MRI EXAM CPT CODE REFERENCE

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1 I EXAM REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the for the order. Creatine levels should be obtained prior to studies. Please call if you have any questions: ext. 300 BRAIN I Brain without I Brain with and Alzheimer s Mental Status Change Confusion Dementia Memory loss Suspected MS Tumor / Mass / Cancer Cranial nerve lesions HIV / AIDS Infection Neurofibromatosis Hearing loss, IAC mass Bell s Palsy (facial weakness) Stroke / CVA Dizziness / Vertigo Headaches Pituitary lesion Acoustic neuroma Visual Change Metastases Vascular lesions (AVM) Elevated prolactin A BRAIN: Arterial Circulation Circle of Willis A Brain without Aneurysm family history Stroke / CVA (cerebrovascular accident) A BRAIN: Venous Circulation A Brain without A Brain with and Venous thrombosis AVM Sinus thrombosis Venous circulatory symptoms A NECK: A Neck with and Alzheimer s Mental status change Stroke / CVA I ORBITS: Includes brain plus cuts through the orbits I Brain with and Graves Disease Expothalmos / proptosis Pseudotumor Vascular lesions (Hemangioma) I NECK: Soft Tissue I Orbits / Face / Neck with Infection Pain Vocal Cord Paralysis I SPINE: Cervical I Cervical Spine I Cervical Spine with Neck pain Arm / Shoulder pain Numbness Myelopthy Page 1

2 I EXAM REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the for the order. Creatine levels should be obtained prior to studies. Please call if you have any questions: ext. 300 I SPINE: Thoracic I Thoracic Spine I Thoracic Spine with Back pain Compression fracture (No history of malignancy) Myelopthy I SPINE: Lumbar I Lumbar Spine Back / leg pain Scoliosis Sciatica / radiculopathy Spondylolisthesis Spinal stenosis Compression fracture (No history of malignancy) I Lumbar Spine with Post-op Hx of back surgery I LUMBOSACRAL PLEXUS I Pelvis without Leg Pain / Sciatica Lumbar plexopathy Sacral / coccyx pain I BRACHIAL PLEXUS I Upper Exremity Non-joint with Shoulder injury Nerve avulsion Brachial plexopathy I CHEST: Mediastinum I Chest / Mediastinum with A AORTA A Abdomen with and Abdominal aortic dissection A AORTA: With peripheral runoff A Abdomen with and A with and Peripheral vascular disease Claudication A CHEST I Chest with Excluding cardiac myocardium Thoracic aorta BREAST I I Breast Bilateral with Newly diagnosed breast cancer Family history of breast cancer BRCA 1 and BRCA 2 genes (Some criteria may apply) Implant Integrity / Rupture Page 2

3 I EXAM REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the for the order. Creatine levels should be obtained prior to studies. Please call if you have any questions: ext. 300 General Abdominal Pain Liver Post embolization Hemangioma Hepatoma Hepatitis Cirrhosis Increased liver function tests Renal Hematuria (blood in urine) Transitional cell carcinoma of kidney Renal mass (cyst or solid) Abnormal findings Adrenal Adrenal mass or lesion Phenochromocytoma Hypertension CP: Biliary Abdominal Pain Biliary obstruction Stones Jaundice Abnormal enzymes CP: Pancreas Pancreatitis Pancreas mass Cholangiocarcinoma Increased liver function tests Painless jaundice Ampulla evaluation PSC (Primary Sclerosing Cholangitis) A ABDOMEN: Adrenal A Abdomen with or Renal artery stenosis Hypertension Mesenteric arterial Ischemia A PELVIS: Iliac vessels A Pelvis with or Pelvic venous thrombosis I PELVIS: Soft Tissue: General I Pelvis with Pain Abscess Decubitus ulcer I PELVIS: Soft Tissue: Uterus / Ovaries I Pelvis with Fibroid Adenomysis Infertility Endometrioma Ovarian Mass Pre/Post-Uterine Fibroid- Embolization (UFE) ENTEROGRAPHY Dual Study: ; I Pelvis with Crohn s disease Celiac disease (Sprue) Crohn s fistulous disease Small bowel tumor Page 3

4 I EXAM REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the for the order. Creatine levels should be obtained prior to studies. Please call if you have any questions: ext. 300 I EXTREMITY, NON-JOINT: Forearm Humerus Lower Leg / Calf Femur / Thigh I Non-Joint : I Non-Joint with and : Abscess Ulcer Tumor / Mass / Mets Plantar fasciitis Fracture Sress fracture Muscle or tendon tear Myositis Morton s neuroma Soft tissue tumor or mass I EXTREMITY, JOINT: UPPER: Hand Wrist Elbow Shoulder SC Joint LOWER: Foot Ankle Knee Hip (whole perlvis) I Joint : I Joint with and : Arthritis Avascular necrosis (AVN) Stress fracture Internal derangement Joint Pain Adscess Ulcer Cellulitis Plantar fasciitis Myositis Meninscal tear Muscle tear Ligament tear Cartilage tear Ostochrondritis dissecans (OCD) Inflamatory arthritis Septic arthritis Tumor / Mass / Mets Labral tear I HIP / PELVIS I Pelvis I Pelvis with and Fracture Hip / Pelvis Pain Muscle / Tendon tear Septic arthritis A UPPER EXTREMITY A with Sublclavian Redness or swelling Tenderness A LOWER EXTREMITY A with Peripheral vascular disease ARTHROGRAM: Shoulder Elbow Wrist I Joint with and without Shoulder Injection Elbow Injection Wrist Injection Shoulder Instability Laberal tear Loose body Ligament injury TFCC tear Page 4

5 I EXAM REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the for the order. Creatine levels should be obtained prior to studies. Please call if you have any questions: ext. 300 ARTHROGRAM: Hip Knee Ankle I Joint with and without Hip Injection Knee Injection Ankle Injection Laberal Tear Loose body OCD lesion (Osteochondritis Dissecans) Post surgical meniscus re-tear Page 5

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