Ultrasound Scheduling Guidelines

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1 April S. Cedar Crest Blvd., Suite 202, Allentown, PA Cetronia Road, Suite 101, Allentown, PA Phone: ; Fax: Phone: ; Fax: NPI: Tax ID: Key: Ultrasound Scheduling Guidelines ABDOMEN COMPLETE Evaluation of all abdominal organs Spleen along with any other RUQ organ, and generally any left sided abdominal symtoms. CPT CODE NOTE: Do not order R/O appendicitis. SIGNS/SYMPTOMS Pre- kidney transplant Pre-operative Ascites Ascites Left and right abdominal pain LUQ pain and RUQ pain Left sided abdominal pain LUQ pain Generalized abdominal pain Pain Splenomegaly (if Dr requests spleen with another organ in the RUQ) Enlarged spleen and/or abnormal labs Generalized epigastric pain Pain Nausea/Vomiting from unknown origin Nausea/Vomiting from unknown origin Cirrhosis R/O Ascites Abnormal blood work Bloating Bloating Leukopenia Abnormal blood work

2 ABDOMEN LIMITED Limited Abdomen is any organ in the RUQ combined together or any single organ ie: Liver, Gallbladder, Pancreas, Biliary Tree, Common Bile Duct, Kidney and Inferior Vena Cava. NOTE: A spleen ONLY is also a limited abdomen; NOTE: Do not order R/O appendicitis. *A Limited Abdomen is also a palpable lump/mass located on the abdomen CPT CODE usually to rule out an umbillical hernia.* SIGNS/SYMPTOMS RUQ pain Pain Abnormal liver function test Abnormal liver function test Splenomegaly (if DR requested spleen only) Enlarged spleen and/or abnormal labs increased Liver Cyst Liver cyst Hemangiomia Abnormal liver function test Jaundice Jaundice Hepatomegaly Abnormal liver function test Gerd R/O gallstones Reflux,belching,pain Nausea/vomiting attn gallbladder R/O gallstones Nausea/vomiting,pain Biliary disease Nausea/vomiting,pain Cirrhosis Nausea/vomiting,pain Pancreatic Pseudocyst Nausea/vomiting,pain Dysphagia Difficulty with swallowing foods Elevated LFT's Abnormal labs Hepatitis Abnormal labs Thrombocytosis Abnormal labs Hyperbilirubinemia Abnormal labs CPT CODE ULTRASOUND ABDOMEN VASCULAR (Tips and portal vein) SIGNS/SYMPTOMS Cirrhosis/check for proper blood flow direction Jaundice, pain Budd Chiari (clot) Abnormal labs Tips Known liver diagnosis CPT CODE ULTRASOUND AORTA SIGNS/SYMPTOMS Abdominal pulsations R/O aneurysm Abdominal pulsation AAA AAA Abdominal pain R/O AAA Abdominal pain R/O AAA Pulsatile mass Palpable mass,swelling Ectasia Aneurysm, aortic regurgitation

3 CPT CODE ULTRASOUND PELVIS - Non OB pelvic US SIGNS/SYMPTOMS Bladder and Pelvic mass Chronic pelvic pain Enlarged Prostate Testicular pain, groin Pain Neurogenic Bladder Abnormal bladder,underactive bladder Pelvic Pain - Male or adolescent female-complete valuation Pain Pellvic Pain - Male or adolescent female-limited evaluation Pain ULTRASOUND PELVIS AND TRANSVAGINAL Both scans are recommended unless: 1. Patient has had both in the past 6 months; 2. Physican requests a limited scan as follow-up to specific finding; 3. Patient is under 16 yrs old, not sexually active, or has never had an internal CPT CODE exam; 4. Patient's age inhibits tolerance of an internal US scan. SIGNS/SYMPTOMS Pelvic Pain Pain Female Genital symptoms Female genital symptoms Fibroids Chronic pelvic pain Ovarian cyst Pelvic bloating Menorrhagia Abnormal bleeding Dysfunctional Uterine Bleeding (DUB) Abnormal bleeding Irregular bleeding Abnormal bleeding Enlarged uterus Palpable uterus Uterine Leiomyoma Pain Dyspareunia Pain during intercourse Check placement of intrauterine contraceptive device Pain, bleeding Ovarian cancer Pain, abnormal bleeding Uterine Myoma Pain CPT CODE ULTRASOUND TRANSVAGINAL SIGNS/SYMPTOMS Fertility Eval endometrial stripe ULTRASOUND BLADDER ONLY NOTE: A retroperitoneal (kidney and bladder) must be ordered for a child 11 years CPT CODE or younger if a kidney (alone) or bladder (alone) is ordered. SIGNS/SYMPTOMS Urinary retention Urinary hesitancy, difficulty voiding UTI Painful voiding Incomplete Emptying Pressure, pain Nocturia frequency Frequent urination Polyuria Excessive amount of urine production Bladder cancer Pain

4 ULTRASOUND RETROPERITONEAL (Kidneys and Bladder- BOTH ) NOTE: A retroperitoneal (kidney and bladder) must be ordered for a child 11 years CPT CODE or younger if a kidney (alone) or bladder (alone) is ordered. SIGNS/SYMPTOMS Urinary Retention Pain, difficulty urinating UTI Pain, difficulty urinating Cystitis Pain, difficulty urinating VU (Vesicoureteral) Reflux Pain, difficulty urinating Neurogenic Bladder Pain, difficulty urinating Incomplete Emptying Residual urine in bladder Nocturia frequency Frequent urination ULTRASOUND KIDNEYS (ONLY) NOTE: A retroperitoneal (kidney and bladder) must be ordered for a child 11 years or younger if a kidney (alone) or bladder (alone) is ordered. CPT CODE Do NOT order R/O renal artery stenosis. SIGNS/SYMPTOMS Hydronephrosis Flank pain, kidney stones, reflux urinary system Incomplete bladder emptying Incomplete bladder emptying Renal tumor Renal tumor Renal cancer Renal cancer Proteinuria Proteinuria UTI Pain, frequency, hematuria Hematuria Hematuria Renal lesion Renal lesion Cyst Cyst Chronic kidney disease BUN,Creatinine labs Potential donor Pre-op Elevated labwork Elevated labwork Neurogenic Bladder Pain, frequency Obstructive Uropathy Abnormal labs Horseshe Kidney Hematuria Urinary Retention Loss of bladder control Benign Hypertrophy of Prostate (BHP) Incomplete emptying, frequency Angiomiolipoma Low grade fever, low flank pain Nephrectomy Nephrectomy Hypercalcemia Abnormal labs Low kidney function Elevated BUN Polycystic kidney disease Pain, frequency, hematuria

5 CPT CODE ULTRASOUND KIDNEY Pre Transplanted SIGNS/SYMPTOMS Pre Transplant Evaluation CPT CODE ULTRASOUND KIDNEY Post Transplanted SIGNS/SYMPTOMS Evaluation of transplant Post-operative CPT CODE ULTRASOUND IVC and Iliac Veins SIGNS/SYMPTOMS S/P filter placement Edema, shortness of breath CPT CODE ULTRASOUND CAROTID SIGNS/SYMPTOMS Dizziness Dizziness Double vision Double vision Carotid Artery Diseease (CAD) Dizziness,headaches, known disease Carotid Artery Stenosis (CAS) Known stenosis Valvular heart disease Palpitations, dizzines, fatigue Bruit Bruit Stroke Slurred speech, visual disturbance Stricture of artery Decreased blood flow Atherosclerosis Slurred speech, visual disturbance Aortic Stenosis Numbness, confusion, weakness, dizziness Vertigo Dizziness Hypertension Abnormal Occlusion carotid artery Occlusion carotid artery Cerebrovascular disease (CVA) Known disease Pulsitile Tenitis Pulsitile Tenitis Dysarthria Dysarthria Memory loss Memory loss Syncope Syncope Transient Ischemic Attack (TIA) Slurred speech, visual disturbance Visual disturbance Visual disturbance Carotid Aneurysm Carotid Aneurysm Persistent vegetative state (PVS) Persistent vegetative state (PVS) Headache Headache Peripheral Vascular Disease (PVD) Peripheral Vascular Disease (PVD) Hypercholesterolemia Abnormal labs Hyperlipidemia Abnormal labs Stenosis Stenosis

6 ULTRASOUND TESTICLES *Neither site performs ultrasound of the PROSTATE* CPT CODE *NO ultrasound study for torsion or for undescended testicles under the age of 18 years* SIGNS/SYMPTOMS Mass Mass Pain Pain Lump Lump Testicular cyst Cyst Torsion (only on patients 18 and older) Pain, lump swelling Hydrocele Pain, lump swelling Undescended testicles (only on patients 18 and older) Pain, lump swelling Spermatocele Pain, lump swelling S/P vasectomy Pain, lump swelling Infertility Pain, lump swelling Tenderness Tenderness Epididymitis Tenderness Varicocele Pain Atrophy of seminal vesicle Pain Edema Swelling CPT CODE ULTRASOUND POPLITEAL FOSSA SIGNS/SYMPTOMS Pain Pain R/O bakers cyst Bakers cyst Bakers cyst Swelling behind knee Swelling behind knee Lump Lump CPT CODE ULTRASOUND SOFT TISSUE SIGNS/SYMPTOMS Neck Palpable lump Chest wall Palpable lump Upper back Palpable lump Abdominal wall Palpable lump Lower back Palpable lump Buttocks Palpable lump Pelvic Wall Palpable lump Penis Palpable lump Perineum Palpable lump Axilla Palpable lump Lower extremity Palpable lump Groin Palpable lump

7 CPT CODE ULTRASOUND SOFT TISSUE - continued SIGNS/SYMPTOMS Upper Extremity Palpable lump Other soft tissue areas Palpable lump CPT CODE ULTRASOUND THYROID SIGNS/SYMPTOMS Nodule Nodule Thyroid cancer Thyroid cancer Goiter Lump Hypothyroidism Abnormal labs Hyperthyroidism Abnormal labs Abnormal labs Abnormal labs Endocrine disorder Abnormal labs Hashimoto's disease Abnormal labs Thyromegaly Abnormal labs Thyroid enlargement Thyroid enlargement Weight gain neck pain Weight gain neck pain CPT CODE ULTRASOUND THYROID LYMPH NODE MAPPING-Cedar Crest ONLY SIGNS/SYMPTOMS Malignant neo thyroid gland S/P thryroidectomy Thyroid cancer S/P thyroidectomy S/P Thyroidectomy CPT CODE VASCULAR UPPER EXTREMITY (to R/O DVT) - NO Upper Bi-Laterals SIGNS/SYMPTOMS Arm swelling redness R/O DVT Arm pain R/O DVT Arm pain, edema Arm pain, edema VASCULAR LOWER EXTREMITY (to R/O DVT)- single leg- STAT study CPT CODE *Do not order R/O claudication* SIGNS/SYMPTOMS Leg pain R/O DVT Leg pain R/O DVT Leg edema Edema R/O DVT VASCULAR LOWER EXTREMITY (to R/O DVT)- bilateral legs - STAT study CPT CODE *Do not order R/O claudication* SIGNS/SYMPTOMS Leg Pain R/O DVT Leg Pain R/O DVT Leg edema Edema R/O DVT

8 ABDOMEN VASCULAR

9 ABDOMEN COMPLETE

10 ABDOMEN LIMITED

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