WHY THIS GUIDE IS IMPORTANT TO YOU AND YOUR PATIENTS

Transcription

1 ORDERING GUIDE

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 Ltd. The guide includes common indications as well as recommendations for the most appropriate examination. It is our goal to provide you and your patients with the most appropriate and complete imaging examination. After the correct order is placed, examinations 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. When ordering an examination please include pertinent history as well as signs or symptoms. Please refrain from ordering r/o exams such as rule out tumor or rule out anomaly unless history and signs/symptoms are included as well. Feel free to specify a particular entity or condition you would like the Radiologist to comment upon in the report. We have also included a list of most commonly used ICD-9 codes. Please note that this is not a complete list so you may need to refer to your most current ICD-9-CM and ICD-10- CM code book for the most appropriate code. The note section at the end of the ICD-9 codes list allows you to add additional codes that are commonly used in your practice. In the back of the guide, you will find a list of our contracted insurance and network plans as well as our imaging centers, addresses and phone numbers. Radiology Ltd. also has a Professional Relations Department with field representatives dedicated to serving your needs. If you have any questions or concerns, please contact the Professional Relations Department at (520) or at pr@radltd.com. Thank you, The Physicians and Staff of Radiology Ltd. 1

3 IMPORTANT CONTACT INFORMATION CENTRALIZED SCHEDULING Tel: (520) Fax: (520) STAT Hotline: (520) Toll Free: (866) Toll Free Fax: (866) SPECIALTY SCHEDULING BREAST BIOPSY Tel: (520) Fax: (520) BREAST MRI Tel: (520) Fax: (520) NEED HELP OR HAVE QUESTIONS ABOUT WHAT TO ORDER? CLINICAL REVIEW Tel: (520) Fax: (520) INTERVENTIONAL COORDINATION Tel: (520) Fax: (520) PET / CT Tel: (520) , opt. 3 Fax: (520) OTHER IMPORTANT NUMBERS AUTHORIZATION VERIFICATION Tel: (520) Fax: (520) CODING & PRICING HOTLINE Tel: (520) Online Requests: radltd.com/request-exam-pricing HIPAA HOTLINE Tel: (520) Toll Free Tel: (866) MEDICAL RECORDS Tel: (520) Fax: (520) Online Requests: radltd.com/medical-record-request PATIENT BILLING Tel: (520) Secure Online Bill Pay: radltd.com/online-bill-pay PROFESSIONAL RELATIONS Tel: (520) Fax: (520) pr@radltd.com For Supplies: Tel: (520) supplies@radltd.com RADVISION Tel: (520) Fax: (520) Toll Free Tel: (866) Website: radltd.com/for-providers After Hours Tech Support: Tel: (520)

4 REFERENCE CONTENTS DIGITAL X-RAY General... 4 DEXA Bone Densitometry... 7 BREAST IMAGING CPT Codes for Women s Imaging... 8 Mammography Ordering Decision Tree... 9 Screening & Diagnostic Mammography Additional Imaging & Procedures Breast MRI PET / CT General Bone Scan ULTRASOUND General Vascular MSK/Extremity CT / CTA CPT Codes for CT Scans General Head & Spine Musculoskeletal Specialty MRI / MRA CPT Codes for MRI Scans Breast General Head & Spine Musculoskeletal (including Arthrography) INTERVENTIONAL Minimally Invasive Diagnostic Procedures Pain Management Vascular Services Drainage Tube / Stent Placement ICD-9 S Neoplasms Benign Neoplasms Endocrine, Nutritional & Metabolic Disorders Blood Diseases Mental Disorders Nervous System & Sense Organ Disorders Circulatory System Respiratory System Digestive System Genitourinary System Musculoskeletal & Connective Tissue Signs & Symptoms Injuries & Adverse Effects ICD-9 Codes Notes ICD-10 S ICD-10 Codes Notes PREFERRED PROVIDER INFORMATION Major Insurance Plans Major Network Plans IMAGING CENTERS Locations TECHNOLOGY RadVision

5 DIGITAL X-RAY: General Digital X-rays are done on a walk-in basis. The digital X-ray CPT codes are for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. PROCEDURE DESCRIPTION Chest 1 View Chest 2 Views Chest Minimum 4 Views Chest Special Views Ribs Unilateral 2 Views Ribs Unilateral 2 Views with PA CXR Ribs Bilateral 3 Views Sternum Minimum 2 Views Sternoclavicular Joints 3 Views Abdomen 1 View Abdomen AP, Additional Oblique + Cone Views Abdomen Complete Abdomen Complete + PA CXR Hip Unilateral 1 View Hip Unilateral Minimum 2 View Hips Bilateral 2 Views + AP Pelvis Pelvis 1 or 2 Views Pelvis Minimum 3 Views Pelvis & Hips Infant / Child up to 11 years old Sacrum & Coccyx Minimum 2 Views Sacroiliac Joints 3+ Views Finger(s) Minimum 2 Views Hand 2 Views Hand Minimum 3 Views Wrist 2 Views Wrist Minimum 3 Views Forearm 2 Views CPT DIGITAL X-RAY Digital X-rays are done on a walk-in basis. 4

6 DIGITAL X-RAY DIGITAL X-RAY: General Digital X-rays are done on a walk-in basis. The digital X-ray CPT codes are for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. PROCEDURE DESCRIPTION Upper Extremity Infant (up to 364 days old) Minimum 2 Views Elbow 2 Views Elbow Minimum 3 Views Humerus Minimum 2 Views Shoulder 1 View Shoulder Minimum 2 Views Acromioclavicular Joints Bilateral Clavicle Complete Scapula Complete Toe(s) Minimum 2 Views Foot 2 Views Foot Minimum 3 Views Calcaneus Minimum 2 Views Ankle 2 Views Ankle Minimum 3 Views Tibia & Fibula 2 Views Lower Extremity Infant (up to 364 days old) 2+ Views Knee 1 or 2 Views Knee 3 Views Knee 4 or More Views Both Knees Standing AP Femur 2 Views Bone Age Studies Bone Length Studies Osseous Complete (Bone Survey) Mandible < 4 Views Mandible 4 Views CPT 5 Digital X-rays are done on a walk-in basis.

7 DIGITAL X-RAY: General Digital X-rays are done on a walk-in basis. The digital X-ray CPT codes are for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. PROCEDURE DESCRIPTION Screening Orbit (Pre MRI) Facial Bones < 3 Views Facial Bones Minimum 3 Views Nasal Bones Minimum 3 Views Orbits Minimum 4 Views Sinuses Paranasal < 3 Views Sinuses Paranasal Minimum 3 Views Skull < 4 Views Skull Minimum 4 Views Neck Soft Tissue C-Spine 2 or 3 Views C-Spine Minimum C-Spine Complete 6 or more T-Spine 2 Views T-Spine 3 Views L/S Spine 2 or 3 Views L/S Spine Minimum 4 Views L/S Spine Complete With Bending Views (Minimum 6 Views) L/S Spine Bending Views (Only 2-3 Views) Spine, Entire, AP & Lateral Thoracolumbar Spine Standing (Scoliosis) Scoliosis Study Including Supine and Erect Thoracolumbar AP & Lateral CPT DIGITAL X-RAY Our care is unsurpassed, with physicians available 24 hours a day, 7 days a week, 365 days a year. Digital X-rays are done on a walk-in basis. 6

8 DEXA DEXA: Bone Densitometry This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. CLINICAL INDICATIONS PROCEDURE Post Menopause Early Surgical Menopause Long-Term Current Use of Other Medication Long-Term Current Use of Steroid Treatment Vertebral Abnormalities Follow-Up Treatment for Prevention / Monitoring of Osteoporosis DEXA Hips, Spine (axial skeleton) DEXA with Vertebral Fracture Assessment DEXA Vertebral Fracture Assessment DEXA DEXA Body Composition Study DEXA Radiology Ltd. is committed to the health of southern Arizona by providing the most comprehensive imaging and interventional services. 7

9 BREAST MRI & 0159T - BILATERAL BREAST MRI STEROTACTIC LOCALIZATION GUIDANCE FOR BREAST BIOPSY CODING VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED EXPLANATION. ULTRASOUND GUIDED NEEDLE CORE BREAST BIOPSY CODING VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED EXPLANATION. BONE DENSITY SCAN DEXA SCAN DEXA WITH VERTEBRAL FRACTURE ASSESSMENT CPT S for WOMEN S IMAGING This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BIOPSY CODING VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED EXPLANATION. SCREENING MAMMOGRAPHY G DIGITAL SCREENING CAD FOR SCREENING SCREENING BREAST 3D TOMOSYNTHESIS DIAGNOSTIC MAMMOGRAPHY UNILATERAL G UNILATERAL DIGITAL DIAGNOSTIC CAD FOR DIAGNOSTIC UNILATERAL BREAST 3D TOMOSYNTHESIS DIAGNOSTIC MAMMOGRAPHY BILATERAL G BILATERAL DIGITAL DIAGNOSTIC CAD FOR DIAGNOSTIC BILATERAL BREAST 3D TOMOSYNTHESIS BREAST IMAGING UTERINE FIBROID EMBOLIZATION (UFE) CODING VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED EXPLANATION. ULTRASOUND UNILATERAL COMPLETE UNILATERAL LIMITED AXILA ALONE For more information on exam codes and pricing, please contact the Radiology Ltd. Coding and Pricing Hotline at (520)

10 BREAST IMAGING MAMMOGRAPHY ORDERING DECISION TREE Does the patient have a problem? YES NO DIAGNOSTIC MAMMOGRAPHY ± 3D Tomosynthesis SCREENING MAMMOGRAPHY (beginning at age 40) ± 3D Tomosynthesis Palpable lesion / focal pain Nipple discharge (reproducible, single duct, bloody or serous) Negative Extra views needed (call back) per radiologist recommendation: Diagnostic order required <30 years old breast ultrasound only 30 years old Order diagnostic mammogram w/breast ultrasound Annual screening mammogram Diagnostic mammogram w/breast ultrasound, if clinically indicated Cyst aspiration (can be performed at time of exam w/ referring provider approval) Order diagnostic mammogram w/ breast ultrasound NEGATIVE: Surgical consultation to consider need for ductography SUSPICIOUS: Order breast biopsy SUSPICIOUS: Order breast biopsy PROBABLY BENIGN: Order 6 month follow-up diagnostic mammogram NEGATIVE: Return to annual screening mammogram 9

11 MAMMOGRAPHY ORDERING DECISION TREE HIGH RISK PATIENT High risk patients including those who: Have a known BRCA1 or BRCA2 gene mutation Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves Have a lifetime risk of breast cancer of 20% to 25% or greater. The Tyrer-Cuzick breast cancer risk assessment model is performed on all our screening patients Had radiation therapy to the chest when they were between the ages of 10 and 30 years Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan- Riley-Ruvalcaba syndrome, or have one of these syndromes in first-degree relatives SPECIAL CIRCUMSTANCES 3 years lumpectomy Suspected leakage implant Skin thickening or retraction Six month follow-up Annual breast MRI in addition to screening mammograms (± 3D Tomosynthesis) Screening mammography should start 10 years before the age of a breast cancer diagnosis in a 1st degree relative (though not before age 25) Order diagnostic mammogram (± 3D Tomosynthesis) w/ultrasound, if clinically indicated WHAT IS THE ARIZONA DENSE BREAST LAW? The law requires that a health care institution or facility that categorizes a patient as having heterogeneously dense or extremely dense breasts based on breast image reporting and the data system (BIRADS) established by the American College of Radiology, must include the following in the summary of the mammography report sent to the patient: BREAST IMAGING Your mammogram indicates that you have dense breast tissue. Dense breast tissue is common and is found in fifty percent of women. However, dense breast tissue can make it more difficult to detect cancers in the breast by mammography and may also be associated with an increased risk of breast cancer. This information is being provided to raise your awareness and to encourage you to discuss with your health care providers your dense breast tissue and other breast cancer risk factors. Together, you and your physician can decide if additional screening options are right for you. A report of your results was sent to your physician. This law went into effect October 1,

12 BREAST IMAGING 11 BREAST IMAGING: Screening and Diagnostic Mammography This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. PATIENT SYMPTOMS & S Asymptomatic Annual Screening (G0202) CAD for Screening (77052) Screening Breast 3D Tomosynthesis (77063) Implants (G0202) CAD for Screening (77052) Mastectomy Annual Screening (G ) CAD for Screening (77052) History of Breast Cancer (G0204 / Bilateral) (G0206 / Unilateral) CAD for Diagnostic (77051) Unilateral Breast 3D Tomosynthesis (77061) Bilateral Breast 3D Tomosynthesis (77062) Clinical Findings Symptoms (G0204 / Bilateral) (G0206 / Unilateral) CAD (77051) Under 30 Years of Age Order Ultrasound (76641 / Unilateral, Complete) (76642 / Unilateral, Limited) PARAMETERS Annual after age 40 (12 months and 1 day since last screening exam) Annual after age 40 (12 months and 1 day since last screening exam) Annual Screening of untreated breast (12 months and 1 day since last exam) Lumpectomy 6 months post surgery Annual 3 years Mass Pain Localized Mass Discharge Localized pain ORDER / PERFORM Screening Mammogram Screening Mammogram Screening Mammogram Diagnostic Mammogram Diagnostic Mammogram Diagnostic Mammogram Diagnostic Ultrasound SUGGESTED TEXT FOR ORDER Screening Mammogram (specify baseline or annual exam) Screening Mammogram (specify patient has implants and is NOT symptomatic but needs extra time for exam) Unilateral Screening Mammogram Diagnostic Mammogram: Personal History of Breast Cancer Lumpectomy Diagnostic Mammogram: With Ultrasound (identify area of mass) Diagnostic Mammogram: Pain (identify area of pain) With Ultrasound (localized pain) Diagnostic Breast Ultrasound With Mammogram (if needed) 3D mammography may be ordered as an adjunct to screening or diagnostic mammography, if the patient has dense breasts or it is deemed appropriate for other reasons.

13 PATIENT SYMPTOMS Short Term Follow-Up Exam Recommendation of Additional Imaging (Callback or Recall Exam) Nipple Discharge Indeterminate Lesion BREAST IMAGING: Additional Imaging and Procedures This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. PARAMETERS Recommendation of Previous Exam (3-6 months) Post Biopsy Exam (1-11 months after previous mammogram) Mammography ORDER / PERFORM Diagnostic Mammogram Diagnostic Mammogram Mammogram Additional Exam SUGGESTED TEXT FOR ORDER Diagnostic Mammogram: Short-Term Follow-Up Diagnostic Mammogram: Post Biopsy Radiology Ltd. will contact the patient to schedule this exam. A report with the final recommendation will be sent to the referring provider. Ultrasound Ultrasound Ultrasound (as specified in call back indicated on mammography report) Unilateral Reproducible Single Duct Discharge (patient must be able to express discharge at time of ductogram) Found on Ultrasound Ultrasound Visualizing Solid Lesion Diagnostic Mammogram First Left / Right Ductogram Ultrasound Guided Core Biopsy Diagnostic Mammogram: Discharge (identify breast and describe discharge) Ductogram for Nipple Discharge Left / Right Indeterminate Lesion / Mass BREAST IMAGING 12

14 BREAST IMAGING BREAST IMAGING: Breast MRI This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. PATIENT SYMPTOMS Cystic Mass / Lesion Found on Previous Breast Ultrasound High Risk Patient Pre-Operative Staging Silicone Implants and Palpable Lump, Pain or Abnormal Mammogram Indeterminate Clinical or Imaging Results Follow-Up for Chemotherapy Treatment PARAMETERS Previous Ultrasound Report Indicating Need for Aspiration See high risk patient parameters on page 10 Recent Diagnosis of Breast Cancer Suspected Silicone Implant Leak Further Evaluation of Indeterminate Clinical or Imaging Results ( radiologist recommendation ) Follow-Up for Neo-Adjuvant Chemotherapy ORDER / PERFORM Left / Right Cystic Aspiration Bilateral Breast MRI Bilateral Breast MRI (and Chest MRI, if necessary) Bilateral Breast MRI Bilateral Breast MRI Bilateral Breast MRI SUGGESTED TEXT FOR ORDER Left / Right Cystic Aspiration Bilateral Breast MRI Bilateral Breast MRI (and Chest MRI, if necessary) Bilateral Breast MRI Implant Protocol Bilateral Breast MRI Bilateral Breast MRI Radiology Ltd. provides a Patient Education Specialist for Women s Imaging, who will be solely dedicated to support you and your patients. The Patient Education Specialist brings a wealth of knowledge to both patients and the referring physician community. If you have questions and would like to speak with our Patient Education Specialist, she can be reached at (520)

15 BODY PART REQUESTED TEXT Skull Base to Mid-Thigh Whole Body PET / CT Skull Base to Mid-Thigh (all other diagnoses) PET / CT Whole Body (Diagnosis: Melanoma, Myeloma, Sarcoma, & Merkel Cell Carcinoma, Cutaneous Lymphoma) PET / CT: Bone Scan This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change Brain PET / CT Brain Myocardium Breast Lung Prostate Thyroid PET / CT: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. PET / CT Myocardium (Cannot be done if patient is diabetic) BODY PART REQUESTED TEXT PET / CT Bone Scan With Sodium Fluoride (This is covered only if the patient is entered into the National Pet Registry and is only open to Medicare eligible patients. ) PET/CT Our PET services are centrally located at our Camp Lowell site. To schedule a PET exam, please call (520) , opt

16 ULTRASOUND ULTRASOUND: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART REASON FOR EXAM PROCEDURE Abdomen Pelvic Area (Non-OB) Aorta (Seen to Iliacs) Abdominal Pain Above Umbilicus Abnormal LFT s Cirrhosis Hepatitis C Hepatomegaly Polycystic Disease Splenomegaly Endometriosis Fibroids / Enlarged Uterus Inguinal Hernia IUD Menstrual Disorders Ovarian Cysts PCOS Pelvic Pain Below Umbilicus (relating specifically to uterus or ovaries; ultrasound is not the exam of choice for intestinal disorders) AAA Abd Bruit / Pulsatile Mass Aortic Dissection AAA Screening for Medicare Must be referred from Initial Preventative Physical Exam (IPPE) Patient must have at least one of the following risks: Family Hx of AAA year old male who has smoked at least 100 cigarettes Additional risk factors include coronary heart disease, hypertension, cerebrovascular disease Abdominal Ultrasound Pelvic Ultrasound Trans Abdominal Abdominal Aorta Ultrasound Abdominal Aorta Ultrasound Medicare screening Trans Vaginal G

17 ULTRASOUND: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART REASON FOR EXAM PROCEDURE Kidneys Bladder Thyroid or Soft Tissue Neck Testicles Flank / Back Pain Hematuria Incomplete Bladder Emptying Neurogenic Bladder Polycystic Kidneys Renal Cyst / Mass Renal Disease (CKD) UTI Bladder Mass / Stone Check Post Void Residual Hematuria Enlarged Lymph Node Enlarged Thyroid / Fullness Goiter Hypo- / Hyper-Thyroid Nodules Palpable Mass on Neck Thyroiditis Epididymitis Hydrocele Orchalgia Pain / Swelling Torsion Varicocele Renal Ultrasound Bladder Ultrasound Thyroid Ultrasound Testicular Ultrasound ULTRASOUND Locally owned and operated, Radiology Ltd. offers seven imaging centers to patients across southern Arizona. 16

18 ULTRASOUND ULTRASOUND: Vascular This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART REASON FOR EXAM PROCEDURE Carotid Venous Upper and Lower Extremity Abdominal Renal Artery Amaurosis Fugax Arterial Vascular Disease Ataxia HTN Hyperlipidemia Stenosis Stroke TIA DVT Redness Reflux Upper and Lower Extremity Swelling / Pain Valvular Incompetency Portal HTN Portal Venous Thrombosis Liver Transplant TIPS Abd Bruit Renal Artery Stenosis Uncontrolled HTN Carotid Duplex / Doppler Venous Duplex / Doppler Abdominal Duplex / Doppler Renal Artery Duplex / Doppler Unilat Bilat Dup Scan Complete (Abdominal, Pelvic, Scrotal contents and/or retroperitoneal organs) Duplex Scan Limited Radiology Ltd. the best care, the best technology, and the best expertise, right in your own backyard. 17

19 ULTRASOUND: MSK/Extremity This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART REASON FOR EXAM PROCEDURE Neck / Head Hands / Wrists Foot Ankle Knee Elbow Groin Unlisted Lymphadenopathy Palpable Abnormality Foreign Body Ganglion Cyst Pain / Swelling Palpable Abnormality Radial / Ulnar Nerve Rheumatoid Arthritis / Arthritis Foreign Body Ganglion Cyst Morton s Neuroma Pain Palpable Abnormality Plantar Fasciitis Plantar Plate Tear Achilles Tendon Ganglion Cysts Foreign Body Pain / Swelling Palpable Abnormality Tendonitis (Anterior Tibialis, Posterior Tibialis, Peroneals) Baker s Cyst Pain / Swelling Palpable Abnormality Patellar Tendon Quadriceps Tendon Biceps Rupture Bursitis Pain / Swelling Palpable Abnormality Ulnar Nerve Inguinal Hernia Lymphadenopathy Palpable Abnormality Palpable Abnormality on the Back or Torso Soft Tissue Ultrasound Neck / Head Soft Tissue Hands / Wrists Ultrasound Soft Tissue Foot Ultrasound Soft Tissue Ankle Ultrasound Soft Tissue Knee Ultrasound Soft Tissue Elbow Ultrasound Soft Tissue Groin Ultrasound Chest Wall Upper Back Lower Back ULTRASOUND 18

20 CT / CTA CPT S for CT SCANS This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. ORBIT / FACE W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST BRAIN W/O CONTRAST W/ CONTRAST W/O & W/CONTRAST MAXILLOFACIAL W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST CERVICAL SPINE W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST SOFT TISSUE NECK W/ CONTRAST CHEST W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST UPPER EXTREMITY W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST THORACIC SPINE W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST LOWER EXTREMITY W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST ABDOMEN PELVIS COMBINATION W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST LUMBAR SPINE W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST 19

21 BODY PART REASON FOR EXAM PROCEDURE Chest Lung Nodules (1 st exam) CT Chest Without and With Contrast Chest, High Resolution CTA Chest (PE Study) CTA Chest & Abdomen Neck CT / CTA: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change Lung Nodules (follow-up) CT Chest Without Contrast Abnormal Chest X-ray COPD Cough Esophageal CA Hemoptysis Lung CA Lymphoma Mass Pneumonia Shortness of Breath Tracheal Stenosis Asbestosis Bronchiectasis Fibrosis Interstitial Lung Disease Pleural Plaques Sarcoidosis Pulmonary Embolism Shortness of Breath Vascular Evaluation Aortic Dissection Thoracic Aortic Aneurysm Cancer Workups Dysphagia Infection Infection of Parotid Gland Infection of Submandibular Gland Lymphadenopathy Mass Parotid Mass Parotid Stone Submandibular Stone CT Chest With Contrast CT Chest Without Contrast, High-Resolution CTA Chest CTA Chest and Abdomen CT Neck With Contrast CT / CTA 20

22 CT / CTA CT / CTA: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART REASON FOR EXAM PROCEDURE Pelvis (Soft Tissue) Pelvis (Bone) Abdomen / Pelvis Cancer Staging Cysts Hernia Infection Mass Pain CT Pelvis With Contrast Fracture, Non-Arthritis Union CT Pelvis Without Contrast Bone Infection Cancer / Mass / Mets / Tumor Stone (Stone protocol) Abdominal Pain Abscess Hernia (ie, ventral, umbilical, inguinal) Mass CT Pelvis With Contrast CT Abdomen and Pelvis Without Contrast (Stone protocol) Area of Concern: Above Iliac Crest (hip bone) CT Abdomen With Contrast Below Iliac Crest (hip bone) CT Pelvis With Contrast Any Cancer Staging Appendicitis Crohns / Ulcerative Colitis Diarrhea Diverticulitis IBD Location unknown or both areas apply CT Abdomen and Pelvis With Contrast CT Abdomen and Pelvis With Contrast Adrenal Adrenal Mass CT Abdomen With and Without Contrast Liver Hepatoma, Hepatitis, Cirrhosis Liver Hemangioma (MR preferred) CT Abdomen With and Without Contrast (Liver protocol)

23 BODY PART REASON FOR EXAM PROCEDURE Pancreas Pancreatic Mass Pancreatitis Pseudocyst CT Abdomen Without and With Contrast (Pancreatic protocol 1st time) CT Abdomen With Contrast Kidney Any Renal Pathology CT Abdomen Without and With Contrast (Kidney protocol) CT Urogram / CT IVP CTA Abdomen & Run Off Abdominal Aorta Mesenteric Vessels Renal Arteries Stent CT / CTA: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Transitional Cell Carcinoma of Kidney and/or Bladder Hematuria Claudication Peripheral Artery Disease (PAD) Mesenteric Ischemia Renal Artery Stenosis AAA Crossing Vessels Stent Obstruction / Leak / Malfunction CT IVP or CT Urogram CTA Abdomen and Run Off CTA Abdomen CTA Abdomen and Pelvis CT / CTA Radiology Ltd. is one of the largest physician-owned group practices in Tucson and has been providing diagnostic imaging services for more than eighty years. 22

24 CT / CTA CT / CTA: Head and Spine This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART REASON FOR EXAM PROCEDURE Head / Brain CTA Brain CTA Neck, Carotid Artery Alzheimer s CVA Headache Less Than 7 Days Hydrocephalus Memory Loss, Confusion Shunt Check Stroke / Bleed Trauma Headache More Than 7 Days HIV Infection Mass / Tumor Meningioma Meningitis Metastatic Staging Seizures Toxoplasmosis Vertigo / Dizziness / Mastoiditis Aneurysm AVM (Arterio / Venous Malformation) Bruit CVA Stroke TIA Vascular Tumor Bruit Carotid Stenosis CVA TIA AVM (Arterio / Vascular Malformation) Vascular Tumor Stroke Vertebrobasilar Insufficiency CT Head / Brain Without Contrast CT Head / Brain With Contrast CTA Head / Brain (Reconstruction) and/or (If both ordered, please authorize both codes) CTA Neck CTA Head, Neck (Please authorize with both) 70498,

25 BODY PART REASON FOR EXAM PROCEDURE Orbit Sinus / Face Spine: Cervical Spine: Thoracic Spine: Lumbar / Sacral Temporal Bone / IAC s CT / CTA: Head and Spine This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Foreign Body Fracture Trauma Cellulitis Exophthalmos Graves Disease Mass Pain Pseudo Tumor Functional Endoscopic Sinus Surgery Ostiomeatal Complex Sinusitis MR Recommended for Disc Herniation, Mets, Infection Trauma, Fracture, Fusion Assess Bony Degenerative Changes MR Recommended for Disc Herniation, Mets, Infection MR Recommended for Disc Herniation, Mets, Infection Trauma, Fracture, Fusion, Pars Defect Cholesteotoma Trauma CT Orbit Without Contrast CT Orbit With Contrast CT Sinus Without Contrast CT Cervical Spine Without Contrast CT Thoracic Spine Without Contrast CT Lumbar Spine Without Contrast CT Inner Ears, Temporal Bones Without Contrast Pituitary MRI Unless Contraindicated CT Brain Without and With Contrast CT / CTA For more information on exam codes and pricing, please contact the Radiology Ltd. Coding and Pricing Hotline at (520)

26 CT / CTA CT / CTA: Musculoskeletal This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART REASON FOR EXAM PROCEDURE Upper Extremity Arm Finger Forearm Hand Wrist Humerus Lower Extremity Ankle Calf Foot Hip Knee Thigh All Bone Exams Ordered Without Contrast Except for Tumor Evaluations All Bone Exams Ordered Without Contrast Except for Tumor Evaluations CT Without Contrast Upper Extremity (mention part) CT Without Contrast Lower Extremity (mention part) Extremities Tumor / Mass / Cancer / Mets CT With Contrast Upper CT With Contrast Lower Ischemia (Lower Extremity) Arterial Stenosis (Lower Extremity) Peripheral Artery Disease CTA Lower Extremity

27 BODY PART Colon Renal Artery (or Mesenteric Artery) Small Intestine (Bowel) Urinary Bladder CT / CTA: Specialty This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. REASON FOR EXAM PROCEDURE Failed Colonoscopy Patients Taking Blood Thinners Who Are Not Candidates for Routine Colonoscopy Screening Hypertension Renal Artery Stenosis Crohn s Disease Small Bowel Related Issues Abscess Bleeding Sources Bowel Obstruction Fistula Inflammation Tumor Bladder Cancer Bladder Polyps Bleeding Hydronephrosis Vesicoureteral Reflux CT Colonography With 3D Rendering (Virtual Colonoscopy) NOTE: Cleansing prep to be given at facility CTA Abdomen For Renal Arteries Screening Diagnostic CT Enterography CT Cystogram (Please authorize BOTH codes) CT Heart Screening, Hyperlipidemia CT Calcium Score Without Contrast CT / CTA CTA Heart Abnormal Echo Chest Pain, Sub Tachycardia CTA Coronary Artery Without and With Contrast CT Low Dose Lung Cancer Screening Screening CT Low Dose Lung Cancer Screening Must Meet Criteria

28 MRI / MRA CPT S for MRI SCANS This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. ORBIT, FACE & NECK W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST TMJ SHOULDER, ELBOW OR WRIST (UPPER EXTREMITY, JOINT) W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST HUMERUS, FOREARM OR NON-JOINT (UPPER EXTREMITY, JOINT) W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST BRAIN W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST CERVICAL SPINE W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST CHEST (CLAVICLE) W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST BREAST W/O & W/ CONTRAST THORACIC SPINE W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST HIP, KNEE OR ANKLE (LOWER EXTREMITY, JOINT) W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST THIGH, LOWER LEG OR FOOT (LOWER EXTREMITY, NON-JOINT) W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST ABDOMEN W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST LUMBAR SPINE W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST PELVIS W/O CONTRAST W/ CONTRAST W/O & W/ CONTRAST 27

29 BODY PART REASON FOR EXAM PROCEDURE Breast (Pre-Operative Staging) Breast (Silicone Implants) Breast (Indeterminate Clinical or Imaging Results) Follow-Up for Chemotherapy Treatment MRI: Breast This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Recent Diagnosis of Breast Cancer Suspected Silicone Implant Leak Palpable Lump Pain Further Evaluation of Indeterminate Clinical or Imaging Results (Radiologist recommendation) Follow-Up for Neo-Adjuvant Chemotherapy Bilateral Breast MRI (and Chest MRI, if necessary) Bilateral Breast MRI in Addition to Implant Protocol (71552) Bilateral Breast MRI Bilateral Breast MRI Please note: Breast MRI does not replace screening mammography. MRI / MRA: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. MRI / MRA BODY PART REASON FOR EXAM PROCEDURE Heart TMJ Urogram Ear Brain (IAC) Enterography Congenital Defect & Heart Valve Issues Past MI - Other Cardiac Issues Internal Derangement Joint Dysfunction Hematuria - Congenital Abnormalities Urinary Tract Obstruction MRI Heart & MRI TMJ MRI Urogram & Hearing Loss MRI Brain Crohn s Disease Inflammatory Bowel Disease MRI Enterography

30 MRI / MRA MRI / MRA: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART REASON FOR EXAM PROCEDURE Abdomen Brachial Plexus Chest Mediastinum Neck (Soft Tissue) Pelvis Prostate Cranial Nerve Series Adrenal MRCP (Biliary / Pancreatic Ducts) Liver Eval Pancreas Eval All Other Reasons Brachial Plexus Injury Nerve Avulsion Tumor / Mass / Cancer / Mets Tumor / Mass / Cancer / Mets Infection Pain Tumor / Mass / Cancer / Mets Vocal Cord Paralysis Adenomyosis Fracture Muscle / Tendon Tear Pelvic Organ Prolapse Pelvic Floor Dysfunction Outlet Obstruction Incontinence Abscess Fibroid Osteomyelitis Pre / Post Fibroid Embolization Septic Arthritis Tumor / Mass / Cancer / Mets Urethral Diverticulum Benign Prostatic Hyperplasia (BPH) Enlarged Prostate Evaluation of Prostate Cancer Infection (Prostatitis) Prostate Abscess Bells Palsy Trigeminal Neuralgia MRI Abdomen Without Contrast (MRCP) MRI Abdomen Without and With Contrast MRI Chest / Mediastinum Without and With Contrast (Specify Brachial Plexus) MRI Chest Without and With Contrast MRI Neck Without and With Contrast MRI Pelvis Without Contrast MRI Dynamic Pelvis MRI Pelvis Without and With Contrast MRI Prostate MRI Brain Att: Cranial Nerves

31 BODY PART REASON FOR EXAM PROCEDURE Abdomen Chest MRI / MRA: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. AAA (Abdominal Aortic Aneurysm) Abdominal Aorta Dissection Mesenteric Ischemia Renal Artery Stenosis Pre Liver Transplant Pre Kidney Transplant Renal Mass-Evaluation / Pre-Op Subclavian Vessels Thoracic Aorta (other than dissection) Vascular Anomalies Aortic Dissection MRA Abdomen Order 2 Exams: MRA Abdomen AND MRI Abdomen Without and With Contrast (Please authorize BOTH codes) MRA Chest Order 2 Exams: MRA Chest AND MRA Abdomen (Please authorize BOTH codes) MRI / MRA Pelvis MRA Abd/Pel w/run Off Peripheral Run-Off AVM May Thurner MRA Pelvis Peripheral Vascular Insufficiency MRA Abdomen, Pelvis and Lower Extremities Claudication Cold Foot Pain Order 4 Exams: MRA Abdomen AND MRA Lower LEFT Extremity AND MRA Lower RIGHT Extremity AND MRA Pelvis (Please authorize ALL codes) 74185, 72198, (x2)

32 MRI / MRA MRI / MRA: Head and Spine This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART REASON FOR EXAM PROCEDURE Pituitary Protocol Spine: Cervical Elevated Prolactin Arm / Shoulder Pain and/or Weakness Chiari Malformation Degenerative Disease Disc Herniation Neck Pain Post-Op Fusion Radiculopathy MRI Brain Att: Pituitary MRI Cervical Spine Without Contrast Discitis Multiple Sclerosis Myelopathy Osteomyelitis Syrinx Tumor / Mass / Cancer / Mets Vascular Lesions, AVM MRI Cervical Spine Without and with Contrast Spine: Thoracic Back Pain Compression Fx (no hx malig / mets) Degenerative Disease Disc Herniation Radiculopathy Trauma Vertebroplasty Planning (with no hx malig) MRI Thoracic Spine Without Contrast AVM Compression Fx (with hx malig / mets) Discitis Multiple Sclerosis Myelopathy Osteomyelitis Syrinx Tumor / Mass / Cancer / Mets Vascular Lesions Vertebroplasty Planning (with hx malig) MRI Thoracic Spine Without and With Contrast

33 BODY PART REASON FOR EXAM PROCEDURE Spine: Lumbar Brain MRI Head NeuroQuant MRI / MRA: Head and Spine This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Back Pain Compression Fx (no hx malig / mets) Degenerative Disease Disc Herniation Radiculopathy Sacrum / SI Joints Sciatica Spondylolisthesis Stenosis Trauma Vertebroplasty Planning (with no hx malig) Compression Fx (hx malig / mets) Discitis Osteomyelitis Post-Op Tumor / Mass / Cancer / Mets Vertebroplasty (with hx malig) Alzheimer s, Confusion, Dementia, Hydrocephalis, Memory Loss, Mental Status Changes Headache Pseudotumor Seizures Tumor / Mass / Cancer / Mets Vascular Lesions All other reasons Dementia Memory Loss Seizures MRI Lumbar Spine Without Contrast MRI Lumbar Spine Without and With Contrast MRI Brain Without Contrast MRI Brain Without and With Contrast MRI Brain with NeuroQuant 70551, MRI / MRA Radiology Ltd. offers a better choice in open MRI called Espree X-Large MRI. The open design of the Magnetom Espree accommodates patients of all sizes and helps eliminate anxiety and claustrophobia. 32

34 MRI / MRA BODY PART REASON FOR EXAM PROCEDURE Brain / Orbits / Face MRI / MRA: Head and Spine This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Exophthalmos, Proptosis Graves Disease MRI Brain and Orbits Without and With Contrast (If patient has not had recent MRI Brain, please add MRI Brain Without and With Contrast) (Please authorize BOTH codes) MRA Arch & Great Vessels Brain Neck MRV Brain Stroke / CVA TIA Vertebrobasilar Insufficiency MRA Brain Without Contrast MRA Neck With Contrast (Please authorize BOTH codes) Venous Thrombosis MRV Without Contrast MRI: Musculoskeletal (including Arthrography) This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART REASON FOR EXAM PROCEDURE Arm Hand Leg Foot Fracture Muscle / Tendon Tear Stress Fracture MRI Non Joint Without Contrast Upper Extremity Lower Extremity Abscess Arthritis (special protocol please specify) Bone Tumor / Mass / Cancer / Mets Cellulitis Faciitis Myositis Morton s Neuroma Osteomyelitis Soft Tissue Tumor / Mass / Cancer / Mets Ulcer MRI Non Joint Without and With Contrast Upper Extremity Lower Extremity

35 BODY PART REASON FOR EXAM PROCEDURE Shoulder Elbow Wrist Finger Hip Knee Ankle Toe Scapula (Not Included In Shoulder) MRI Arthrography Elbow Wrist Hip Knee Ankle Shoulder MRI: Musculoskeletal (including Arthrography) This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Avascular Necrosis (AVN) Cartilage Tear Fracture Internal Derangement Joint Pain (specify joint) Labral Tear Ligament Tear Meniscal Tear Muscle Tear Osteochondritis Dissecans (OCD) Plantar Fascitis Stress Fracture Tendon Tear Abscess Arthritis Cellulitis Fasciitis Inflammatory Arthritis (pannus eval) Myositis Osteomyelitis Septic Arthritis Tumor / Mass / Cancer / Mets Ulcer Pain Sprain / Strain Tear Labral Tear Loose Bodies OCD Stability Post-Op Meniscus Evaluation MRI Joint Without Contrast Upper Extremity Lower Extremity MRI Lower Extremity Joint Without and With contrast Upper Extremity Lower Extremity MRI Chest Without and With Contrast MRI Joint With Contrast Order with 3 codes: 1 Lower Extremity With Contrast OR Upper Extremity With Contrast 2 Fluoro Guided Arthrogram 3 Choose body part: Shoulder Elbow Wrist Hip Knee Ankle & & & & & & MRI / MRA 34

36 INTERVENTIONAL Sedation Required INTERVENTIONAL RADIOLOGY SERVICES This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Minimally Invasive Diagnostic Procedures Interventional Service Modality CPT Code(s) Performed By Evaluation Required No Labs Required Arthrogram (Shoulder, Elbow, Wrist, Hip, Knee, and Ankle) Fluoroscopy is used to place a thin needle into the symptomatic joint. Dye is injected and images are obtained. In most cases additional images are then obtained using MRI or CT. Fluoroscopy; then MRI or CT Upper Joints Shoulder: 73222, 23350, 73040, Elbow: 73222, 24220, 73085, Wrist: 73222, 25246, 73115, Lower Joints Hip: 73722, 27093, 73525, 77002, Knee: 73722, 27370, 73580, Ankle: 73722, 27648, 73615, Interventional, Body, or Musculoskeletal Radiologist No Only if patient is taking Coumadin No Upper Joints Replace code with Lower Joints Replace code with Myelogram (Thoracic, Lumbar) Fluoroscopy is used to place a thin needle into the spinal canal. Dye is injected and images are obtained. In most cases additional images are then obtained using CT. Fluoroscopy; then CT T-Spine: 62303, L-Spine: 62304, Use for 2 or 3 levels Neuroradiologist No Only if patient is taking Coumadin Local anesthetic Arthrocentesis (Joint Fluid Aspiration, Joint Tap, Synovial Fluid Aspiration) A needle is placed into a joint space and fluid is removed for diagnostic analysis or to help relieve pain and pressure on the joint. Fluoroscopy or CT Small Joint or Bursa (fingers, toes): 20600, Intermediate Joint or Bursa (TMJ, acromioclavicular, wrist, elbow, ankle, olecranon bursa): 20605, Major Joint or Bursa (shoulder, hip, knee, subacromial bursa): 20610, Interventional or Body Radiologist No No Small Joint or Bursa (fingers, toes): 20600, Intermediate Joint or Bursa (TMJ, acromioclavicular, wrist, elbow, ankle, olecranon bursa): 20605, Major Joint or Bursa (shoulder, hip, knee, subacromial bursa): 20610, To schedule an interventional procedure, please call (520) or fax (520)

37 Minimally Invasive Diagnostic Procedures Sedation Required Labs Required Evaluation Required Interventional Service Modality CPT Code(s) Performed By Ultrasound Paracentesis A thin needle or tube is placed into the abdomen in order to remove fluid for diagnosis and/or reduce discomfort. INTERVENTIONAL RADIOLOGY SERVICES This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. No Yes, call for specifics No Interventional or Body Radiologist or CT Ultrasound Yes Yes, call for specifics Yes Interventional or Body Radiologist or Thoracentesis A thin needle or tube is placed into the chest in order to remove fluid for diagnosis and/or to reduce discomfort CT Thyroid: 60100, Lung/Mediastinum: 32405, Liver: 47000, Renal: 50200, Abdominal/Retroperitoneal Mass: 49180, CT, Image-Guided Percutaneous Biopsy A needle is placed in a desired location using imaging guidance in order to obtain a small piece of tissue so that it can be examined by a pathologist. Certain biopsies may need to be performed at the hospital due to their risk of complications. Yes Yes, call for specifics Yes Interventional or Body Radiologist Thyroid: 60100, Lung/Mediastinum: 32405, Liver: 47000, Renal: 50200, Abdominal/Retroperitoneal Mass: 49180, Ultrasound or Thyroid: 60100, Lung/Mediastinum: 32405, Liver: 47000, Renal: 50200, Abdominal/Retroperitoneal Mass: 49180, Fluoroscopy INTERVENTIONAL To schedule an interventional procedure, please call (520) or fax (520)

38 INTERVENTIONAL Pain Management Sedation Required Labs Required Evaluation Required Interventional Service Modality CPT Code(s) Performed By INTERVENTIONAL RADIOLOGY SERVICES This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Epidural: L-Spine: 62311, Nerve Root/Block (per level/per side) L-Spine: 64483, Fluoroscopy No Only if patient is taking Coumadin Neuroradiologist Yes Epidural: L-Spine: 77012, SI: 77012, Nerve Root/Block (per level/per side) L-Spine: 64483, or CT Spinal Injection (Epidural, Nerve Root, Facet, and Sacroiliac) Anesthetics and/ or steroid medications are injected in the spine to reduce back and/or leg pain. These can be both diagnostic and therapeutic and include epidural, nerve root, facet and sacroiliac joint injections. Fluoroscopy Lumbar Facet: (1st), (2nd), (3rd) No Only if patient is taking Coumadin Yes Interventional, Body, or Musculoskeletal Radiologist or Joint Injection (Lumbar Facet and Sacroiliac) Steroid medication is injected into the symptomatic joint to decrease pain and swelling. Sacroiliac (SI): (1st), (2nd), (3rd) CT No Only if patient is taking Coumadin Yes, may require a consult. Must have either MRI or CT. Fluoroscopy 62270, Neuroradiologist Lumbar Puncture (Spinal Tap, Spinal Puncture, Thecal Puncture, Rachiocentesis) Local anesthesia is injected into the lumbar region of the back, and a needle is inserted into the spinal canal. Cerebrospinal fluid (CSF) can then be removed for testing. Due to the sensitive nature of some interventional procedures, the following services are usually performed by Radiology Ltd. staff in a hospital setting: Loopogram Shuntogram Stent Ureteral Catheter or Stent Venogram Cholangiogram (T-Tube) Fistulogram (dialysis or other than dialysis) Gastric Emptying Study IVC Filter Placement Biliary Dilation w/o or w/stent Biliary Drain Biopsy (Renal / Lung) Catheter Placement (Renal / Pelvis) Catheter Stripping Angiogram Angioplasty Aortagram Arteriogram Biliary Tube Change 3837 To schedule an interventional procedure, please call (520) or fax (520)

39 Pain Management Sedation Required Labs Required Evaluation Required Interventional Service Modality CPT Code(s) Performed By INTERVENTIONAL RADIOLOGY SERVICES This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. T-Spine: 22510, each add l level use (if biopsy is performed on separate vertebrae, use 20225) L-Spine: 22511, each add l level use (if biopsy is performed on separate vertebrae, use 20225) Vertebroplasty (Thoracic, Lumbar) Fluoroscopy or CT guidance is used to place a needle into a fractured vertebra. Bone cement is then injected to stabilize the fracture. Fluoroscopy Yes Yes, call for specifics Yes, may require a consult. Must have either MRI or CT+ Bone Scan prior to evaluation. Interventional Radiologist or Neuroradiologist or T-Spine: 22513, each add l level use (if biopsy is performed on separate vertebrae, use 20225) L-Spine: 22514, each add l level use (if biopsy is performed on separate vertebrae, use 20225) CT Kyphoplasty (Thoracic, Lumbar) Fluoroscopy or CT guidance is used to place a needle into a fractured vertebra. Bone cement is then injected to stabilize the fracture. Unilateral: 0200T, Yes Yes, call for specifics Yes, may require a consult. Must have either MRI or CT+ Bone Scan prior to evaluation. Interventional Radiologist or Neuroradiologist Sacroplasty CT is used to guide two needles into a fractured sacrum. A mixture of bone cement and contrast is then injected into the sacrum through the needles to stabilize the fracture. CT Bilateral: 0201T, No Only if patient is taking Coumadin Fluoroscopy 62273, Neuroradiologist Sometimes Epidural Blood Patch Epidural Blood Patch (EBP) is used to treat spinal headaches that are most commonly encountered after dural puncture. The blood patch acts as a gelatinous glue which prevents cerebrospinal fluid (CSF) leakage and allows the dural hole to heal. INTERVENTIONAL To schedule an interventional procedure, please call (520) or fax (520)

40 INTERVENTIONAL Sedation Required INTERVENTIONAL RADIOLOGY SERVICES This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Vascular Services Interventional Service Modality CPT Code(s) Performed By Evaluation Required Yes Labs Required Venogram A catheter is placed in a vein, and images are taken while dye is injected in order to detect narrowing or clotting of the vein. Fluoroscopy Unilateral: 75820, Bilateral: 75822, (x2) (Foot and lower leg Venograms are performed on site. All other venograms are performed in a hospital setting.) Interventional Radiologist Yes Only if patient is taking Coumadin No PICC Lines Placement Fluoroscopy and ultrasound are used to guide a catheter through a vein in the arm and then into the upper chest. The catheter is used for long term IV therapy and eliminates the necessity for multiple needle punctures. Fluoroscopy & Ultrasound 36569, 77001, Interventional Radiologist Yes Only if patient is taking Coumadin Radiology Ltd. offers two interventional out-patient facilities in Tucson. Our Radiology Ltd. La Cholla Center for Diagnostic Imaging and Treatment located at 5960 N. La Cholla Blvd. and Radiology Ltd. Wilmot Center for Diagnositc Imaging and Treatment located at 677 N. Wilmot Rd To schedule an interventional procedure, please call (520) or fax (520)