Is patient diabetic or over 60 years old? If yes to either question, will need current creatinine (within 30 days).

Transcription

1 Is patient diabetic or over 60 years old? If yes to either question, will need current creatinine (within 30 days). Is patient allergic to IV contrast? If yes, what is reaction? Will need patient pharmacy information. All contrast allergy patients must have creatinine results prior to exam day. All references to Contrast in procedure name refer to IV contrast. Physician orders for Abd & Pelvis exams must specify contrast: a) With oral or without oral b) With IV, without IV or with and without IV **An authorization maybe required for any Cat Scan procedures. Please call insurance to verify. CT Scan Abdomen w/oral contrast w/o oral contrast - aka Stone Protocol Abdomen w/ Contrast w/oral contrast w/o oral contrast Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast) Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast)

2 CT Scan Abdomen w/oral contrast w/o oral contrast Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast) Abdomen & Pelvis w/oral contrast w/o oral contrast Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast) Abdomen & Pelvis w/ Contrast Abdomen & Pelvis w/oral contrast w/o oral contrast Abdomen & Pelvis w/ Contrast Enteroclysis - aka CTE No oral contrast Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast) Time: 1 Hr Prep: NPO 4 hours prior

3 CT Scan Abscess Drainage ALL **Request specific CPT code** Time: 1 Hr Prep: NPO 4 hrs prior No blood thinners x 5 days Biopsy ALL CT Angiogram ( CTA ) All IV Contrast only Abdomen Abdomen & Pelvis Aorta w/runoff Chest/Thorax Head Lower Extremity Neck Pelvis Thorax/Abd Aorta w/iliacs Upper Extremity **Visualizes blood flow** **Request specific CPT code** Time: 1 ½ Hrs Prep: No blood thinners x 5 days NPO 4 hrs prior - except thyroid biopsy (no NPO) Schedule AM only M, T, Th, Fri Prep: NPO 4 hrs prior Schedule before 1PM Head Head w/ Contrast Head Prep: NPO 4 hrs prior IAC IAC w/ Contrast Prep: NPO 4 hrs prior

4 CT Scan Joint injection/aspiration ALL **Request specific CPT code when scheduling** Time: 1 Hr Prep: No blood thinners x 5 days Lower Extremity Lower Extremity w/ Contrast Lower Extremity Prep: NPO 4 hrs prior Mastoid Maxillofacial Maxillofacial w/ Contrast Maxillofacial Prep: NPO 4 hrs prior Orbits Post Fossa Orbits Post Fossa w/ Contrast Orbits Post Fossa Pelvis w/oral contrast w/o oral contrast Prep: NPO 4 hrs prior Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast)

5 CT Scan Pelvis w/ Contrast Pelvis w/oral contrast w/o oral contrast Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast) Sinuses Sinuses w/ Contrast Sinuses Prep: NPO 4 hrs prior Soft Tissue Neck **Tissue, organs, glands no views of boney structures** Soft Tissue Neck w/ Contrast Soft Tissue Neck **Tissue, organs, glands no views of boney structures** Spine Cervical Thoracic Lumbar Prep: NPO 4 hrs prior

6 CT Scan Spine w/ Contrast Cervical Thoracic Lumbar Prep: NPO 4 hrs prior Spine Cervical Thoracic Lumbar Thorax Thorax w/ Contrast Thorax Prep: NPO 4 hrs prior Upper Extremity Upper Extremity w/ Contrast Upper Extremity Prep: NPO 4 hrs prior

7 Tech Line- x 6190 All contrasted exams: will need current creatinine (within 30 days) if patient is diabetic or over 60 years old No nursing home patients after 3:30 PM or after 12 PM on Friday **An authorization maybe required for any MRI procedure. Please call insurance to verify. MRI ORDER CPT NOTES Abdomen (includes liver, kidneys, pancreas) Time: 60 mins Arthrogram w/ MRI: Ankle Hip Knee Shoulder Wrist Brain Time: 90 mins Prep: No blood thinners x 5 days **Wrist schedule in AM only** Brain & IAC S Time: 60 mins Brain & Orbits Time: 60 mins Brain & Pituitary Time: 60 mins Brain & Sinuses Time: 60 mins Breast all Time: 60 mins Schedule 7-10 days after 1 st day of menstrual cycle

8 Chest MRI ORDER CPT NOTES (w/o or w) 60 mins (w/wo) Cervical Spine Lower Extremity Joint (includes ankle, knee, hip joints) Lower Extremity (includes foot, leg) Lumbar Spine MRA Abdomen (includes Abdominal Aorta or Renal Arteries depending on DX) MRA Abdomen w/ Lower Extremity Runoff Time: 60 mins Time: 60 mins MRA Chest (includes Thoracic Aorta) **If GFR is below 30 - cannot do exam** Time: 60 mins MRA Head Circle of Willis MRA Head w/o & Neck w/wo Contrast MRA Lower Extremity w/wo Contrast Time: 60 mins Time: 60 mins

9 MRA Neck - Carotid MRI ORDER CPT NOTES MRA Upper Extremity w/wo Contrast MRCP w/o contrast Time: 60 mins Note: Medicare will not pay for this exam Time: 60 mins Prep: NPO for 6 hrs Orbits Face Neck Time: 60 mins Orbits Sinus IAC S Pituitary Time: 60 mins Pelvis Sagittal Spinal Survey Spinal Screening (includes C,T & L spine sagittal views only) Time: 90 mins TMJ **we do not have dedicated TMJ coil** Thoracic Spine Upper Extremity Joint (includes shoulder, elbow, wrist)

10 MRI ORDER CPT NOTES Upper Extremity (includes forearm, humerus, hand, scapula)

11 Bone Scans: **An authorization maybe required for any NM procedures. Please call insurance to verify. Nuclear Medicine ORDER CPT NOTES Total Body Bone Scan w/spect if indicated head to toe exam Or Limited Bone Scan w/spect if indicated one specific area of the body (i.e. L2- L4 spine) **see attached information sheet** add if spect exam Time: Prep: Notes: 1 hr None Pt arrival 3 hrs prior to scan time register, inject isotope, pt released then returns at scheduled scan time Bone Scan 3-Phase w/spect if indicated add if spect exam Time: Prep: Notes: Initial 30 mins Delay images 1 hr None Scans extremities knees, hands, feet, legs Cardiac Stress Test Dobutamine Lexiscan ETT Myoview Time: Prep: 90 mins Patient arrival 45 mins prior to exam time; doctor time is 30 mins after scheduled exam time; NM tech or nurse will call patient with instructions Ceretec Whole Body Ceretec Limited (for specific area/body part) **Patient must bring list of medications** Notes: Schedule time per Tech - standard is 8 AM with delayed images at 1PM **Any other exams must be scheduled 2 days post Ceretec scan** Cisternogram Time: Initial 30 mins Return scans 1 hr **Dose must be ordered 1 week in advance**

12 Nuclear Medicine ORDER CPT NOTES Gallium Scan (Tumor or Abscess Localization) Time: Initial 30 mins Return scans - 1 ½ hrs Prep: Per Tech Gastric Emptying Time: 2 hrs **If scheduled Thursday 7:30 time only** GI Bleed Scan, Tagged RBC Time: 2 hrs Prep: No barium 48 hrs prior to exam Hepatobiliary Scan aka HIDA/DISHIDA Time: 3 hrs Prep: NPO for 8 hrs and no barium 48 hrs prior to exam **Schedule AM only** Indium Scan Whole body Limited (scans specific site (ex: leg ulcer) Liver Hemangioma aka RBC Tagged Study Time: Prep: 1 hr per visit No barium 48 hrs prior to exam **Scheduled Mon Thurs only** Time: 2 ½ hrs Prep: No Barium 48 hrs prior to exam Liver/Spleen Scan Time: 1 ½ hrs Prep: No barium 48 hrs prior to exam Lung Scan Complete Perfusion Ventilation Time: Prep: 1 hr CXR on day of exam **Schedule Complete unless otherwise specified; no ventilator patients** Lymphoscintograpy Time: 2 ½ hrs

13 Nuclear Medicine ORDER CPT NOTES Meckel s Diverticulum Adult Child Time: Prep: 1 ½ hrs adults 2 ½ hrs children Tagament 300mg (OTC) every 6 hrs for 48 hrs prior to exam; no upper gi or barium enema 3-4 days prior to exam; npo 4-6 hrs Muga Scan Time: 1 ½ hrs Parathyroid w/spect (Sest) Time: 3 hrs Peritoneal Shunt Patency **If child must be coordinated with Anesthesia** Renal Scan aka Renogram Time: 1 ½ hrs Renal Scan with Captopril Time: 2 hrs Prep: Well hydrated day before scan; no ace inhibitors x 7 days; NPO x 8 hrs; Patient must arrive 1 ½ hrs prior to exam nurse prep **Schedule AM only** Sentinel Node Injection **If breast cancer diagnosis book 2 hrs prior to surgery or; if melanoma diagnosis a Lymphoscintography needs to be done prior to the day of SNI to determine correct time to schedule SNI** Thyroid Scan (Technetium) Time: 2 hrs Prep: No thyroid medication x 3 weeks prior to exam.

14 Nuclear Medicine ORDER CPT NOTES Thyroid Scan I Time: Capsule administration - 30 minutes, 6 hr return scan - 30 minutes, 24 hr return scan - 1 hr. Prep: Check for Iodine allergy, NPO after midnight, no thyroid medications x 3 weeks prior and no iodine x 6 8 weeks (CT/IVP/Specials,etc.);.ch eck vitamins or medications for Iodine. **Scheduled on Mondays at 8:30** Tumor Localization Ask for specific CPT as the time of scheduling Time: 1 hr a day for up to 3 days. Prep: NPO 4 hrs, no barium 48 hrs prior to exam, bowl prep, and pt should be well hydrated. **Scheduled M Th only after 11 am**

15 **An authorization maybe required for any Routine Rad procedure. Please call insurance to verify. Routine Radiology Arthrogram w/ct Ankle, hip, knee, shoulder, wrist Barium Swallow (aka Esophogram) Ask for specific CPT as the time of scheduling Prep: No blood thinners x 5 days **Schedule AM only** **If CT ABD & PELVIS ordered also, schedule CT first, then BS 2 days after CT** Barium Swallow, Modified (MBS) Time: 60 mins **Schedule before 11 AM** **All Medicare patients will need 2 diagnosis** Barium Enema (Colon) w/air If referring physician wants to order both UGI and BE Schedule UGI with BE to follow 2 days later. The prep for BE will clean out barium from UGI Time: 60 mins Fleets prep kit (pt. to pick up at their local pharmacy) **If patient has had recent colonoscopy must be scheduled 7 days after that procedure **Schedule AM only** **If CT ABD & PELVIS ordered also, schedule CT first, then BS 2 days after CT** Gastrografin Swallow Time: 30 minutes **Schedule AM only** Gastrografin UGI Time: 30 minutes **Schedule AM only**

16 Hysterosalpingogram (HSG) Routine Radiology Time: 60 mins Prep: Schedule after period but before ovulation and on the 3 rd day of an antibiotic course; serum pregnancy test same day immediately prior to exam; no sex for 7 days prior to exam; patient must arrive 45 minutes prior to exam (lab first); patient must have a designated driver if taking sedative. **Schedule before 3 pm** Intravenous Pylegram (IVP)--ALL (No tomos capability) Time: 60 mins Prep: Current creatinine (30 days or <) if patient is diabetic or 60 y/o or >. NPO after midnight with 18 hour bowel prep (pick up at local pharmacy). If the patient is Diabetic no diabetic meds the morning of the procedure. **Schedule AM only** **Non-Rockwood/Jones patients will need bowel prep instructions** Lumbar Puncture Time: 60 mins Prep: No blood thinners x 5 days **Schedule AM only** Myelogram Cervical Lumbar Thoracic Time: 60 mins Prep: No blood thinners x 5 days **Schedule before 11 AM**

17 Routine Radiology Skeletal Survey Time: 60 mins **Schedule after 2 PM only** Upper GI Series (UGI) With air W/o air - babies (includes Barium Swallow) Upper GI with Small Bowel FT With air W/o air - babies. (includes Barium Swallow) NPO 4 hrs - babies **Schedule AM only; with air unless specifically ordered without** **If CT ABD & PELVIS ordered also, schedule CT first, then UGI 2 days after CT** Time: 1 24 hrs depending on patient; pt could possibly be at HCM all day and may have to return the following day **Schedule AM only; with air unless specifically ordered without** **If CT ABD & PELVIS ordered also, schedule CT first, then UGI w/sbft 2 days after CT** Voiding Cystourethrogram (VCUG) Time: 60 mins **Schedule after 2 PM** **If Renal US ordered also, schedule VCUG after US**

18 **An authorization maybe required for any Cath Lab or Specials procedure. Please call insurance to verify. Cath Lab/Specials ORDER Angiogram: Arteriogram NOTES Time: 2 hrs Prep: per PAT staff Vascular or Radiologist Antigrade Nephrostogram (inject contrast into existing nephrostomy tube) Biopsy Bronchoscopy Drainage: Biliary, Abscess, Pelvic, Abdominal, Pericardiocentesis Time: 1 hr Prep: No Prep Time: 1 ½ hrs Prep: NPO x 6 hrs Time: 1 ½ hrs Time: 1 ½ hrs Prep: NPO x 6 hrs EGD Embolization Chemo-Embolization ERCP Time: 1 hr Time: 2 hrs Prep: NPO 8 hrs Time: 2 hrs Prep: NPO x 8 hrs EVAR Time: 4 hrs **Mon & Thurs only - AM or PM** **if requested for other day, scheduling physician must call and clear with anesthesia before scheduling**

19 Cath Lab/Specials ORDER Feeding Tube: (insert feeding or peg tube) NOTES Time: 1 ½ Hours Prep: NPO x 8 hrs See Replace Duodenstomy/JEJ for replacement only procedure Filter Vena Cava IVC Filter Placement Usually done with endo docs Time: 1 ½ hrs Prep: NPO x 6 hrs if sedation Fistulogram If dialysis patient 2 hrs Procedure by vascular surgeon If abscess pt 1 hr Heart Cath Time: 1 2 hrs Prep: NPO x 6 hrs Time: 2 hrs Prep: NPO x 6 hrs ICD Gen Change Time: 1 ½ Hours Prep: NPO x 6 hrs Injection/Aspiration: Joint Injection/Aspiration Sialogram Discogram Nephrostogram (contrast used to check existing tube does not include replacing tube) Time: 1 hr Time: 1 ½ hrs Time: 1 ½ hrs Prep: NPO x 6 hrs

20 Cath Lab/Specials ORDER Nephrostomy (tube placement or replacement) Pacemaker Loop Recorder Pacemaker Gen Change NOTES Time: 1 ½ hr Prep: NPO x 6 hrs No blood thinners x 5 days **Urologist must call and clear with the Radiologist before procedure can be scheduled** **Schedule AM only** Time: 1 ½ Hrs Prep: NPO x 6 hrs. Time: 1 ½ Hrs Prep: NPO x 6 hrs NPO 4 hrs Pain Management: aka Nerve Root Block PICC Line: aka Central Line Placement Pleurodesis Port-a-Cath aka Port Placement Port Removal Replace Duodenostomy/JEJ: Feeding Tube Replace Time: 1 ½ hrs Prep: No blood thinners x 5 days **Schedule AM only** Time: 1 ½ hrs Prep: NPO x 6 hrs (if done w/sedation) Need creatinine and contrast allergy info. Time: 1 ½ hrs Prep: NPO x 8 hrs Time: 1 ½ hrs Prep: NPO 6 hrs Need H & P **Schedule AM only** Time: 1 hr Time: 1 hr

21 Cath Lab/Specials ORDER Vertebroplasty NOTES Time: 2 hrs Prep: No blood thinners x 5 days **Schedule AM only** Vertebroplasty Evaluation Time: 1 hr Prep: Prior MRI or CT + NM Bone Scan required

22 **An authorization maybe required for any Ultrasound procedures. Please call insurance to verify. Ultrasound Abdomen Complete No CT w/barium prior to exam Abdomen Limited (single organ, quadrant or follow-up example: liver, gall bladder or both) Abscess Drainage All **Request specific CPT** Time: 1 Hr No blood thinners x 5 days PT/INR prior to procedure Ankle/Arm Indices aka ABI s Aorta Arterial Lower Extremities Unilateral Bilateral (includes ABI s) Arterial Upper Extremities Unilateral Bilateral Biopsy All **Request specific CPT** Time: 1 Hr Time: 1 Hr Time: 1 ½ Hr Prep: NPO 4 hours - (except thyroid; no blood thinners x 5 days; PT/INR prior to procedure Schedule M, T, TH, F AM only Bladder Residual Study Time: 1 Hr Prep: Drink 30 oz. water 1 hr prior

23 Ultrasound Carotid Doppler Bilateral Chest Cyst Aspiration All **Request specific CPT** Time: 1 ½ Hr Prep: No blood thinners x 5 days PT/INR prior to procedure **Schedule in AM** Duplex Abdomen Ltd (Liver Doppler includes veins and arteries) Time: 1 Hr Echocardiogram Complete Time: 1 Hr Notes: No patient s under 20 yo Echo with Bubble Study Time: 1 Hr Echocardiogram Stress Time: 2 Hrs Prep: NPO 8 hours No Beta Blockers x 24 hrs Extremity Soft Tissue Fetal, Biophysical Profile Head & Neck Soft Tissue Hip Infant Time: 1 Hr Joint Injection/Aspiration All **Request specific CPT** Time: 1 Hr Prep: NPO 4 hours No blood thinners x 5 days

24 Ultrasound OB 1 st Trimester OB 2 nd Trimester NOT TWINS Time: 1 Hr Prep: Full bladder OB 1 st /2 nd TWINS Trimester Time: 1 Hr Prep: Full bladder Paracentesis Pelvis Complete (includes transabdominal and transvaginal exam) Time: 1 Hr Prep: No blood thinners x 5 days PT/INR prior to procedure Prep: Full bladder Renal Artery Renal Arteries + Kidneys Retroperitoneal Limited (includes kidneys and bladder) Time: 1 Hr Spinal Canal and Contents Time: 1 Hr Testicular Thoracentesis Time: 1 Hr Prep: No blood thinners x 5 days PT/INR prior to procedure Thyroid Time: 30 minutes Transesophageal Echocardiogram aka TEE Time: 1 Hr Prep: NPO 8 hours Venous Bilateral Time: 1 Hr Venous Unilateral Time: 30 minutes

25 Cardiopulmonary/RT EEG Time: 2 ½ hrs Schedule: M, T, W, F: 8:00 3:00 NOTE: No patients under age 13 Event Monitor 30 days CARD.30D Holter Monitors 24 hours CARD.24H PFT Basic RT.PFT PFT Pre/Post with Bronchodilators RT.P/PO1 Aka PFT Complete **includes DLCO** PFT Pre/Post with DLCO RT.P/PO2 Time: 30 minutes pt will need to return in 30 days to have the monitor removed. Schedule: M F: 7:00 5:00 Time: 15 minutes pt will need to return the following day at same time to return monitor Schedule: M F: 7:00 5:00 Time: 1 hour Prep: No breathing treatments or smoking 4 hours prior to exam Schedule: M, T, W, F: 8:00 4:00 Th: 8:00 11:00 Time: 1 hour Prep: No breathing treatments or smoking 4 hours prior to exam Schedule: M F: 8:00 4:00 Th: 8:00 11:00 Time: 1 hour Prep: No breathing treatments or smoking 4 hours prior to exam. Schedule: M F: 8:00 4:00 Th: 8:00 11:00

26 **An authorization maybe required on any of the Sleep Study procedures.. Please call insurance to verify. Sleep Studies Sleep Study Basic Time: Overnight DX: unspecified sleep apnea OSA Prep: Instruction packet will be mailed to patient prior to exam Sleep Study CPAP Titration Time: Overnight Prep: Instruction letter will be mailed to patient prior to study Sleep Study Split Night Basic Study + CPAP Titration VA patients schedule Split Night only Sleep Study MSLT Basic Sleep Study + MSLT Time: Overnight Prep: Instruction packet will be mailed to patient prior to exam Time: Varies Prep: Instruction letter will be mailed to patient prior to study Revised 8/17/12