with Contrast MRI Joint Upper Extremity without Contrast MRI Joint Upper Extremity without and with Contrast MRI Upper Extremity Joint with Contrast

73218 73220 73221 73223 73222

6/14

Scheduling: 717.291.1016 or 888.MRI.1377 Fax: 717.509.8642 Web Site:

EPIC Ordering Reference Sheet ? MSK Lower Extremity

Body Part

RAD Code

Foot/Toes

Foot/Toes

Ankle

Ankle

Ankle Arthrogram

Lower Leg (Tib/Fib or Calf) Lower Leg (Tib/Fib or Calf) Knee

Knee

Knee Arthrogram

Thigh/Femur

Thigh/Femur

Hip

Hip

Hip Arthrogram

Pelvis - MSK Pelvis ? MSK

LEFT ? RAD07107 RIGHT ? RAD07110 LEFT ? RAD07106 RIGHT ? RAD07109 LEFT ? RAD07035 RIGHT ? RAD07041 LEFT ? RAD07040 RIGHT ? RAD07046 LEFT ? RAD07036 RIGHT ? RAD07042 LEFT ? RAD07231 RIGHT ? RAD07234 LEFT ? RAD07230 RIGHT ? RAD07233 LEFT ? RAD07160 RIGHT ? RAD07166 LEFT ? RAD07165 RIGHT ? RAD07171 LEFT ? RAD07161 RIGHT ? RAD07167 LEFT ? RAD07098 RIGHT ? RAD07101 LEFT ? RAD07097 RIGHT ? RAD07100 LEFT ? RAD07136 RIGHT ? RAD07142 LEFT ? RAD07135 RIGHT ? RAD07141 LEFT ? RAD07131 RIGHT ? RAD07137 RAD07196 RAD07195

Procedure to Pre-Cert

MRI Non-Joint Lower Extremity without Contrast MRI Non-Joint Lower Extremity without and with Contrast MRI Joint Lower Extremity without Contrast MRI Joint Lower Extremity without and with Contrast MRI Joint Lower Extremity with Contrast

CPT Code

73718

73720

73721

73723

73722

MRI Non-Joint Lower Extremity without Contrast MRI Non-Joint Lower Extremity without and with Contrast MRI Joint Lower Extremity without Contrast MRI Joint Lower Extremity without and with Contrast MRI Joint Lower Extremity with Contrast

73718 73720 73721 73723 73722

MRI Non-Joint Lower Extremity without Contrast MRI Non-Joint Lower Extremity without and with Contrast MRI Joint Lower Extremity without Contrast MRI Joint Lower Extremity without and with Contrast MRI Joint Lower Extremity with Contrast

73718 73720 73721 73723 73722

MRI Pelvis without Contrast MRI Pelvis without and with Contrast

72195 72197

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