CT Ordering Guide - iHealthSpot Interactive



Ultrasound Standard Operating ProceduresExam OrderedReason for ExamExam DescriptionChange ToRAD0459US Abdomen Complete Abdominal mass Abdominal pain Cirrhosis Gallstones Hepatitis Nausea Pancreatitis Vomiting Elevated LFT’sIncludes Liver, GB, CBD, Pancreas, Spleen, Kidneys, Upper Abdominal Aorta and IVCRAD0459 76700 *If indication is for above plus portal hypertension, portal vein thrombosis, cirrhosis, Budd-Chiari, hepatic artery aneurysm then perform Duplex Scan (Colorflow Doppler with spectral analysis waveform )Duplex scan of arterial inflow and venous outflow of the abdomen. All duplex scans require both color flow Doppler and Spectral analysis *RAD180376700+93975* If indication is for above plus portal vein hypertension, portal vein thrombosis, cirrhosis, hepatic aneurysm, portal vein aneurysm then perform Duplex Scan (Colorflow with spectral analysis waveform)Duplex scan of only part of an organ, follow-up duplex or a limited examination is performed.*RAD1655 76700+93976*If indication is for hematuria, renal calculi then perform retroperitonealCompleteKidneys, ureters, bladder, prostate*RAD046176770Ultrasound Standard Operating ProceduresExam OrderedReason for ExamExam DescriptionChange ToRAD0460US Abdomen LTD Abdominal mass Abdominal pain Cirrhosis Hernia Ascites Pyloric Stenosis Gallstones AppendicitisSingle abdominal organ or single quadrant onlyi.e. Gallbladder, Liver*RAD0460 76705*If indication is for above plus Portal Vein Hypertension, Portal Vein Thrombosis, Cirrhosis, Hepatic Artery Stenosis/Aneurysm then perform Duplex. ExamDuplex scan of arterial inflow and venous outflow of the abdomen. All duplex scans require both color flow Doppler and Spectralanalysis *RAD1804 76705+93975*If indication is for above plus Portal Vein Hypertension, Portal Vein Thrombosis, Cirrhosis, Hepatic Artery Stenosis/Aneurysm then perform Duplex examDuplex scan of only part of an organ, follow-up duplex or a limited examination is performed *RAD1648 76705+93976RAD0461US RetroperitoneumAAABladder Mass/CAChronic Kidney DiseaseHematuriaHydronephrosisRenal InsufficiencyRenal/kidney StonesUTIKidneysBladderAortaIliacsIVCRAD046176770*If indication is for above plus uncontrolled hypertension or concern for Renal Arterial Stenosis perform duplex exam Duplex scan of arterial inflow and venous outflow of the abdominal, pelvic, scrotal contents and/or retroperitoneal organ: complete study*RAD0236 or RAD1903Status of transplanted Kidney with Duplex Scan*If indication includes transplanted kidney then perform kidney transplant exam.This examination evaluates the transplanted kidney with images of the kidney using gray scale along with spectral and color Doppler to evaluate renal blood flow*RAD0497 76776Ultrasound Standard Operating ProceduresExam OrderedReason for ExamExam DescriptionChange ToRAD0462US Retroperitoneum LTDAAAIVCLymphadenopathyUrinary BladderExamination that is limited to either one retroperitoneal organ or area or a follow-up examination of a limited areaRAD046276775*If indication is for a screening study for an abdominal aortic aneurysm please perform screening exam.Examination of the abdominal aorta, real-time with image documentation, screening studyfor abdominal aortic aneurysmRAD 119976706RAD0465US ChestPleural FluidSuperficial Mass Chest areaMediastinal MassSoft Tissue masses of the chest wall or upper backEvaluation of the pleural spaces for the presence of fluid. Additionally, masses in the chest or chest wall.RAD046576604RAD1056 Us Axilla Palpable axillary massAxillary pain Metastatic disease Ultrasound of the axilla when performed alone.RAD105676882RAD1956Us Right Breast completePalpable mass, pain, asymmetric density,nodule,calcifications,abcess,nipple discharge Ultrasound of all four quadrants in the breast, retroareolar area and axilla when performedRAD195676641*If indication is for a single quadrant including axilla please perform a limited exam Ultrasound focused, limited exam including axilla when performed.*RAD195876642RAD1958Us Right Breast limitedPalpable mass, pain, asymmetric density,nodule, calcifications, abscess, nipple dischargeUltrasound focused, limited exam including axilla when performed.*RAD195876642 *If indication is for multiple quadrants including axilla is performed please perform complete exam.Ultrasound of all four quadrants in the breast, retroareolar area and axilla.*RAD195676641RAD1957Us Left Breast completePalpable mass, pain, asymmetric density,nodule, calcifications, abscess, nipple dischargeUltrasound of all four quadrants in the breast, retroareolar area and axillaRAD195776641*If indication is for a single quadrant including axilla please perform a limited exam Ultrasound focused, limited exam including axilla when performed*RAD1959 76642 Ultrasound Standard Operating ProceduresExam OrderedReason for ExamExam DescriptionChange ToRAD1959Us Left Breast limitedPalpable mass, pain, asymmetric density,nodule, calcifications, abscess, nipple dischargeUltrasound focused, limited exam including axilla when performed RAD1959 76642*If indication is for multiple quadrants including axilla is performed please perform complete exam.Ultrasound of all four quadrants in the breast, retroareolar area and axilla.*RAD1957 76641 RAD1960Us Breast Bilateral completePalpable mass, pain, asymmetric density,nodule, calcifications, abscess, nipple dischargeUltrasound Bilateral complete exam including axilla when performed RAD1960 76641 *If indication is for a single quadrant bilaterally limited exam including axilla when performedUltrasound focused, Bilateral limited exam including axilla when performed*RAD1959 76642RAD1961US Breast Bilateral LtdPalpable mass, pain, asymmetric density,nodule, calcifications, abscess, nipple dischargeUltrasound focused, Bilateral limited exam including axilla when performedRAD1961 76642*If indication is for multiple quadrants bilaterally perform a complete exam including axilla if performedUltrasound Bilateral limited examIncluding axilla when performed *RAD1960 76641RAD1356 ( Right )RAD1357 ( Left )US Extremity Non-Vascular complete Complete joint:ShoulderWristElbowAnkle Evaluation of a specific jointthat includes the evaluation of muscles, tendons,joint,other soft tissue and any identifiable abnormalityRAD1356RightRAD1357Left76881RAD1354 ( Right)RAD1355 ( Left) US Extremity Non-Vascular limited*If the indication is limited to the patients specific signs and symptoms as they relate to joint, tendon, muscles or evaluation of a mass within the soft tissue perform a limited examLimited evaluation of an upper or lower extremity joint or mass within the soft tissue*RAD1354 (Right)76882*RAD1355(Left)76882Ultrasound Standard Operating ProceduresExam OrderedReason for ExamExam DescriptionChange ToRAD0478US Fetal Biophysical Profile W/O Stress NSTRAD0479US Fetal Biophysical Profile with Stress NSTPost dates for deliveryLow amniotic fluid volumeDecrease in fetal movementFetal Assessment of tone, breathing, movement and fluid onlyRAD047876819*If indication includes above plus fetal stress testing perform biophysical profile with stress testingFetal Assessment of tone, breathing, movement and fluid only*RAD047976818RAD0495US Hips Infant DynamicRAD0496US Hips Infant StaticHistory of breech deliveryFamily history of hip dysplasiaClicking on physical exam*If indication includes patient with a restraint device or follow up after initial diagnosis perform static examWhen the hip is first examined and the Ortolani maneuver is performed, which requires manipulation to see if the femoral head comes out of the acetabulum. This exam requires a physician or other qualified health care professional to perform the manipulation. RAD049576885*RAD0496 76886RAD0500US OB Complete Greater than 14 weeksIf the patient >or = 14 weeks and this is her 1st US and will not be the detailed scanFetal and Maternal Evaluation after 1st trimesterRAD050076805*If indication is less than 14 weeks perform less than 14 week complete1st trimester scan – May need OB Transvaginal Obstetric order if really early IUPRAD0518RAD049976801*RAD051876817RAD0518US Transvaginal Obstetric*If indication above includes additional cervical evaluation for cervical shortening or placenta previa perform transvaginal obstetric. Typically only done during 1st trimester. If not well seen on transabdominal US or if cervical length or placental end need better evaluation*RAD051876817RAD0469US OB Exam RepeatFollow-up Fetal Size & AFIRe-evaluation of organ systems suspected to be abnormal *If indication is for an anatomical follow -up after patient has had 2nd trimester screening perform US OB RepeatThis exam is designed to reassess fetal size and interval growth or reevaluate one or more anatomic abnormalities of a fetus previously identified on an ultrasound*RAD046976816Ultrasound Standard Operating ProceduresExam OrderedReason for ExamExam DescriptionChange ToRAD0504US OB LimitedAFICervical LengthFetal HeartbeatFetal PositionPlacenta location*If indication is for any of the above after patient has had a second trimester screening perform a US OB LimitedEvaluation of fetal viability, fetal position, or amniotic fluid check*RAD050476815RAD0502US OB Detailed Single FetusFetal and Maternal evaluation plus detailed fetal anatomic examination. Only used for high-risk pregnancy evaluation by OB specialist Detailed fetal anatomic examination is not intended to be the routine ultrasound examination performed for all pregnancies. It is an indication-driven examination performed for a known or suspected fetal anatomic abnormality, known fetal growth disorder, genetic abnormality.RAD050276811*If indication is NOT for detailed fetal anatomic evaluation and referral is NOT to perinatology perform a 76805*RAD0500 76805RAD0499US OB Less than 14 weeks Single FetusFetal and Maternal Evaluation 1st trimester1st trimester scan – May need OB Transvaginal Obstetric order if really early IUPRAD0518RAD049976801*If indication is greater than 20 weeks Perform OB US single fetus greater than 20 weeksTypically only done during 1st trimester. If not well seen on transabdominal US or if cervical length or placental end need better evaluation*RAD050076805Confirm fetal viability; Evaluate cervical length and the position of the placenta relative to the internal cervical os.Performed during weeks 11wk2d – 14wk2dRAD051876817If NT requested, First trimester fetal nuchal translucency measurement transabdominal or transvaginalPerformed during weeks 11wk2d – 14wk2dRAD117576813Ultrasound Standard Operating ProceduresExam OrderedReason for ExamExam DescriptionChange ToRAD1176US OB Nuchal Translucency additional fetusFirst trimester fetal nuchal translucency measurement transabdominal and transvaginal approach each additional fetusRAD117676814RAD0503US OB Multiple Gestation CompleteFetal and Maternal evaluation plus detailed fetal anatomic examination, transabdominal approachIf the patient is >or = 14 weeks and this is her 1st US and it will not be the detailed scan76812RAD0505US Pelvic complete DUB (Dysfunctional Uterine Bleeding)EndometriosisFibroidsIrregular MensesOvarian CystsOvarian TorsionPelvic PainAdnexal Mass Ovarian Mass Ectopic pregnancyEvaluation and measurement of the uterus, adnexal structures, endometrium, bladder when applicable. Transabdominal examination is needed for an overview of pelvic anatomy and to visualize masses outside the range of the vaginal probe.RAD123776856 + 76830RAD0506US Pelvic LimitedRAD00243D Rendering*Short term follow up to pelvic pathologyafter complete pelvic has been performedFollow up on pelvic pathology *RAD1933 76857 + 76830*If indication requires additional detail of the uterus endometrium, ovaries and adnexal regions Transvaginal exam is neededfor improved visualization of the uterus, adnexa and endometrium. *RAD76856 + 76830 *If indication or exam findings suggest adnexal torsion (medical necessary) then spectral and color Doppler should be includedDuplex scan of the arterial inflow and venous outflow *RAD180676856+76530+93975 *For IUD position, Fibroid position, endometrial polyps, and SIS 3D of the uterus can be used if the dx cannot be made with 2D aloneThere are two ways to perform3D rendering3D Rendering on US machine3D rendering on an independent workstation.*RAD0024 76376*RAD0107 76377Ultrasound Standard Operating ProceduresExam OrderedReason for ExamExam DescriptionChange ToRAD0509US Scrotum and Testicles*RAD1808 (compl)*RAD1650 (LTD)Testicular/scrotal painScrotal swellingTesticular TorsionPalpable massExamination of the testis, epididymis, and vessels involving the pampiniform plexus.RAD050976870*If clinical presentation suggest testicular torsion then perform pelvic duplexDuplex scan of the arterial inflow and venous outflow to the scrotal contentsRAD180893975 (complete)RAD1650 93976 (limited)RAD0236Duplex scan of the abdomin,pelvic,scrotal contents and/or retroperitoneal organsRAD 0806 LTD examRenal FailureHypertensionTesticular pain/swelling Portal hypertension/Liver diseaseSMA/Celiac Evaluation Duplex evaluation of the arterial supply and venous drainage of the organs in the abdomen,retroperitoneum,or pelvisLimited study that is utilized for follow up duplex of an organ or when part of the organ is evaluatedRAD023693975RAD080693976RAD0810 ExtracranialArteriesRAD1055 LeftRAD0787 RightUnilateral or limited studyCarotid BruitCarotid StenosisCVA/TIA symptomsS/P CEAOcclusionStent placementStenosisBilateral evaluation of extracranial arteries. This includes CCA,ICA,ECA,and VertebralUnilateral evaluation/limitedRAD081093880RAD1055 LeftRAD0787 Right93882RAD1238 NIVL BilateralArterial LE Duplex ScanningClaudication, evaluation of bypass graft, stent, PAD, pulseless extremity, cold extremity*If indication is for peripheral arterial disease perform ABI/TBI’SComplete bilateral lower extremity arterial duplex to include ABI/TBIs*RAD201393925+93922RAD0773 NIVL RtRAD1054 NIVL Lt. Unilateral Arterial LE Duplex scanningClaudication, evaluation of bypass graft, stent ,PAD*If indication is for peripheral arterial disease perform ABI/TBI’SLimited or unilateral (Rt. Or Lt.) lower extremity duplex arterial or graft evaluation, follow up studies to include ABI/TBIs.*RAD0773 (Rt.)93826 + 93922*RAD1054 (Lt)93826 + 93922Ultrasound Standard Operating ProceduresExam OrderedReason for ExamExam DescriptionChange To ................
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