I EXAM REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the for the order. Creatine levels should be obtained prior to studies. Please call if you have any questions: ext. 300 BRAIN I Brain without I Brain with and 70551 70553 Alzheimer s Mental Status Change Confusion Dementia Memory loss Suspected MS Tumor / Mass / Cancer Cranial nerve lesions HIV / AIDS Infection Neurofibromatosis Hearing loss, IAC mass Bell s Palsy (facial weakness) Stroke / CVA Dizziness / Vertigo Headaches Pituitary lesion Acoustic neuroma Visual Change Metastases Vascular lesions (AVM) Elevated prolactin A BRAIN: Arterial Circulation Circle of Willis A Brain without 70544 Aneurysm family history Stroke / CVA (cerebrovascular accident) A BRAIN: Venous Circulation A Brain without A Brain with and 70544 Venous thrombosis 70546 AVM Sinus thrombosis Venous circulatory symptoms A NECK: A Neck with and 70549 Alzheimer s Mental status change Stroke / CVA I ORBITS: Includes brain plus cuts through the orbits I Brain with and 70533 Graves Disease Expothalmos / proptosis Pseudotumor Vascular lesions (Hemangioma) I NECK: Soft Tissue I Orbits / Face / Neck with 70543 Infection Pain Vocal Cord Paralysis I SPINE: Cervical I Cervical Spine I Cervical Spine with 72141 72156 Neck pain Arm / Shoulder pain Numbness Myelopthy Page 1
I EXAM REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the for the order. Creatine levels should be obtained prior to studies. Please call if you have any questions: ext. 300 I SPINE: Thoracic I Thoracic Spine I Thoracic Spine with 72146 72157 Back pain Compression fracture (No history of malignancy) Myelopthy I SPINE: Lumbar I Lumbar Spine 72148 Back / leg pain Scoliosis Sciatica / radiculopathy Spondylolisthesis Spinal stenosis Compression fracture (No history of malignancy) I Lumbar Spine with 72158 Post-op Hx of back surgery I LUMBOSACRAL PLEXUS I Pelvis without 72195 Leg Pain / Sciatica Lumbar plexopathy Sacral / coccyx pain I BRACHIAL PLEXUS I Upper Exremity Non-joint with 73220 Shoulder injury Nerve avulsion Brachial plexopathy I CHEST: Mediastinum I Chest / Mediastinum with 71552 A AORTA A Abdomen with and Abdominal aortic dissection A AORTA: With peripheral runoff A Abdomen with and A with and 73725 Peripheral vascular disease Claudication A CHEST I Chest with 71555 Excluding cardiac myocardium Thoracic aorta BREAST I I Breast Bilateral with 77059 Newly diagnosed breast cancer Family history of breast cancer BRCA 1 and BRCA 2 genes (Some criteria may apply) Implant Integrity / Rupture Page 2
I EXAM REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the for the order. Creatine levels should be obtained prior to studies. Please call if you have any questions: ext. 300 General Abdominal Pain Liver Post embolization Hemangioma Hepatoma Hepatitis Cirrhosis Increased liver function tests Renal Hematuria (blood in urine) Transitional cell carcinoma of kidney Renal mass (cyst or solid) Abnormal findings Adrenal Adrenal mass or lesion Phenochromocytoma Hypertension CP: Biliary Abdominal Pain Biliary obstruction Stones Jaundice Abnormal enzymes CP: Pancreas Pancreatitis Pancreas mass Cholangiocarcinoma Increased liver function tests Painless jaundice Ampulla evaluation PSC (Primary Sclerosing Cholangitis) A ABDOMEN: Adrenal A Abdomen with or Renal artery stenosis Hypertension Mesenteric arterial Ischemia A PELVIS: Iliac vessels A Pelvis with or 72198 Pelvic venous thrombosis I PELVIS: Soft Tissue: General I Pelvis with Pain Abscess Decubitus ulcer I PELVIS: Soft Tissue: Uterus / Ovaries I Pelvis with Fibroid Adenomysis Infertility Endometrioma Ovarian Mass Pre/Post-Uterine Fibroid- Embolization (UFE) ENTEROGRAPHY Dual Study: ; I Pelvis with Crohn s disease Celiac disease (Sprue) Crohn s fistulous disease Small bowel tumor Page 3
I EXAM REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the for the order. Creatine levels should be obtained prior to studies. Please call if you have any questions: ext. 300 I EXTREMITY, NON-JOINT: Forearm Humerus Lower Leg / Calf Femur / Thigh I Non-Joint : I Non-Joint with and : 73218 73718 73220 73720 Abscess Ulcer Tumor / Mass / Mets Plantar fasciitis Fracture Sress fracture Muscle or tendon tear Myositis Morton s neuroma Soft tissue tumor or mass I EXTREMITY, JOINT: UPPER: Hand Wrist Elbow Shoulder SC Joint LOWER: Foot Ankle Knee Hip (whole perlvis) I Joint : I Joint with and : 73221 73721 73223 73723 Arthritis Avascular necrosis (AVN) Stress fracture Internal derangement Joint Pain Adscess Ulcer Cellulitis Plantar fasciitis Myositis Meninscal tear Muscle tear Ligament tear Cartilage tear Ostochrondritis dissecans (OCD) Inflamatory arthritis Septic arthritis Tumor / Mass / Mets Labral tear I HIP / PELVIS I Pelvis I Pelvis with and 72195 Fracture Hip / Pelvis Pain Muscle / Tendon tear Septic arthritis A UPPER EXTREMITY A with 73225 Sublclavian Redness or swelling Tenderness A LOWER EXTREMITY A with 73725 Peripheral vascular disease ARTHROGRAM: Shoulder Elbow Wrist I Joint with and without Shoulder Injection Elbow Injection Wrist Injection 73222 23350 24220 25246 Shoulder Instability Laberal tear Loose body Ligament injury TFCC tear Page 4
I EXAM REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the for the order. Creatine levels should be obtained prior to studies. Please call if you have any questions: ext. 300 ARTHROGRAM: Hip Knee Ankle I Joint with and without Hip Injection Knee Injection Ankle Injection 73722 27093 27370 27093 Laberal Tear Loose body OCD lesion (Osteochondritis Dissecans) Post surgical meniscus re-tear Page 5