Physician CPT Code Desktop Reference

Transcription

1 Physician Code Desktop Reference Radiology Diagnostic Center 1310 Las Tablas Road, Ste 103 Templeton P: (805) F: (805) Five Cities Medical Imaging 921 Oak Park Blvd, Ste. 102 Pismo Beach P: (805) F: (805) Digital Medical Imaging 522 East Plaza Drive Santa Maria P: (805) F: (805) Interventional Radiology Services P: (805) * F: (805)

2 WHY THIS GUIDE IS IMPORTANT TO YOU AND YOUR PATIENTS This ordering guide is meant to assist you when ordering a study with Radiology Associates. The guide includes common indications as well as recommendations for the most appropriate exam. It is our goal to provide you and our mutual patients with the most appropriate and complete imaging. After the correct order is placed, exams are further tailored to each patient s specific condition. Thus, it is very important for the radiologist to be aware of the clinical question or specific condition in question so that the appropriate imaging can be performed. It is ideal for us to receive the most recent chart notes relating to the patient s condition or reason for their imaging study in addition to the imaging order. When ordering an examination please include pertinent history as well as signs or symptoms. Please refrain from ordering R/O, Possible, or Suspected exams such as Suspected tear or Rule out anomaly unless history and signs/symptoms are included as well. Feel free to specify a particular entity or condition upon which you would like comment in the report. If you have any questions or concerns, please contact us at one of the numbers listed on the cover of this book. Thank you, The Physicians at Radiology Associates Bone Density Diagnostic Services DMI QCT only FCMI RDC QCT only DX & QCT CT Scan Digital Mammography Fluoroscopy MRI High Field MRI High Field Open Nuclear Medicine PET / CT Imaging Ultrasound X-Ray Interventional Radiology (IR) Services Most procedures performed at SVH or FH. Call IR to coordinate. Abdominal Aortic Aneurysm Abscess / Fluid Drainage Angiography / Angioplasty / Stenting Arterial Disease / Plaque Excision Biliary Interventions Biopsies Dialysis Access DVT Thrombolysis Fibroid Embolization Gastrostomy Tubes Inferior Vena Cava (IVC) Filters Infertility Internal Bleeding Pelvic Congestion Syndrome Peripheral Arterial Disease Spine Interventions / Pain Management Thromobolysis TIPS (Transjugular Intrahepatic Portosystemic Shunt) Varicose Vein / Spider Vein Treatment Vascular Access Vertebroplasty

3 CT - Computed Tomography CT - Head BODY PART REASON FOR EXAM EXAM TO PRE-CERT Head / Brain Trauma CT Head / Brain Headaches Without Contrast CVA, Stroke Bleed, Hemorrhage Alzheimer s Memory Loss, Confusion Vertigo, Dizziness Shunt Check Hydrocephalus Metastatic Staging CT Head / Brain Mass/Tumor With Contrast Infection Headache w/ associated neurologic signs Melanoma CT Head / Brain HIV Toxoplasmosis Orbits Trauma CT Orbit Fracture Without Contrast Foreign Body Graves Disease Pseudo Tumor CT Orbit Pain With Contrast Exopthalmus Abscess Mass CT Orbit Retinoblastoma Facial Bones Trauma CT Facial Bones Fracture Without Contrast Cellulitis CT Facial Bones With Contrast Sinuses Sinusitis CT Sinus Limited Osteomeatal Complex CT Sinus Complete Sinusitis Polyps Temporal Hearing Loss, Conductive* CT Inner Ears, Temporal Bones Bone Cholesteotoma Without Contrst Trauma *Sensory neuro hearing loss, order MRI with and without contrast.

4 CT - Computed Tomography CT - Head (Continued) BODY PART REASON FOR EXAM EXAM TO PRE-CERT Neck Mass CT Neck CT- Spine Infection Cancer Workups Parotid Mass With Contrast *If elevated creatinine order without contrast Hoarseness CT Neck Vocal Chord Paralysis Voice Changes Without Contrast Submandibular Stone CT Soft Tissue Neck Infection of Submandibular Gland Infection of Parotid Gland Parotid Stone BODY PART REASON FOR EXAM EXAM TO PRE-CERT Cervical Trauma, Fracture, Fusion CT Cervical Spine Spine Assess Bone Degenerative Changes Without Contrast *MRI recommended for disc herniation, mets, infection Thoracic Trauma, Fracture, Fusion CT Thoracic Spine Spine Assess Bony Degenerative Changes Without Contrast *MRI recommended for disc herniation, mets, infection Lumbar Trauma, Fracture, Fusion CT Lumbar Spine Spine Assess Bony Degenerative Changes Without Contrast *MRI recommended for disc herniation, mets, infection Chest F/U nodules CT Chest Renal Failure Patients Without Contrast Cough CT Chest Pneumonia With Contrast Lung CA Esophageal CA Lymphoma Lung Nodule Mass Tracheal Stenosis Chest Wall Mass

5 CT - Computed Tomography CT- Chest BODY PART REASON FOR EXAM EXAM TO PRE-CERT Chest, High Interstitial Disease CT Chest Resolution Fibrosis Without Contrast COPD Hemoptysis Bronchiectasis Sarcoidosis Pleural Plaques Asbestosis CT- Abdomen & Pelvis BODY PART REASON FOR EXAM EXAM TO PRE-CERT Abdomen F/U for pts with renal cell carcinoma in renal failure (recommend MRI) CT Abdomen Without Contrast Abdominal Pain (generalized) CT Abdomen Mass With Contrast RUQ Pain LUQ Pain Epigastric Pain Pseudocyst Pancreatitis Abdomen & Hematuria with Pain CT Abdomen and Pelvis Pelvis Stone (Stone Study) Without Contrast Abdominal Pain CT Abdomen and Pelvis Crohns/Ulcerative Colitis/IBD With Contrast Diverticulitis Abscess Mass Hernia (i.e., umbilical, inguinal) Kidney Cyst vs. Mass CT Abdomen Without and Cancer Staging With Contrast CT Pelvis With Contrast Abdomen Adrenal Mass - No Oral Prep CT Abdomen (Renal/ Adrenal) Abnormal Ultrasound Renal Mass - No Oral Prep Liver Hemangioma - No Oral Prep (recommend MRI) Hepatitis, Cirrhosis - No Oral Prep

6 CT - Computed Tomography CT- Abdomen & Pelvis (Continued) BODY PART REASON FOR EXAM EXAM TO PRE-CERT Pelvis Fracture CT Pelvis Non-Union Prostate Treatment Planning Without Contrast Arthritis CT Pelvis Cancer Staging Mass Cysts Pain Infection Abscess With Contrast Bone Infection CT Pelvis (recommend MRI) CT Urogram Transitional Cell Carcinoma of CT Abdomen and Pelvis (Kidneys/ Bladder) Kidney and/or Bladder With and Without Contrast Defects/Bladder Leakage CT Enteropgraphy Crohns Disease/ CT Abdomen and Pelvis Inflammatory Bowel Disease Suspected Partial SBO (Small Bowel Obstruction) Small Bowel Masses Celiac Disease With Contrast CT Cystogram Leakage CT Abdomen and Pelvis Colovesical Fistula With and Without Contrast Virtual Colon Survey CT Abdomen and Pelvis Colonoscopy Failed Colonoscopy Without Contrast CT- Extremities BODY PART REASON FOR EXAM EXAM TO PRE-CERT DIAGNOSTIC SCREENING Upper Extremities Fracture CT Upper Extremity Finger Fusion Without Contrast Hand Non-Union/Malunion Wrist Infection CT Upper Extremity Forearm Tumor/Mass/Cancer/Mets With Contrast (recommend MRI) Elbow Humerus Shoulder Clavicle Scapula

7 CT - Computed Tomography CT- Extremities Continued BODY PART REASON FOR EXAM EXAM TO PRE-CERT Sternoclavicular Fracture CT Chest Joint Non Union/Malunion Without Contrast Lower Extremities Fracture CT Lower Extremity Foot Fusion Without Contrast Ankle Non-Union/Malunion Calf (Tibia/ Fibula) Arthritis Knee Patello Femoral Malalignment Thigh (Femur) Anteversion/Malrotation (Bilateral) Infection CT Lower Extremity Tumor/Mass/Cancer/Mets (recommend MRI) With Contrast Leg Lengths Abnormality Leg Length CT Limited Malrotation XR Bone Length FAI Protocol Femoral Anteversion for CT Hip Without Contrast AND FAI Cam Lesion CT Knee Without Contrast CT- Arthrography BODY PART REASON FOR EXAM EXAM TO PRE-CERT CT Arthrogram Cartilage Abnormality Requires 3 codes: Hip Meniscus Abnormality 1 - Choose upper or lower ext: Knee Labrum Abnormality Lower Extremity With Contrast Ankle Loose Bodies OR Shoulder Upper Extremity With Contrast Elbow 2 - Fluoro Guided Arthrogram Wrist 3 - Choose body part: Hip Knee Ankle Shoulder Elbow Wrist CTA Brain/ Head TIA, CVA CTA Brain Vascular Malformation Aneurysm AVM (Arterio/ Venous Malformation)

8 CT - Computed Tomography CT- Angiograpghy (CTA) BODY PART REASON FOR EXAM EXAM TO PRE-CERT CTA Carotid/ Neck Carotid Stenosis CTA Carotid Bruit TIA, CVA Carotid Dissection CTA Chest Thoracic Aortic Dissection CTA Chest Thoracic Aortic Aneurysm Coarctation Aortic Root Dilation CTA Chest Chest Pain / Dyspnea CTA Chest PE Study Tachypnea Shortness of Breath Pulmonary Hypertension (PA HTN) CTA Chest and Thoracic and Abdominal CTA Chest CTA Abdomen Aortic Dissection CTA Abdomen * Dissection going past renals Calcium Scoring Calcium Scoring of Coronary Arteries Calcium Score Fanily History of CAD Aorta, Renal, Stent Aneurysm (AAA) CTA Abdomen and Stent Obstruction/Leak/Malfunction CTA Pelvis Crossing Vessels Anatomic Marking for Partial/ Complete Nephrectomy Renal Artery Stenosis CTA Upper Trauma CTA Upper Extremity Extremities Arterial Stenosis CTA Upper Peripheral Artery Disease CT Lower Extremity Extremities Ischemia to Lower Extremity Arterial Stenosis CTA Run-Off Peripheral Artery Disease (PAD) CTA Abdomen, Pelvis, Bilateral Ischemia to Lower Extremity Arterial Stenosis Lower Extremities

9 MRI - Magnetic Resonance Imaging MRI- Head & Neck BODY PART REASON FOR EXAM PROCEDURE TO PRE-CERT Brain Alzheimer s, Dementia, Memory Loss MRI Brain Mental Status Changes, Confusion Headache Without Focal Symptoms Seizures (children) Stroke, CVA, TIA Trauma Without Contrast Cranial Nerve Lesions MRI Brain Dizziness, Vertigo Headache With Focal Symptoms HIV IAC/Hearing Loss Infection Multiple Sclerosis Neurofibromatosis Pituitary Lesion, Elevated Prolactin Seizures (adult new onset) Tumor / Mass / Cancer / Mets Vascular Lesions Vision Changes Trigeminal Neuralgia Order 2 exams: MRI Brain MRI Orbits / Face / Neck Orbits Grave s Disease MRI Orbits / Face / Neck Trauma Without Contrast Exopthalmos, Proptosis MRI Orbits / Face / Neck Pseudotumor Tumor / Mass / Cancer / Mets Vascular Lesions Optic Neuritis Neck Infection MRI Orbits/Face/Neck Pain Tumor / Mass / Cancer / Mets Vocal Cord Paralysis Parotid Gland MRI Orbits/Face/Neck 70543

10 MRI - Magnetic Resonance Imaging MRI- Spine BODY PART REASON FOR EXAM PROCEDURE TO PRE-CERT Cervical Arm / Shoulder Pain or Weakness MRI Cervical Spine Degenerative Disease Neck Pain Disc Herniation Without Contrast Cervical Fusion Radiculopathy Discitis MRI Cervical Spine Osteomylitis Multiple Sclerosis Myelopathy Syrinx Tumor / Mass / Cancer / Mets Vascular Lesions, AVM Thoracic Back Pain MRI Thoracic Spine Compression Fx (no hx cancer) Degenerative Disease Disc Herniation Radiculopathy Trauma Without Contrast Compression Fx (with hx cancer) MRI Thoracic Spine Discitis Osteomylitis Multiple Sclerosis Myelopathy Syrinx Tumor / Mass / Cancer / Mets Vascular Lesions AVM Lumbar Back Pain MRI Lumbar Spine Compression Fx (no hx malig / mets) Degenerative Disease Disc Herniation Radiculopathy Sciatica Spondylolithesis Stenosis Trauma Without Contrast Compression Fx (no hx malig / mets) MRI Lumbar Spine Discitis Osteomylitis Tumor / Mass / Cancer / Mets

11 MRI - Magnetic Resonance Imaging MRI- Chest / Abdomen / Pelvis BODY PART REASON FOR EXAM PROCEDURE TO PRE-CERT Brachial Brachial Plexus Injury MRI Chest Plexus Nerve Avulsion MRI Neck Tumor / Mass / Cancer / Mets (Please authorize BOTH codes.) Chest- Tumor / Mass / Cancer / Mets MRI Chest / Mediastinum Mediastinum Breast Implant Rupture MRI Bilateral Breast Without Contrast Abnormal Mammogram MRI Bilateral Breast Abnormal Ultrasound Dense Breast/High Risk Mass / Lesion / Cancer Palpable Mass Abdomen MRCP (Biliary / Pancreatic Ducts) MRI Abdomen Without Contrast Adrenal Adenoma MRI Abdomen Adrenal Mass (not adenoma) Hemangioma Liver, Kidney, or Pancreas Mass Tumor / Mass / Cancer / Mets Pelvis Adenomyosis MRI Pelvis Without Contrast Fracture Muscle / Tendon Tear Urethral Diverticulum Sports Hernia Fibroids MRI Pelvis Osteomylitis Septic Arthritis Tumor / Mass / Cancer / Mets Abcess Ulcer MRI- Enterography Abdomen & Pelvis BODY PART REASON FOR EXAM PROCEDURE TO PRE-CERT Abdomen Crohns Disease/Inflammatory Order 2 Exams: Pelvis Bowel Disease MRI Abdomen GI Bleed Suspected Partial SBO MRI Pelvis (Small Bowel Obstruction) Small Bowel Masses Celiac Disease

12 MRI - Magnetic Resonance Imaging MRI- Extremities BODY PART REASON FOR EXAM PROCEDURE TO PRE-CERT Non-Joint: Fracture MRI Non Joint Without Contrast Arm Stress Fracture Lower Extremity Hand Muscle / Tendon Tear Upper Extremity Finger Abcess MRI Non Joint Without and With Leg Ulcer I.V. Contrast Foot Bone Tumor / Mass / Cancer / Mets Lower Extremity Toe Cellulitis Upper Extremity Fasciitis Myositis Morton s Neuroma Osteomylitis Soft Tissue Tumor / Mass / Cancer Joint: Arthritis MRI Joint Without Contrast Shoulder Avascular Necrosis (AVN) Lower Extremity Elbow Fracture Upper Extremity Wrist Stress Fracture Hip Internal Derangement Knee Joint Pain (specify joint) Ankle Labral Tear Meniscal Tear Muscle Tear Tendon Tear Ligament Tear Cartilage Tear Osteochondritis Dessicans (OCD) Abcess MRI Joint Without and With Ulcer I.V. Contrast Cellulitis Lower Extremity Fasciitis Upper Extremity Myositis Inflammatory Arthritis (pannus eval) Osteomylitis Septic Arthritis Tumor / Mass / Cancer / Mets

13 MRI - Magnetic Resonance Imaging MRI- Arthrography Joints BODY PART REASON FOR EXAM PROCEDURE TO PRE-CERT Shoulder Labral Tear MRI Joint With Intra-articular Contrast Elbow Loose Bodies Wrist OCD Stability Requires 3 codes: Hip Post-op Meniscus Evaluation 1 Lower Extremity With Contrast OR Knee Upper Extremity With Contrast Ankle 2 Fluoro Guided Arthrogram Choose one code for body part: Shoulder Elbow Wrist Hip Knee Ankle MRA / MRV- MR Angiography / MR Venography BODY PART REASON FOR EXAM PROCEDURE TO PRE-CERT Head (MRA) Stroke, CVA, TIA MRA Head Without Contrast Aneurysm Head (MRV) Venous Thrombosis MRV Head Without Contrast Neck Stroke, CVA, TIA MRA Neck Without Contrast Dissection MRA Neck Chest Thoracic Aorta MRA Chest (other than dissection) Vascular Anomalies Subclavian Vessels Aortic Dissection Order 2 Exams: MRA Chest MRA Abdomen Arch & Great Stroke, CVA, TIA MRA Neck Vessels Abdomen AAA (abdominal aortic aneurysm) MRA Abdomen (MRA) Abdominal Aortic Dissection Mesenteric Ischemia Pre Kidney Transplant Renal Mass Order 2 Exams: Uncontrolled Blood Pressure MRA Abdomen MRI Abdomen 74183

14 MRI - Magnetic Resonance Imaging MRA / MRV- MR Angiography / MR Venography BODY PART REASON FOR EXAM PROCEDURE TO PRE-CERT Abdomen Venous Thrombosis MRV Abdomen (MRV) Venous Pathology Pelvis AVM (arteriovenous malformation) MRA Pelvis Pelvic Congestion Order 2 Exams: MRA Pelvis MRI Pelvis Peripheral Claudication Requires 3 codes: Run-Off Cold Foot MRA Abdomen Pain MRA Lower Extremity (Left) MRA Lower Extremity (Right)

15 Nuclear Medicine Nuclear Medicine- Bone Scan COMMON INDICATIONS S Primary or metastatic tumors initial evaluation or follow-up of therapy Total body Pain of suspected musculoskeletal etiology Multi-area Paget s disease 3-phase Stress or occult fractures Bone SPECT Trauma Limited Area Osteomyelitis or musculoskeletal inflammation Bone viability grafts or avascular necrosis (AVN) Metabolic bone disease Arthritities Prosthetic joint evaluation for loosening or infection Evaluation of abnormal findings by other imaging modalities Evaluation of abnormal lab findings, especially elevated alkaline phosphatase Reflex sympathetic dystrophy (RSD) Suspected Charcot s joint Nuclear Medicine- Biliary Scan COMMON INDICATIONS S Right upper quadrant or abdominal pain Biliary Gallstones on CT or ultrasound Biliary with CCK Evaluation of gallbladder ejection fraction i.e., CCK Biliary Assessment of liver transplant function Evaluation of biliary atresia in pediatric patients Evaluation of bile leak Evaluation of common bile duct obstruction Evaluation of choledochal cyst Nuclear Medicine- Gallium Scan COMMON INDICATIONS S Evaluation of fevers of unknown origin Total body Disk space or joint space infection Limited area Evaluation of infection in immuno-compromised individuals SPECT Osteomylitis (Bone Gallium) Infection of prosthetic joints Detection of inflammatory disease such as sarcoid and tuberculosis. Evaluation of vascular graft infection Abscess localization Evaluation of pulmonary inflammation due to drug/environmental reaction, e.g., Amiodarone toxicity Polynephritis Post-operative surgical incision site infection Evaluation of inflammatory bowel disease Evaluation of diabetic ulcers

16 Nuclear Medicine Nuclear Medicine- Gastric Emptying Scan COMMON INDICATIONS S Abdominal pain Gastro-esophageal reflux Vomiting Gastroparesis/Diabetics Weight loss Feeling of fullness Nuclear Medicine- Indium & Ceretec WBC Scan COMMON INDICATIONS Evaluation of fevers of unknown origin Disk space or joint space infection Evaluation of infection in immunocompromised individuals Osteomylitis Infection of prosthetic joints Evaluation of vascular graft infection Abscess localization Post-operative surgical incision site infection Evaluation of inflammatory bowel disease Evaluation of diabetic ulcers Note: Indium is a better choice for ortho patients with hardware. S for both Nuclear Medicine- Lung (VQ) Scan COMMON INDICATIONS S The assessment of the probability of acute or chronic pulmonary VQ scan thromboembolic disease VQ QUANT The establishment of the presence of chronic, unresolved pulmonary emboli The quantification of differential pulmonary function The evaluation of lung transplants The evaluation of the effects of congenital heart/lung disease The confirmation of the presence of bronchopleural fistulae The evaluation of effects of chronic pulmonary parenchymal disorders such as cystic fibrosis Nuclear Medicine- Parathyroid Scan COMMON INDICATIONS S Parathyroid adenoma Increased PTH levels Hypercalcemia

17 Nuclear Medicine Nuclear Medicine- Renal Scan COMMON INDICATIONS S Urinary tract obstruction DTPA or MAG Evaluate renal function Captopril renal Renal vascular disease Renal with Lasix Polycystic kidney disease DMSA renal Post transplant evaluation Pyelonephritis Parenchymal scarring Nuclear Medicine- Thyroid Scan and Uptake COMMON INDICATIONS S Assessment of size and location of thyroid tissue Thyroid scan only Evaluation of thyroid masses Abnormal thyroid lab results (Hyperthyroidism / Hypothyroidism) Thyroid uptake and scan Differentiation of hyperthyroidism/thyroiditis Abnormal weight gain or weight loss I123 Thyroid uptake and scan Cardiac arrythmia Nuclear Medicine- I-131 Whole Body Scan COMMON INDICATIONS S Evaluation and treatment of thyroid carcinoma Hyperthyroidism

18 Ultrasound Ultrasound- Neck BODY PART REASON FOR EXAM PREP Soft Tissues Mass None Neck (Thyroid), Abnormalities detected on other imaging Head / Face (CT / MRI / PET / NM) Enlarged thyroid gland Multinodular goiter (MNG) Abnormal lab tests (elevated calcium levels / abnormal thyroid level) Parathyroid adenomas Hyperthyroidism / Hypothyroidism Carotid Artery Weakness None Headache Syncope Hemiplegia Difference in arm blood pressure Aphasia Ataxia Reversible ischemic neurological deficit (RIND) Bruit Vertigo / dizziness (non medicare) Memory loss (non medicare) Dementia (non medicare) Transient ischemic attack (TIA) Confusion Stroke Visual disturbance Cerebrovascular accident (CVA) Amaurosis fugax Ultrasound- Chest BODY PART REASON FOR EXAM PREP Chest Diaphragm paralysis None Pleural effusion Superficial mass Aorta Aortic aneurysm (follow up to AAA) NPO 6 hours prior (Limited Pulsatile aorta to exam Retroperitoneal) Bruit Family history AAA (non medicare)

19 Ultrasound Ultrasound- Abdomen BODY PART REASON FOR EXAM PREP Abdomen Cirrhosis or hepatic disease NPO 6 hours prior Complete (Hepatitis / Portal Hypertension) to exam Abdominal distention (fluid collection) ascites Pain (Abdominal / Epigastric / Periumbilical) Nausea / Vomiting Gallstones Obstructive symptoms of the biliary system (Jaundice) Abnormal diagnostic tests (CT / MR) Gastroesophageal reflux (GERD) Splenomegaly Abnormal liver functions (Elevated LFT s / Fatty liver) Hepatomegaly Abdomen * all of the above NPO 6 hours prior Limited to exam Abdomen Cirrhosis or hepatic disease (hepatitis/ NPO 6 hours prior Doppler portal hypertension) to exam (Vascular) Ascites Varices Portal vein thrombosis Budd-Chiari Syndrome Intrahepatic Portosystemic Venous Shunts TIPS Hepatomegaly Splenomegaly Ultrasound- Pelvis BODY PART REASON FOR EXAM PREP Pelvis Pain (pelvic or adnexal tenderness) Pelvis Complete Ovarian cyst Transvaginal Uterine fibroids Enlarged uterus or ovary (mass) *Please note: An Us Pelvis Complete is a Transabdominal exam. If a Transvaginal Us is needed it must be specifically Adnexal abnormalities indicated. Dysfunctional uterine bleeding Post menopausal bleeding Precocious puberty Polycystic ovary Disease (PCOD) Fill bladder with 32 oz of water 1/2 hour prior to exam. Do not void. Ovarian follicle monitoring Pelvic Doppler Ovarian torsion/pelvic pain Fill bladder with 32 oz Follow up fibroid embolization of water 1 hour prior Ovarian vein embolization Evaluation of pelvic congestion syndrome (PCS) to exam. Do not void. Transvaginal Only: No prep

20 Ultrasound Ultrasound- Pelvis BODY PART REASON FOR EXAM PREP Scrotum Pain Trauma Torsion Mass Varicocele Epididymitis Hydrocele (swelling) Undescended testes Ultrasound- Retroperitoneal BODY PART REASON FOR EXAM PREP Kidney (renal) Pain (CVA tenderness/flank pain) Only for bladder: and Bladder Obstruction (hydronephrosis) Fill bladder with 32 oz Hypertension Follow up to other diagnostic imaging test (CT or MRI) Abnormal lab values (BUN or Creatinine) Stones (renal) Chronic renal medical disease (renal function/ renal failure) Polycystic kidney disease (PCKD) Urinary tract infection/cystitis/pyelonephritis Renal cancer Trauma Hematuria (microscopic or gross) Neurogenic bladder Urinary retention - Evaluate post void residual (PVR) of water 1/2 hour prior to exam. Do not void. Bladder diverticula Renal Transplant Post renal transplant None Urinoma Lymphocele Pain Elevated lab values (creatinine) Poor renal function Renal Doppler Renal artery stenosis NPO 6 hours prior Renal artery aneurysm to exam Renal vein thrombosis Hypertension Abnormal laboratory values (elevated creatinine/bun)

21 Ultrasound Ultrasound- Extremities/ Musculoskeletal BODY PART REASON FOR EXAM PREP Upper or Lower Pain None Extremity Fluid collection (Bakers Cyst) Limited Complete (non Doppler) Mass Limited Musculoskeletal Biceps tendon/rotator cuff exams (MSK radiologist needs to perform - Book w/jris) Complete Biceps tendon scan with injection Bakers cyst aspiration with injection Limited Joints/shoulder/elbow/ankle/knee ultrasound Upper or Lower Edema/swelling None Extremity Venous Calf pain (non medicare) Doppler Post surgical (non medicare) Redness Follow up DVT Positive Homan sign (shooting pain with foot dorsiflexion) History long plane/car trip Upper or Lower Claudication/pain with walking None Extremity Arterial Decreased or absent pulses Doppler (PVR) Arthrosclerosis Duplex Bruit None High risk family history (non medicare) Numbness (non medicare) S/P graft or stenting Ulcer on foot or toe (non medicare) Discoloration of feet or legs (non medicare) Thoracic outlet syndrome Decrease arm pressure Cold fingers or toes (poor circulation) Venous Reflux Edema/swelling None Leg ulcer (non medicare) Pain (non medicare) Venous insufficiency Varicose veins Burning or tingling (non medicare) Phlebitis/Thrombophlebitis Arterial Screening Carotid None Aorta ABI (ankle brachial indices)

22 Flouroscopy Flouroscopy EXAM PREP SPECIAL INSTRUCTIONS IR Lumbar Epidural (Includes FL Guidance 77003) Myelogram (Includes Intrathecal Injection 62284) - Thoracic None Schedule in morning first and CT to follow Needs Recovery Time, Needs Driver Myelogram (Includes Intrathecal Injection 62284) - Lumbar None Schedule in morning first and CT to follow Needs Recovery Time, Needs Driver Esophogram - Contrast XR w/ Barium NPO 8 hrs prior to exam Schedule in morning Swallowing Function - Contrast XR w/ Barium NPO 4 hrs prior to exam UGI (Upper Gastrointestinal) NPO 8 hrs prior to exam UGI with KUB UGI with SBFT UGI with Air UGI with Air and KUB UGI with Air and SBFT SBFT (Small Bowel Follow Thru) NPO after midnight Schedule at 8:30 (may take 4 hrs) Hypotonic Duodenography BE (Barium Enema) with or without KUB Pick up BE Prep kit 2 days prior BE with Air Pick up BE Prep kit 2 days prior IVP No food 2 hrs prior to exam. Patient can drink Cystourethrogram - Retrograde Cystourethrogram - Voiding (VCUG) None Patient needs to arrive pre-cathed Must be done between the 7th - 10th day following the start of the patient's menstrual cycle. Hysterosalpinogram (HSG) (Includes cpt 58340) No sexual contact once period has started until after Schedule 7th- 10th day following first day of procedure. menstrual cycle Venogram - Extremity Unilateral (Includes Injection 36005) Venogram - Extremity Bilateral (Includes Injection 36005) Arthrogram None Schedule MRI or CT to follow FL Guided Lumbar Puncture Hydrate well day before exam Schedule morning exam before 10 am Patient needs a driver FL Guided Needle Placement FL Guided Picc Placement None None FL Guided Port Study None Tunneled ports need to come pre-accessed SNIFF Test

23 X-Rays X rays EXAM PREP SPECIAL INSTRUCTIONS Chest 1 View schedule s/p Thoracentesis Chest 2 View Lumbar Spine 2-3 Views Lumbar Spine includes bending views; only 2 or 3 views Lumbar Spine Complete includes bending views; minimum of 6 views Abdomen (KUB) 1 View Thoracic 3 View Cervical 2-3 Views Sinus less than 3 Views Pelvis 1-2 Views Shoulder minimum 3 Views Elbow minimum 3 Views Forearm 2 Views Wrist 2 Views Hand 2 Views Fingers minimum 3 Views Hip minimum 2 Views Ankle 2 View Foot 2 View Toes minimum 2 Views Small Intestines 74250