DX PROCEDURES ANGIO CERVICOCEREBRAL INC ORIG ANGIO EXTREMITY BILAT S&I ANGIO EXTREMITY UNILAT S&I RT
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1 DX PROCEDURES NAME CPT CODE ABDOMEN 1 VIEW ABDOMEN ACUTE COMP INCL CXR ABDOMEN AP & OBL & CONED VIEWS ABDOMEN COMP INCL DECUB/ERECT ABSCESS FISTULA OR SINUS TRACT AC JOINTS BILAT W OR WO WEIGHT ANGIO AV SHUNT S&I ANGIO BRACHIAL RETROGRA LT S&I ANGIO BRACHIAL RETROGRA RT S&I ANGIO CAROTID CERVI UNI S&I LT 75676LT ANGIO CAROTID CERVI UNI S&I RT 75676RT ANGIO CERVICOCEREBRAL INC ORIG ANGIO EXTREMITY BILAT S&I ANGIO EXTREMITY UNILAT S&I LT 75710LT ANGIO EXTREMITY UNILAT S&I RT 75710RT ANGIO PELVIC SELECT S&I ANGIOPLASTY PERIPHERAL ART S& ANGIOPLASTY PERIPHERAL EA ADD ANGIOPLASTY R/VC ART EA ADD S& ANGIOPLASTY RENAL/VISC ART S&I ANGIOPLASTY VENOUS S&I ANKLE 1 VIEW LEFT ANKLE 1 VIEW RIGHT ANKLE 2 VIEWS LEFT 73600LT ANKLE 2 VIEWS RIGHT 73600RT ANKLE ARTHROGRAM INJ PROC ANKLE COMP MIN 3 VIEWS LEFT 73610LT ANKLE COMP MIN 3 VIEWS RIGHT 73610RT ANORECTAL MANOMETRY AORTO ABD+BILAT ILIOFEM LOW EX AORTOGRAPHY ABDOMEN SERIAL S&I ARTHRITIS/JOINT SURVEY JUVEN ARTHROCENTESIS OF KNEE JOINT ARTHROGRAM ANKLE S&I LEFT 73615LT ARTHROGRAM ANKLE S&I RIGHT 73615RT BARIUM ENEMA COLON BARIUM ENEMA THERAPEUTIC BARIUM ENEMA W/AIR CONTRAST BONE AGE HEMISKELETON BONE AGE STUDIES BONE LENGTH SCANOGRAM BONE SURVEY COMPLETE BONE SURVEY INFANT UP TO 2 YRS BONE SURVEY LIMITED 77074
2 BRONCH W/TRANS LUNG BX 1 LOBE CALCANEUS MIN 2 VIEWS LEFT 73650LT CALCANEUS MIN 2 VIEWS RIGHT 73650RT C-ARM FLUOROSCOPY CAROTID CERVICAL ARTERIO BILAT CHEMO ADMIN CNS.include punct CHEST 1 VIEW CHEST 2 VIEWS CHEST COMPLETE MIN 4 VIEWS CHEST SPECIAL VIEWS OBL DECUB CHEST WITH APICAL LORDOTIC CHEST WITH FLUORO CHEST WITH OBLIQUES CHEST/ABD COMBINED NEONATE CHOC EMP SINGLE VIEW CHEST CHOLANG EXIST TUBE INJ PROC CHOLANGIOGRAM EXIST T-TUBE S&I CHOLANGIOGRAM OPER ADD SET S&I CHOLANGIOGRAM OPERATIVE S&I CHOLANGIOGRAM TRANSHEPATIC CHOLECYSTOGRAM ORAL CONTRAST CLAVICLE COMPLETE LEFT 73000LT CLAVICLE COMPLETE RIGHT 73000RT COLONIC TRANSIT TIME COMPLEX SPEECH EVAL BY CINE CYSTO W INSERT URETERAL STENT CYSTO W/REMOVAL/MANIP/CALCULUS CYSTO/VOIDING URETHRO INJ PROC CYSTOGRAM MIN 3 VIEWS S&I DEFECOGRAPHY ELBOW 1 VIEW LEFT ELBOW 1 VIEW RIGHT ELBOW 2 VIEWS LEFT 73070LT ELBOW 2 VIEWS RIGHT 73070RT ELBOW ARTHROGRAM INJ PROC ELBOW ARTHROGRAM S&I LEFT 73085LT ELBOW ARTHROGRAM S&I RIGHT 73085RT ELBOW COMPLETE MIN 3 VIEWS LT 73080LT ELBOW COMPLETE MIN 3 VIEWS RT 73080RT ENDOSCOPIC CATH BILIARY PANC ENTIRE LOWER EXTREMITY LT 77074LT ENTIRE LOWER EXTREMITY RT 77074RT ENTIRE UPPER EXTREMITY LT 77074LT ENTIRE UPPER EXTREMITY RT 77074RT EPIDIDY VASOGRAM ESOPH PHARYNX/CERVICAL ESOPHAGRAM 74220
3 EYE FOR FOREIGN BODY FACIAL BONES COMP MIN 3 VWS FACIAL BONES LESS THAN 3 VWS FEMUR 1 VIEW LEFT FEMUR 1 VIEW RIGHT FEMUR 2 VIEWS LEFT 73550LT FEMUR 2 VIEWS RIGHT 73550RT FINGER MIN 2 VIEWS INDEX LEFT 73140F1 FINGER MIN 2 VIEWS INDEX RIGHT 73140F6 FINGER MIN 2 VIEWS LITTLE LEFT 73140F4 FINGER MIN 2 VIEWS LITTLE RIGH 73140F9 FINGER MIN 2 VIEWS MIDDLE LEFT 73140F2 FINGER MIN 2 VIEWS MIDDLE RIGH 73140F7 FINGER MIN 2 VIEWS RING LEFT 73140F3 FINGER MIN 2 VIEWS RING RIGHT 73140F8 FINGER MIN 2 VIEWS THUMB LEFT 73140FA FINGER MIN 2 VIEWS THUMB RIGHT 73140F5 FISTULA SINUS TRACT INJECTION FLUORO FOR LITHO LEFT FLUORO FOR LITHO RIGHT FLUORO GUID NDL PLACE BXASINJL FLUORO GUIDE CENTRAL VEN ACCES FLUORO GUIDE LOC NDL OR CATH FLUORO GUIDLOC SPINAL INJ PROC FLUORO MORE THAN 1HR NON RAD P FLUORO SEPARATE PROC UP TO 1HR FLUOROSCOPY FOR PAIN MGMT FOOT 1 VIEW LEFT FOOT 1 VIEW RIGHT FOOT 2 VIEWS LEFT 73620LT FOOT 2 VIEWS RIGHT 73620RT FOOT COMPLETE MIN 3 VIEWS LEFT 73630LT FOOT COMPLETE MIN 3 VIEWS RIGH 73630RT FOREARM 1 VIEW LEFT FOREARM 1 VIEW RIGHT FOREARM 2 VIEWS LEFT 73090LT FOREARM 2 VIEWS RIGHT 73090RT GI TUBE INTRO LONG SEPAR PROC HAND 1 VIEW LEFT HAND 1 VIEW RIGHT HAND 2 VIEWS LEFT 73120LT HAND 2 VIEWS RIGHT 73120RT HAND COMP MIN 3 VIEWS LEFT 73130LT HAND COMP MIN 3 VIEWS RIGHT 73130RT HIP ARTHRO INJ PROC W/ ANESTH HIP ARTHRO INJ PROC W/O ANESTH HIP ARTHROGRAM S&I LEFT 73525LT
4 HIP ARTHROGRAM S&I RIGHT 73525RT HIP BILAT INCL AP PELVIS HIP IN SURGERY LEFT 73530LT HIP IN SURGERY RIGHT 73530RT HIP UNILAT 1 VIEW LEFT 73500LT HIP UNILAT 1 VIEW RIGHT 73500RT HIP UNILAT 2 VIEWS LEFT 73510LT HIP UNILAT 2 VIEWS RIGHT 73510RT HUMERUS 1 VIEW LEFT HUMERUS 1 VIEW RIGHT HUMERUS MIN 2 VIEWS LEFT 73060LT HUMERUS MIN 2 VIEWS RIGHT 73060RT HYSTEROSALPINGOGRAM CATH INTRO HYSTEROSALPINGOGRAM S&I ILEAL CONDUIT/LOOPOGRAM INJ PR INJ W/FLUORO, EVAL CV DEVICE INSERT NON INDWELLING CATHETER INSERT OF INDWELLING CATHETER INT CAROTID CEREBRAL ART BILAT INT CAROTID CEREBRAL ART LT 75665LT INT CAROTID CEREBRAL ART RT 75665RT INTERNAL AUDITORY MEATI COMP INTRAVENOUS PYELOGRAM INTRO LONG GI TUBE FLUORO S&I JOINT/BURSA INJECT OR ASPIRAT KNEE 1 OR 2 VIEWS LEFT 73560LT KNEE 1 OR 2 VIEWS RIGHT 73560RT KNEE 3 VIEWS LEFT 73562LT KNEE 3 VIEWS RIGHT 73562RT KNEE ARTHROGRAM INJ PROC KNEE ARTHROGRAM S&I LEFT 73580LT KNEE ARTHROGRAM S&I RIGHT 73580RT KNEE COMP 4 OR MORE VIEWS LEFT 73564LT KNEE COMP 4 OR MORE VIEWS RIGH 73564RT LOWER EXT INFANT MIN 2 VWS LT 73592LT LOWER EXT INFANT MIN 2 VWS RT 73592RT MANDIBLE COMPLETE MIN 4 VIEWS MANDIBLE LESS THAN 4 VIEWS MANUAL STRESS FOR JOINT BY PH MASTOIDS COMPLETE MIN 3 VIEWS MASTOIDS LESS THAN 3 VIEWS MYELO AND/OR CT,SPINAL INJ PRO MYELOGRAM 2 OR MORE REGION S& MYELOGRAM CERVICAL S&I MYELOGRAM LUMBAR S&I MYELOGRAM THORACIC S&I NASAL BONES COMP MIN 3 VWS 70160
5 NECK SOFT TISSUE NOSE TO RECTUM FOR F/B CHILD OCG ADDL/RPT/MULTIDAY EXAM OPTIC FORAMINA ORBITS COMPLETE MIN 4 VIEWS PEL & HIPS INFANT/CHILD MIN 2V PELVIS 1 0R 2 VIEWS PELVIS COMPLETE MIN 3 VIEWS PERINEOGRAM (SEX DETERM/ANOM) PYELO ANTE EXIST TUBE/CATH IN RAD GUIDE FOR PERC DRG S&I RECTAL STENT PLACEMENT IMAGIN RETROGRADE UROGRAPHY REVIEW OF OUTSIDE RAD EXAM RIB BILAT MIN 4 VIEWS W/PA CX RIBS BILAT 3 VIEWS RIBS UNILAT 2 VIEWS LT 71100LT RIBS UNILAT 2 VIEWS RT 71100RT RIBS UNILAT PACXR MIN 3 VWS L 71101LT RIBS UNILAT PACXR MIN 3 VWS R 71101RT SACROILIAC JOINTS MIN 3 VIEWS SACRUM AND COCCYX MIN 2 VIEWS SALIVARY GLAND FOR CALCULUS L 70380LT SALIVARY GLAND FOR CALCULUS R 70380RT SC JOINT OR JOINTS MIN 3 VIEW SCAPULA COMPLETE LEFT 73010LT SCAPULA COMPLETE RIGHT 73010RT SCOLIOSIS STUDY INCL SUP & ER SELLA TURCICA SHOULDER 1 VIEW LEFT 73020LT SHOULDER 1 VIEW RIGHT 73020RT SHOULDER ARTHROGRAM INJ PROC SHOULDER ARTHROGRAM S&I LEFT 73040LT SHOULDER ARTHROGRAM S&I RIGHT 73040RT SHOULDER COMP MIN 2 VIEWS LEF 73030LT SHOULDER COMP MIN 2 VIEWS RT 73030RT SHUNTOGRAM S&I SIALOGRAM S&I LT 70390LT SIALOGRAM S&I RT 70390RT SIALOGRAPHY INJ PROC SINUSES PARANASAL COMP MIN 3V SINUSES PARANASAL LESS THAN SJH SINGLE VIEW CHEST SKULL COMPLETE MIN 4 VIEWS SKULL LESS THAN 4 VIEWS SMALL BOWEL DUODENOGRAPHY SMALL BOWEL ENTEROCLYSIS 74251
6 SMALL BOWEL SERIES SPINAL PUNCTURE LUMBAR DIAG SPINE CERVICAL 1 VIEW SPINE CERVICAL 2 OR 3 VIEWS SPINE CERVICAL MIN 4 VIEWS SPINE CERVICAL W/FLEX OR EXT SPINE ENTIRE SURVEY SPINE LUMBAR 1 VIEW SPINE LUMBAR 2 OR 3 VIEWS SPINE LUMBAR BEND ONLY MIN 4VW SPINE LUMBAR COMP INCL BENDING SPINE LUMBAR MIN 4 VIEWS SPINE THORACIC 1 VIEW SPINE THORACIC 3 VIEWS SPINE THORACOLUMBAR 2 VIEWS SPINE THORAIC 2 VIEWS SPINE TL STANDING (SCOLIOSIS) STERNUM MIN 2 VIEWS SURGICAL BREAST SPECIMEN SURGICAL SPECIMEN SWALLOW FUNCTION W/ CINE/VIDEO TIBIA AND FIBULA 1 VIEW LEFT TIBIA AND FIBULA 1 VIEW RIGHT TIBIA AND FIBULA 2 VIEWS LEFT 73590LT TIBIA AND FIBULA 2 VIEWS RIGH 73590RT TMJ OPEN AND CLOSED BILAT TMJ OPEN AND CLOSED UNILAT LT 70328LT TMJ OPEN AND CLOSED UNILAT RT 70328RT TOE 1ST LEFT 73660TA TOE 1ST RIGHT 73660T5 TOE 2ND LEFT 73660T1 TOE 2ND RIGHT 73660T6 TOE 3RD LEFT 73660T2 TOE 3RD RIGHT 73660T7 TOE 4TH LEFT 73660T3 TOE 4TH RIGHT 73660T8 TOE 5TH LEFT 73660T4 TOE 5TH RIGHT 73660T9 TOMOGRAPHY SINGLE PLANE TUBE/CATH CHANGE PERC W/CON S UGI & SB W/AIR CONTRAST UGI AIR/HD, W/KUB UGI AIR/HD, W/O KUB UGI AND SMALL BOWEL UGI SERIES WITH KUB UGI SERIES WITHOUT KUB UNLISTED RADIOLOGY PROCEDURE 76499
7 UPPER EXTREM INFANT MIN 2VW L 73092LT UPPER EXTREM INFANT MIN 2VW R 73092RT URETHROCYSTOGRA RETRO INJ PRO URETHROCYSTOGRAM S&I UROGRAPHY ANTEGRADE NEPH/LOOP UROGRAPHY IV W OR WO KUB TOMO UROGRAPHY W/NEPHROTOMOGRAPHY VENOGRAM BILAT S&I VENOGRAM UNILAT LEFT S&I 75820LT VENOGRAM UNILAT RIGHT S&I 75820RT VENOGRAPHY CAVAL INFERIOR SER VENOGRAPHY CAVAL SUPERIOR SER VENOGRAPHY EXTREMITY INJ PROC VOIDING CYSTOURETHROGRAM S&I WRIST 1 VIEW LEFT WRIST 1 VIEW RIGHT WRIST 2 VIEWS LEFT 73100LT WRIST 2 VIEWS RIGHT 73100RT WRIST ARTHRGRAMAM INJ PROC WRIST ARTHROGRAM S&I LEFT 73115LT WRIST ARTHROGRAM S&I RIGHT 73115RT WRIST COMP MIN 3 VIEWS LEFT 73110LT WRIST COMP MIN 3 VIEWS RIGHT 73110RT Revised 9/27/13
Department of Radiology DX PROCEDURES
ABDOMEN 1 VIEW 74000 ABDOMEN ACUTE COMP INCL CXR1 74022 ABDOMEN AP & OBL & CONED VIEWS 74010 ABDOMEN COMP INCL DECUB/ERECT 74020 ABSCESS FISTULA OR SINUS TRACT 76080 AC JOINTS BILAT W OR WO WEIGHT 73050
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CT abdomen; with contrast 74160 Cardiac cath bilateral 93453. CT ablation renal radiofrequency 50592 Cardiac cath left heart 93452
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