CT Ordering Guide
MRI Standard Operating Procedures
|Body Part |Reason For Exam |IV Contrast |Procedure to Pre-Cert |CPT Code |
| |Alzheimer’s | | | |
| |Confusion | | | |
| |CVA | | | |
| |Dementia | | | |
| |Dizziness |No |MRI Without Contrast |70551 |
| |Headache w/o Focal Symptoms | | | |
| |Memory Loss | | | |
| |Mental Status Changes | | | |
| |Stroke | | | |
| |TIA | | | |
| |Trauma | | | |
| |Vertigo | | | |
|Brain |Vision Changes | | | |
| | | | | |
| |Adenoma | | | |
| |Cranial Nerve Lesions | | | |
| |HIV | | | |
| |Infection | | | |
| |Multiple Sclerosis |Yes |MRI With & Without Contrast |70553 |
| |Neurofibromatosis | | | |
| |Seizures | | | |
| |Tumor/Mass/Cancer/Mets | | | |
| |Vascular Lesions | | | |
|“IAC” |IAC/Hearing Loss |Yes | | |
|“Pituitary” |Elevated Prolactin |Yes |MRI With & Without Contrast |70553 |
|“Pituitary” |Pituitary Lesion |Yes | | |
| | | | | |
| |To guide surgery planning, | | | |
| |radiation therapy, or other | | | |
| |surgical treatments for the brain, | | | |
| |such as laser ablation; for | | | |
| |preoperative planning to localize | | |70555 |
| |language dominance and for | |fMRI |96020 |
| |functional localization of memory; | | | |
| |to localize abnormal brain | | | |
| |functionfor epilepsy surgery | | | |
| |Stroke | | | |
|MRA Brain |CVA | | | |
| |TIA |No |MRA Brain Without Contrast |70544 |
| |Aneurysm | | | |
| |Arterial Venous | | | |
| |Alzheimer’s | | | |
| |Dementia |No |MRI Spectroscopy Without Contrast |76390 |
|Brain Spectroscopy |Seizures | | | |
| |Encephalopathy | | | |
| |Ischemia | | | |
| |Hypoxia | | | |
| |Brain Injury | |MRI Spectroscopy With and/or Without |76390 |
| | |Yes |Contrast | |
| |Tumor/Mass/Cancer/Mets | | | |
| |Infection | | | |
| |Multiple Sclerosis | | | |
| |Toxic Metabolic (peds) | | | |
|Body Part |Reason For Exam |IV Contrast |Procedure to Pre-Cert |CPT Code |
| | | | | |
|MRV Brain |Venous Thrombosis |No |MRA Without Contrast |70544 |
| | | | | |
| |Demyelination/Multiple | | | |
| |Diplopia | | | |
| |Dysthyroid Eye Disease | | | |
|Orbits |Exopthalmos | | | |
| |Grave’s Disease |Yes |MRI Orbits/Face/Neck With & Without |70543 |
| |Proptosis | |Contrast | |
| |Pseudotumor | | | |
| |Sclerosis | | | |
| |Trauma | | | |
| |Tumor/Mass/Cancer/Mets | | | |
| |Vascular Lesions | | | |
| | | | | |
| | | | | |
| |Infection | | | |
|Neck |Tumor/Mass/Cancer/Mets |Yes |MRI Orbits/Face/Neck With & Without |70543 |
| |Vocal Cord Paralysis | |Contrast | |
| | | | | |
| |Aneurysm | | | |
| |Arterial Venous Malformation | | | |
|MRA Neck |CVA |Yes |MRA Neck With & Without Contrast |70549 |
| |Stroke | | | |
| |Subclavian Steal | | | |
| |TIA | | | |
| | | | | |
| | | | | |
| |Aneurysm(Neck specific) | | | |
|MRA Arch & Great Vessels |Arterial Venous Malformation |Yes |MRA Neck With & Without Contrast |70549 |
| |CVA | | | |
| |Stroke | | | |
| |Subclavian Steal | | | |
| |TIA | | | |
| | | | | |
| | | | | |
| | | | | |
| |Arm/Shoulder Pain and/or | | | |
| |Weakness | | |2141 |
| |Degenerative Disease |No |MRI Cervical Spine Without Contrast | |
| |Disc Herniation | | | |
|Spine: Cervical |Neck Pain | | | |
| |Radiculopathy | | | |
| | | | | |
| |Post-op for tumor | | | |
| |Abscess/Infection | | | |
| |Discitis | |MRI Cervical Spine With & Without | |
| |Multiple Sclerosis |Yes |Contrast |72156 |
| |Myelopathy | | | |
| |Osteomyelitis | | | |
| |Syrinx | | | |
| |Tumor/Mass/Cancer/Mets | | | |
| |Vascular Lesions/AVM | | | |
| | | | | |
|Body Part |Reason For Exam |IV Contrast |Procedure to Pre-Cert |CPT Code |
| | | | | |
| |Back Pain | | | |
| |Compression Fracture (no hx | | | |
| |cancer/mets) |No |MRI Thoracic Without Contrast |72146 |
| |Degenerative Disease | | | |
| |Disc Herniation | | | |
| |Radiculopathy | | | |
| |Trauma | | | |
| |Vertebroplasty Planning (no hx of | | | |
|Spine: Thoracic |cancer/mets) | | | |
| |Compression Fracture (with hx of | | | |
| |cancer/mets) | | | |
| | | | | |
| |Post-op for tumor | | | |
| |Abscess/Infection | | | |
| |AVM | | | |
| |Discitis | | | |
| |Multiple Sclerosis | | | |
| |Myelopathy | |MRI Thoracic With & Without Contrast | |
| |Osteomyelitis |Yes | |72157 |
| |Syrinx | | | |
| |Tumor/Mass/Cancer/Mets | | | |
| |Vascular Lesions | | | |
| |Vertebroplasty Planning (with hx of| | | |
| |cancer/mets) | | | |
| | | | | |
| | | | | |
| |Back Pain | | | |
| |Compression Fracture (no hx | | | |
| |cancer/mets) | | | |
| |Degenerative Disease | | | |
| |Disc Herniation |No |MRI Lumbar Without Contrast |72148 |
| |Radiculopathy | | | |
| |Sciatica | | | |
|Spine: Lumbar |Spondylolithesis | | | |
| |Stenosis | | | |
| |Trauma | | | |
| |Vertebroplasty (no hx of | | | |
| |cancer/mets) | | | |
| | | | | |
| | | | | |
| |Postop (any hx lumbar surgery | | | |
| |within 2 yrs) | | | |
| |Abscess/Infection | | | |
| |Compression Fracture (with hx of | | | |
| |cancer/mets) | | | |
| |Demyelinating |Yes |MRI Lumbar With & Without Contrast |72158 |
| |Discitis | | | |
| |Osteomyelitis | | | |
| |Tumor/Mass/Cancer/Mets | | | |
| |Vertebroplasty Planning (with hx of| | | |
| |cancer/mets) | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
|Body Part |Reason For Exam |IV Contrast |Procedure to Pre-Cert |CPT Code |
| | | | | |
|Chest |Tumor/Mass/Cancer/Mets |Yes |MRI Chest/Mediastinum With & Without | |
|Mediastinum | | |Contrast |71552 |
| | | | | |
| |Aneurysm | | | |
| |Arterial Venous Malformation | | | |
| |Coarctation | | | |
| |Dissection |Yes |MRA Chest With or Without Contrast |71555 |
|MRA Chest |Pulmonary Embolism | | | |
| |Thoracic Aorta (other than the | | | |
| |heart) | | | |
| |Thoracic Outlet Syndrome | | | |
| |Vascular Anomalies Subclavian | | | |
| |Vessels | | | |
| | | | | |
| |Arterial Venous Malformation | |MRA Chest With or Without |71555 |
|MRV Chest |Venous Occlusion/ Thrombosis |Yes |Contrast | |
| | | | | |
| | | |MRI Breast Without Contrast | |
| |Implant Rupture |No |Bilateral |77059 |
| | | |Unilateral (specify breast) |77058 |
| | | | | |
|Breast | | | |77059 |
| |Abnormal Mammogram | |MRI Breast Bilateral With & or Without | |
| |Abnormal Ultrasound |Yes |Contrast | |
| |Dense Breast/High Risk | | |77058 |
| |Mass/Lesion/Cancer | |MRI Breast Unilateral With & or Without | |
| |Palpable Mass | |Contrast (Specify Side) | |
| | | | | |
| |Brachial Plexus Injury |No |MRI Chest/Mediastinum With & Without |71552 |
|Brachial Plexus |Nerve Avulsion | |Contrast | |
| | | | | |
| |Tumor/Mass/Cancer/Mets |Yes | | |
| |Neuropathy | | | |
| | | | | |
| |Anomalous Coronary Artery -CCTA |No |Morphology & Function Without Contrast |75557 |
| | | | | |
| |If looking for Valve | |Morphology & Function Without | |
| |Insuffciency/Regurgilation, ASD/VSD| |Contrast; With Flow/Velocity |75557 |
| |and the patient is unable to | |Quantification | |
|Cardiac |receive a |No | |75565 |
| |contrast agent. | | | |
| | | |Morphology & Function Without and With | |
| |ARVD | |Contrast and Further Sequences | |
| |Mass |Yes | |75561 |
| |Myocardial Infarction | | | |
| |Pericardial Disease | |Morphology & Function Without Contrast; | |
| |Sarcoldosis | |With Flow/Velocity | |
| |Viability | |Quantification | |
| | | | |75561 |
| |Valve Insuffciency/Regurgilation |No | | |
| |Atrial/Ventricular Septal Defect | | |75565 |
|Body Part |Reason For Exam |IV Contrast |Procedure to Pre-Cert |CPT Code |
| | | | | |
| |Abnormal Enzymes | | | |
| |MRCP (Biliary/Pancreatic Ducts, |No |MRI Abdomen Without Contrast |74181 |
| |Stones, Jaundice) | | | |
| | | |MRI Abdomen & Pelvis Without Contrast | |
| |r/o appy or renal stone in pregnant|No | |74181 & 72195 |
|Abdomen |pt. | | | |
| |Fetal MRI | | | |
| | |Yes |MRI Abdomen With & Without |74183 |
| |Abdominal Pain | |Contrast | |
| |Abscess/Ascites | | | |
| |Adrenal Mass | | | |
| |Liver | | | |
| |Pancreatic Mass/Lesion | | | |
| |Renal Lesion | | | |
| |Tumor/Mass/Cancer/Mets | | | |
| | | | | |
| |AAA(abdominal aortic aneurysm) |Yes |MRA Abdomen With or Without contrast |74185 |
| |Dissection | | | |
| |Mesenteric Ischemia | | | |
|MRA Abdomen |Renal Artery Stenosis | |Order 2 Studies | |
| | | |MRA Abdomend With or Without Contrast | |
| |Pre Liver Transplant |Yes | |74185 |
| |Pre Kidney Transplant | |MRI Abdomen With Or Without Contrast | |
| |Renal Mass | | | |
| | | | |74183 |
| | | | | |
| |Venous Anomaly | |MRA Abdomen With or Without Contrast |74185 |
|MRV Abdomen |Venous Occlusion |Yes | | |
| |Venous Thrombosis | | | |
| | | | | |
| |Fracture | | | |
| |Muscle/Tendon Tear |No |MRI Pelvis Without Contrast |72195 |
| |Urethral Diveticulum | | | |
| |Rectal Cancer | | | |
| | | | | |
| |Placenta Accreta/Previa/Increta | | | |
| | |No |MRI Abdomen & Pelvis Without Contrast |74181 & 72195 |
|Pelvis |Abscess | | | |
| |Adenomyosis | | | |
| |Embolization | | | |
| |Endometrioma | | | |
| |Fibroid | |MRI Pelvis With & Without Contrast | |
| |Osteomyetits |Yes | |72197 |
| |Plexopathy | | | |
| |Pre/Post Fibroid | | | |
| |Prostate Cancer | | | |
| |Septic Arthritis | | | |
| |Tumor/Mass/Cancer/Mets | | | |
| | | | | |
| |Aneurysm | | | |
| |AVM (artriovenous malformation) |Yes |MRA Pelvis With or Without |72198 |
|MRA Pelvis | | |Contrast | |
|Or | | | | |
|MRV Pelvis |May Thurner Syndrome | |Order 2 Exams: | |
| |Pelvic Congestion | |MRA Pelvis With or Without Contrast |72198 |
| |Venous Occlusion |Yes | | |
| | | |MRI Pelvis With and Without Contrast | |
| | | | |72197 |
|Body Part |Reason For Exam |IV Contrast |Procedure to Pre-Cert |CPT Code |
| | |Yes | | |
| |Claudication |Yes |Order 3 Exams: |74185 |
|MRA Peripheral |Cold foot | |MRA Abdomen with/without contrast & | |
|(Run-off) |Gangrene | | | |
| |Pain | |MRA Lower Extremity with/without |73725 |
| |Ulcer | |contrast LEFT & | |
| | | | | |
| | | |MRA Lower Extremity with/without |73725 |
| | | |contrast RIGHT | |
| | | | | |
|MRA Extremity or |Aneurysm | |MRA Extremity with & without contrast | |
|MRV Extremity |Arterial Occlusion/Stenosis |Yes |Upper Extremity | |
| |Venous Occlusion | | |73225 |
| | | |Lower Extremity | |
| | | | |73725 |
| |Fracture | | | |
| |Muscle/Tendon tear | |MRI Non-Joint Without Contrast | |
|Extremity, |Stress Fracture |No |Lower-Extremity | |
|Non-Joint | | | |73718 |
| | | |Upper-Extremity | |
|Arm |Abscess | | |73218 |
|Hand |Cellultis | | | |
|Finger |Fasciitis | |MRI Non-Joint Without & With Contrast | |
|Femur |Myositis |Yes |Lower-Extremity | |
|Lower Leg |Osteomyelitis | | | |
|Foot |Soft Tissue Tumor/Mass/ | |Upper-Extremity |73720 |
|Toe |Cancer/Mets | | | |
| |Ulcer | | |73220 |
| | | | | |
| |Arthritis | | | |
|Extremity, Joint |AVN (Avascular Necrosis) | | | |
| |Cartilage Tear | |MRI Joint Without Contrast | |
|Shoulder |Fracture |No | | |
|Elbow |Internal Derangement | |Lower-Extremity |73721 |
|Wrist |Joint Pain (specify joint) | | | |
|Hip |Labral Tear | |Upper-Extremity |73221 |
|Knee |Ligament Tear | | | |
|Ankle |Meniscus Tear | | | |
|Foot |Muscle Tear | | | |
| |Osteochondritis Dessicans (OCD) | | | |
| |Stress Fracture | | | |
| |Sprain/Strain | | | |
| |Tendon Tear | | | |
| | | | | |
|Extremity, Joint |Abscess | | | |
| |Cellulitis | |MRI Joint Without & With Contrast | |
|Shoulder |Fasciitis | | | |
|Elbow |Inflamatory Arthritis | |Lower-Extremity | |
|Wrist |Myositis |Yes | |73723 |
|Hip |Osteomyelitis | |Upper-Extremity | |
|Knee |Septic Arthritis | | |73223 |
|Ankle |Tumor/Mass/Cancer/Mets | | | |
| |Ulcer | | | |
|Body Part |Reason For Exam |IV Contrast |Procedure to Pre-Cert |CPT Code |
| | | | | |
| | | |MRI Joint with Contrast-Order 2 Exams | |
| | | | | |
| | | |Lower Extremity With Contrast | |
| |Labral Tear |Yes | |73722 |
|MR Arthrography |Loose Bodies | |Upper Extremity With Contrast | |
| |OCD Stability | | |73222 |
| |Post-op shoulder | | | |
| |Post-op meniscus repair | | | |
| | | |Fluoroscopy Guided Joint Injection | |
| | | |Please state which joint in comments |76000 |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
| | | | | |
................
................
In order to avoid copyright disputes, this page is only a partial summary.
To fulfill the demand for quickly locating and searching documents.
It is intelligent file search solution for home and business.