Use this reference to quickly determine the correct …

CT EXAM CPT CODE REFERENCE

Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the CPT for the order.

Please include creatinine levels for patients over 60 or with history of renal failure. If not available, you can schedule the patient at WR Garner, WR Chapel Hill or WR Cary and we will check their levels for you.

Body Part CT Head

Procedure for Pre-Authorization

CT Head without contrast

CTA Head (Circle of Willis)

CT Orbits

CT Head with and without contrast

(Note: MRI Brain may be preferred study if patient is able. Consult the radiologist.)

CTA Brain with and without contrast

CT Orbits without contrast

CT Orbits with and without contrast

CT Sinus

CT Sinus without contrast

CT Face (From orbits to mandible)

CT Maxillofacial without contrast CT Maxillofacial with contrast

CT Temporal CT Temporal Bones without contrast Bones/Mastoids

CT Temporal Bones with and without contrast

CPT Code

Indication for CT Exam or Study

70450

Trauma Headaches CVA Stroke/Bleed Alzheimer's Memory Loss/Confusion

Shunt Check Hydrocephalus TIA Change in Mental Status Dizziness/Vertigo

70470 Metastases/known cancer (MRI preferable)

70496 70480 70481

Aneurysm

3rd nerve palsy

Family history of aneurysm Vascular malformation

Trauma Fracture

Foreign Body Bony Abnormalities

Infection Abscess/Cellulitis

Pain Mass/Tumor/Cancer

70486 70486

Sinusitis Mass Pain Foreign Body

Trauma Pain

Congestion Nasal Polyps Deviated Septum Sinus Headache

Fracture Bony Abnormality

70487 Tumor Swelling/Mass in Face

Infection Abscess

70480 Hearing Loss Tinnitus (ringing in ears) Cholesteatoma

Drainage in Ear Mass

70482 Acoustic Neuroma (When there are contraindications for MRI)

Contrast Spec No Contrast

Neuro

Yes Contrast Neuro

Yes Contrast Neuro

No Contrast Neuro

Yes Contrast Neuro

No Contrast

Neuro

No Contrast Neuro Yes Contrast

Neuro

No Contrast Neuro

Yes Contrast Neuro

CT Neck

CT Soft tissue neck with contrast

CTA Neck Arteries

CT Soft tissue neck with and without contrast

CT Angiography Neck with and without contrast

CT Abdomen: General

CT Abdomen with contrast

CT Abdomen & Pelvis: General (From lung bases to pubis)

CT Abdomen & Pelvis; with contrast

CT Pelvis: General (From iliac crest to pubis)

CT Abdomen & Pelvis; without contrast 1 or both with contrast 1 or both

CT Pelvis with contrast

CTE Abdomen & CT Abdomen & Pelvis; with contrast Pelvis Enterography

CT Chest: General

CT Chest with contrast

High Resolution Chest

CT Chest with and without contrast, high resolution

CT Extremities Upper (hand, wrist, elbow, radius/ulna, humerus, shoulder)

CT Extremities Lower (foot, ankle, knee, hip, tibia/fibula, femur)

Dual Study: CT Upper Extremity with contrast CT Lower Extremity with contrast

Dual Study: CT Upper Extremity without contrast CT Lower Extremity without contrast

CT Spine

Triple Study: CT Cervical without contrast CT Thoracic without contrast CT Lumbar without contrast

CT Pelvis/Hips CT Pelvis with contrast Acetabulum

CT Liver

CT Pelvis without contrast

(Note: MRI Pelvis may be preferred study in some circumstances. Consult the radiologist.)

CT Abdomen with and without contrast

(Note: MRI Abdomen may be preferred study in some circumstances. Consult the radiologist.)

Renal Stone

CT Abdomen & Pelvis without contrast

Tri-phase Renal CT Abdomen with and without contrast

CT Urogram

(Urinary System, kidneys to bladder)

Adrenal

CTA Abdomen

CT Abdomen & Pelvis; without contrast 1 or both with contrast 1 or both

CT Abdomen with and without contrast

CTA Abdominal with and without contrast

70491 Focal Mass Swollen Lymph Nodes Lymphoma

70492 Salivary gland stone

Dysphagia Goiter Esophageal Cancer

70498

Carotid stenosis Stroke/CVA/TIA Bruit Abnormal carotid sonogram

74160

Abdominal Pain RUQ or LUQ pain Abnormal U/S Neoplasm

Mass Weight Loss Hernia Trauma

74177

Mass

Weight Loss

Abdominal Pain/Pelvic Pain Hernia

RLQ or LLQ Pain

Trauma

Appendicitis

Rectal Bleeding

Lymphoma

Constipation/Obstruction

Nausea/Vomiting/Diarrhea IBD (Inflammatory Bowel Disease)

Bloody Stool

METS

Diverticulitis

Ovarian Cancer Staging

Diverticulosis

Prostate/Colon Cancer Staging

Abnormal U/S

Neoplasm

All cancer staging except Melanoma or carcinoid

Cancer staging for Melanoma or carcinoid 74178

Yes Contrast As Determined by Radiologist Yes Contrast Yes Contrast Yes Contrast

Yes Contrast

Neuro Neuro Neuro Body

Body

Body

72193

LLQ or RLQ Pain Pelvic Pain Groin Pain Abnormal Pelvic U/S Pelvic Mass

Ovarian Cancer Umbilical Hernia Trauma Adnexal Mass

74177

Crohn's Disease Suspected Small Bowel Tumors Mesenteric/Intestinal Bleeding Suspected GI Bleeding Evaluation of Bowel Patency

71260

Abnormal CXR Adenopathy Pneumonia Cough Hemoptysis Sarcoidosis Hilar Abnormality Hx Cancer/Tumor/Mets Chest Pain Pulmonary Embolism Aortic Dissection

Neoplasm Abscess Pulmonary nodule Enlarged Aortic Arch Lung Lesion Lymphadenopathy Asbestos Exposure Shortness of Breath Abdominal Aortic Aneurysm Thoracic Aneurysm

71270 Interstitial Disease Fibrosis Bronchiectasis

COPD/Emphysema Asbestos Exposure

Infection 73201 Tumor/Mass/Cancer/Mets 73701 (MRI is more sensitive)

Pain 73200 Arthritis 73700 Fracture

Fusion Malunion

Yes Contrast Body

Yes Contrast Body

Yes Contrast

Body

As Determined by Radiologist Body Yes Contrast

Ortho No Contrast

Ortho

72125 Pain

Fracture

72128 Trauma

Post-op/Fusion

72131 Degenerative disc disease

No Contrast

Neuro

72193 Soft Tissue Mass Tumor/Mets Abscess

Infection Cellulitis

72192 Pain Fracture Cancer/Mets

Arthritis Bone Lesions

74170

Increased LFTs RUQ Pain Abnormal Abdominal U/S Jaundice History of liver cancer Liver transplant

Hepatoma Hemachromatosis Hemangioma Hepatitis Cirrhosis

74176

Hematuria Flank plain Low back pain Urinary frequency

Stone Prostatitis Dysuria

74170

Hematuria Flank Pain Hydronephrosis Low back pain Abnormal U/S

Renal Failure/Mass/Transplant Hypertension History of renal cancer History of stones Polycystic kidney disease

Abnormal Cystogram 74178 Painless Hematuria

Bladder Mass or Tumor

History of Renal Cancer Abnormal Renal U/S Suspected Renal Mass

74170 Adrenal Mass

74175

Abdominal Aortic Aneurysm (AAA) Trauma

Renal Artery Stenosis

Abnormal U/S

Dissection

Post Stent Grafting

Retroperitoneal Bleed

Mesenteric Ischemia

Yes Contrast Ortho

No Contrast Ortho

Yes Contrast

Body

No Contrast Body

Yes Contrast Body

Yes Contrast Body

Yes Contrast Body Yes Contrast

Body

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