WHY THIS GUIDE IS IMPORTANT TO YOU AND YOUR PATIENTS

ORDERING GUIDE

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) 901-6614 or at pr@radltd.com. Thank you, The Physicians and Staff of Radiology Ltd. 1

IMPORTANT CONTACT INFORMATION CENTRALIZED SCHEDULING Tel: (520) 733-7226 Fax: (520) 290-8377 STAT Hotline: (520) 545-1919 Toll Free: (866) 565-2220 Toll Free Fax: (866) 707-0750 SPECIALTY SCHEDULING BREAST BIOPSY Tel: (520) 901-6792 Fax: (520) 545-1848 BREAST MRI Tel: (520) 901-6631 Fax: (520) 901-6746 NEED HELP OR HAVE QUESTIONS ABOUT WHAT TO ORDER? CLINICAL REVIEW Tel: (520) 545-1819 Fax: (520) 545-1844 INTERVENTIONAL COORDINATION Tel: (520) 545-1906 Fax: (520) 545-1898 PET / CT Tel: (520) 545-1906, opt. 3 Fax: (520) 545-1898 OTHER IMPORTANT NUMBERS AUTHORIZATION VERIFICATION Tel: (520) 901-6767 Fax: (520) 545-1981 CODING & PRICING HOTLINE Tel: (520) 545-1818 Online Requests: radltd.com/request-exam-pricing HIPAA HOTLINE Tel: (520) 545-1969 Toll Free Tel: (866) 683-2199 MEDICAL RECORDS Tel: (520) 545-1822 Fax: (520) 326-7989 Online Requests: radltd.com/medical-record-request PATIENT BILLING Tel: (520) 296-0278 Secure Online Bill Pay: radltd.com/online-bill-pay PROFESSIONAL RELATIONS Tel: (520) 901-6614 Fax: (520) 545-1726 Email: pr@radltd.com For Supplies: Tel: (520) 733-4104 Email: supplies@radltd.com RADVISION Tel: (520) 901-6747 Fax: (520) 901-6634 Toll Free Tel: (866) 386-9459 Website: radltd.com/for-providers After Hours Tech Support: Tel: (520) 545-1720 2

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... 11 Additional Imaging & Procedures... 12 Breast MRI... 13 PET / CT General... 14 Bone Scan... 14 ULTRASOUND General... 15 Vascular... 17 MSK/Extremity... 18 CT / CTA CPT Codes for CT Scans... 19 General... 20 Head & Spine... 23 Musculoskeletal... 25 Specialty... 26 MRI / MRA CPT Codes for MRI Scans... 27 Breast... 28 General... 28 Head & Spine... 31 Musculoskeletal (including Arthrography)... 33 INTERVENTIONAL Minimally Invasive Diagnostic Procedures... 35 Pain Management... 37 Vascular Services... 39 Drainage Tube / Stent Placement... 40 ICD-9 S Neoplasms... 41 Benign Neoplasms... 41 Endocrine, Nutritional & Metabolic... 41 Disorders... 41 Blood Diseases... 42 Mental Disorders... 43 Nervous System & Sense Organ Disorders... 43 Circulatory System... 45 Respiratory System... 46 Digestive System... 47 Genitourinary System... 48 Musculoskeletal & Connective Tissue... 50 Signs & Symptoms... 51 Injuries & Adverse Effects... 54 ICD-9 Codes Notes... 56 ICD-10 S ICD-10 Codes Notes... 57 PREFERRED PROVIDER INFORMATION Major Insurance Plans... 59 Major Network Plans... 59 IMAGING CENTERS Locations... 60 TECHNOLOGY RadVision... 62 3

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 71010 Chest 2 Views 71020 Chest Minimum 4 Views 71030 Chest Special Views 71035 Ribs Unilateral 2 Views 71100 Ribs Unilateral 2 Views with PA CXR 71101 Ribs Bilateral 3 Views 71110 Sternum Minimum 2 Views 71120 Sternoclavicular Joints 3 Views 71130 Abdomen 1 View 74000 Abdomen AP, Additional Oblique + Cone Views 74010 Abdomen Complete 74020 Abdomen Complete + PA CXR 74022 Hip Unilateral 1 View 73500 Hip Unilateral Minimum 2 View 73510 Hips Bilateral 2 Views + AP Pelvis 73520 Pelvis 1 or 2 Views 72170 Pelvis Minimum 3 Views 72190 Pelvis & Hips Infant / Child up to 11 years old 73540 Sacrum & Coccyx Minimum 2 Views 72220 Sacroiliac Joints 3+ Views 72202 Finger(s) Minimum 2 Views 73140 Hand 2 Views 73120 Hand Minimum 3 Views 73130 Wrist 2 Views 73100 Wrist Minimum 3 Views 73110 Forearm 2 Views 73090 CPT DIGITAL X-RAY www.radltd.com Digital X-rays are done on a walk-in basis. 4

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 73092 Elbow 2 Views 73070 Elbow Minimum 3 Views 73080 Humerus Minimum 2 Views 73060 Shoulder 1 View 73020 Shoulder Minimum 2 Views 73030 Acromioclavicular Joints Bilateral 73050 Clavicle Complete 73000 Scapula Complete 73010 Toe(s) Minimum 2 Views 73660 Foot 2 Views 73620 Foot Minimum 3 Views 73630 Calcaneus Minimum 2 Views 73650 Ankle 2 Views 73600 Ankle Minimum 3 Views 73610 Tibia & Fibula 2 Views 73590 Lower Extremity Infant (up to 364 days old) 2+ Views 73592 Knee 1 or 2 Views 73560 Knee 3 Views 73562 Knee 4 or More Views 73564 Both Knees Standing AP 73565 Femur 2 Views 73550 Bone Age Studies 77072 Bone Length Studies 77073 Osseous Complete (Bone Survey) 77075 Mandible < 4 Views 70100 Mandible 4 Views 70110 CPT 5 Digital X-rays are done on a walk-in basis.

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) 70030 Facial Bones < 3 Views 70140 Facial Bones Minimum 3 Views 70150 Nasal Bones Minimum 3 Views 70160 Orbits Minimum 4 Views 70200 Sinuses Paranasal < 3 Views 70210 Sinuses Paranasal Minimum 3 Views 70220 Skull < 4 Views 70250 Skull Minimum 4 Views 70260 Neck Soft Tissue 70360 C-Spine 2 or 3 Views 72040 C-Spine Minimum 4-5 72050 C-Spine Complete 6 or more 72052 T-Spine 2 Views 72070 T-Spine 3 Views 72072 L/S Spine 2 or 3 Views 72100 L/S Spine Minimum 4 Views 72110 L/S Spine Complete With Bending Views (Minimum 6 Views) 72114 L/S Spine Bending Views (Only 2-3 Views) 72120 Spine, Entire, AP & Lateral 72010 Thoracolumbar Spine Standing (Scoliosis) 72069 Scoliosis Study Including Supine and Erect 72090 Thoracolumbar AP & Lateral 72080 CPT DIGITAL X-RAY www.radltd.com 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

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 77080 Hips, Spine (axial skeleton) DEXA with Vertebral Fracture Assessment DEXA 77085 Vertebral Fracture Assessment DEXA 77086 DEXA Body Composition Study DEXA 76499 Radiology Ltd. is committed to the health of southern Arizona by providing the most comprehensive imaging and interventional services. 7

BREAST MRI 77059 & 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 77080 - DEXA SCAN 77086 - 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 G0202 - DIGITAL SCREENING 77052 - CAD FOR SCREENING 77063 - SCREENING BREAST 3D TOMOSYNTHESIS DIAGNOSTIC MAMMOGRAPHY UNILATERAL G0206 - UNILATERAL DIGITAL DIAGNOSTIC 77051 - CAD FOR DIAGNOSTIC 77061 - UNILATERAL BREAST 3D TOMOSYNTHESIS DIAGNOSTIC MAMMOGRAPHY BILATERAL G0204 - BILATERAL DIGITAL DIAGNOSTIC 77051 - CAD FOR DIAGNOSTIC 77062 - BILATERAL BREAST 3D TOMOSYNTHESIS BREAST IMAGING www.radltd.com UTERINE FIBROID EMBOLIZATION (UFE) CODING VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED EXPLANATION. ULTRASOUND 76641 - UNILATERAL COMPLETE 76642 - UNILATERAL LIMITED 76882 - AXILA ALONE For more information on exam codes and pricing, please contact the Radiology Ltd. Coding and Pricing Hotline at (520) 545-1818. 8

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

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 www.radltd.com 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, 2014. 10

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 (G0202-52) 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.

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 www.radltd.com 12

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) 901-6668. 13

BODY PART REQUESTED TEXT Skull Base to Mid-Thigh Whole Body PET / CT Skull Base to Mid-Thigh (all other diagnoses) 78815 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. 78816 Brain PET / CT Brain 78608 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) 78459 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. ) 78816 PET/CT www.radltd.com Our PET services are centrally located at our Camp Lowell site. To schedule a PET exam, please call (520) 545-1906, opt. 3. 14

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 65-75 year old male who has smoked at least 100 cigarettes Additional risk factors include coronary heart disease, hypertension, cerebrovascular disease Abdominal Ultrasound 76700 Pelvic Ultrasound 76856 Trans Abdominal Abdominal Aorta Ultrasound Abdominal Aorta Ultrasound Medicare screening 76830 Trans Vaginal 76775 G0389 15

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 76770 Bladder Ultrasound Thyroid Ultrasound Testicular Ultrasound 76857 76536 76870 ULTRASOUND www.radltd.com Locally owned and operated, Radiology Ltd. offers seven imaging centers to patients across southern Arizona. 16

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 93880 93971 Unilat 93970 Bilat 93975 93975 Dup Scan Complete (Abdominal, Pelvic, Scrotal contents and/or retroperitoneal organs) 93976 Duplex Scan Limited Radiology Ltd. the best care, the best technology, and the best expertise, right in your own backyard. 17

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 76536 76881 Soft Tissue Foot Ultrasound 76881 Soft Tissue Ankle Ultrasound 76881 Soft Tissue Knee Ultrasound 76881 Soft Tissue Elbow Ultrasound 76881 Soft Tissue Groin Ultrasound 76881 Chest Wall Upper Back Lower Back 76604 76604 76705 ULTRASOUND www.radltd.com 18

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 70480 - W/O CONTRAST 70481 - W/ CONTRAST 70482 - W/O & W/ CONTRAST BRAIN 70450 - W/O CONTRAST 70460 - W/ CONTRAST 70470 - W/O & W/CONTRAST MAXILLOFACIAL 70486 - W/O CONTRAST 70487 - W/ CONTRAST 70488 - W/O & W/ CONTRAST CERVICAL SPINE 72125 - W/O CONTRAST 72126 - W/ CONTRAST 72127 - W/O & W/ CONTRAST SOFT TISSUE NECK 70491 - W/ CONTRAST CHEST 71250 - W/O CONTRAST 71260 - W/ CONTRAST 71270 - W/O & W/ CONTRAST UPPER EXTREMITY 73200 - W/O CONTRAST 73201 - W/ CONTRAST 73202 - W/O & W/ CONTRAST THORACIC SPINE 72128 - W/O CONTRAST 72129 - W/ CONTRAST 72130 - W/O & W/ CONTRAST LOWER EXTREMITY 73700 - W/O CONTRAST 73701 - W/ CONTRAST 73702 - W/O & W/ CONTRAST ABDOMEN PELVIS COMBINATION 74176 - W/O CONTRAST 74177 - W/ CONTRAST 74178 - W/O & W/ CONTRAST LUMBAR SPINE 72131 - W/O CONTRAST 72132 - W/ CONTRAST 72133 - W/O & W/ CONTRAST 19

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. 71270 Lung Nodules (follow-up) CT Chest Without Contrast 71250 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 71260 CT Chest Without Contrast, High-Resolution 71250 CTA Chest 71275 CTA Chest and Abdomen 71275 74175 CT Neck With Contrast 70491 CT / CTA www.radltd.com 20

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 72193 Fracture, Non-Arthritis Union CT Pelvis Without Contrast 72192 Bone Infection Cancer / Mass / Mets / Tumor Stone (Stone protocol) Abdominal Pain Abscess Hernia (ie, ventral, umbilical, inguinal) Mass CT Pelvis With Contrast 72193 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 74176 74160 72193 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) 74177 74177 74170 74170 21

BODY PART REASON FOR EXAM PROCEDURE Pancreas Pancreatic Mass Pancreatitis Pseudocyst CT Abdomen Without and With Contrast (Pancreatic protocol 1st time) 74170 CT Abdomen With Contrast 74160 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 74170 CT IVP or CT Urogram 74178 CTA Abdomen and Run Off 75635 CTA Abdomen 74175 CTA Abdomen and Pelvis 74174 CT / CTA www.radltd.com 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

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 70450 CT Head / Brain With Contrast 70460 CTA Head / Brain (Reconstruction) and/or (If both ordered, please authorize both codes) 70496 CTA Neck 70498 CTA Head, Neck (Please authorize with both) 70498, 70496 23

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 70480 CT Orbit With Contrast 70481 CT Sinus Without Contrast 70486 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 72125 72128 72131 70480 70470 CT / CTA www.radltd.com For more information on exam codes and pricing, please contact the Radiology Ltd. Coding and Pricing Hotline at (520) 545-1818. 24

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) 73200 73700 73201 73701 Peripheral Artery Disease CTA Lower Extremity 73706 25

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 74263 Screening 74261 Diagnostic 74175 CT Enterography 74177 CT Cystogram (Please authorize BOTH codes) CT Heart Screening, Hyperlipidemia CT Calcium Score Without Contrast 72192 51600 75571 CT / CTA www.radltd.com CTA Heart Abnormal Echo Chest Pain, Sub Tachycardia CTA Coronary Artery Without and With Contrast 75574 CT Low Dose Lung Cancer Screening Screening CT Low Dose Lung Cancer Screening Must Meet Criteria 71250 26

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 70540 - W/O CONTRAST 70542 - W/ CONTRAST 70543 - W/O & W/ CONTRAST TMJ 70336 SHOULDER, ELBOW OR WRIST (UPPER EXTREMITY, JOINT) 73221 - W/O CONTRAST 73222 - W/ CONTRAST 73223 - W/O & W/ CONTRAST HUMERUS, FOREARM OR NON-JOINT (UPPER EXTREMITY, JOINT) 73218 - W/O CONTRAST 73219 - W/ CONTRAST 73220 - W/O & W/ CONTRAST BRAIN 70551 - W/O CONTRAST 70552 - W/ CONTRAST 70553 - W/O & W/ CONTRAST CERVICAL SPINE 72141 - W/O CONTRAST 72142 - W/ CONTRAST 72156 - W/O & W/ CONTRAST CHEST (CLAVICLE) 71550 - W/O CONTRAST 71551 - W/ CONTRAST 71552 - W/O & W/ CONTRAST BREAST 77059 - W/O & W/ CONTRAST THORACIC SPINE 72146 - W/O CONTRAST 72147 - W/ CONTRAST 72157 - W/O & W/ CONTRAST HIP, KNEE OR ANKLE (LOWER EXTREMITY, JOINT) 73721 - W/O CONTRAST 73722 - W/ CONTRAST 73723 - W/O & W/ CONTRAST THIGH, LOWER LEG OR FOOT (LOWER EXTREMITY, NON-JOINT) 73718 - W/O CONTRAST 73719 - W/ CONTRAST 73720 - W/O & W/ CONTRAST ABDOMEN 74181 - W/O CONTRAST 74182 - W/ CONTRAST 74183 - W/O & W/ CONTRAST LUMBAR SPINE 72148 - W/O CONTRAST 72149 - W/ CONTRAST 72158 - W/O & W/ CONTRAST PELVIS 72195 - W/O CONTRAST 72196 - W/ CONTRAST 72197 - W/O & W/ CONTRAST 27

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 77059 (71552) 77059 Bilateral Breast MRI 77059 Bilateral Breast MRI 77059 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 www.radltd.com 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 75557 & 75561 MRI TMJ 70336 MRI Urogram 74183 & 72197 Hearing Loss MRI Brain 70553 Crohn s Disease Inflammatory Bowel Disease MRI Enterography 74183 72197 28

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 74181 74183 71552 71552 70543 72195 MRI Dynamic Pelvis 72195 MRI Pelvis Without and With Contrast 72197 MRI Prostate 72197 MRI Brain Att: Cranial Nerves 70553 29

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 74185 Order 2 Exams: MRA Abdomen AND MRI Abdomen Without and With Contrast (Please authorize BOTH codes) 74185 74183 MRA Chest 71555 Order 2 Exams: MRA Chest AND MRA Abdomen (Please authorize BOTH codes) 71555 74185 MRI / MRA www.radltd.com Pelvis MRA Abd/Pel w/run Off Peripheral Run-Off AVM May Thurner MRA Pelvis 72198 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, 73725 (x2) 74185 73725 73725 72198 30

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 70553 72141 Discitis Multiple Sclerosis Myelopathy Osteomyelitis Syrinx Tumor / Mass / Cancer / Mets Vascular Lesions, AVM MRI Cervical Spine Without and with Contrast 72156 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 72146 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 72157 31

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 72148 72195 72158 70551 70553 MRI Brain with NeuroQuant 70551, 76377 MRI / MRA www.radltd.com 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

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) 70553 70543 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) 70544 70548 Venous Thrombosis MRV Without Contrast 70544 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 73218 73718 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 73220 73720 33

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 73221 73721 73223 73723 71552 73722 73222 77002 23350 & 73040 24220 & 73085 25246 & 73115 27093 & 73525 27370 & 73580 27648 & 73615 MRI / MRA www.radltd.com 34

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, 77002 Elbow: 73222, 24220, 73085, 77002 Wrist: 73222, 25246, 73115, 77002 Lower Joints Hip: 73722, 27093, 73525, 77002, 27095 Knee: 73722, 27370, 73580, 77002 Ankle: 73722, 27648, 73615, 77002 Interventional, Body, or Musculoskeletal Radiologist No Only if patient is taking Coumadin No Upper Joints Replace code 73222 with 73201 Lower Joints Replace code 73722 with 73701 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, 72129 L-Spine: 62304, 72132 Use 62305 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, 77002 Intermediate Joint or Bursa (TMJ, acromioclavicular, wrist, elbow, ankle, olecranon bursa): 20605, 77002 Major Joint or Bursa (shoulder, hip, knee, subacromial bursa): 20610, 77002 Interventional or Body Radiologist No No Small Joint or Bursa (fingers, toes): 20600, 77012 Intermediate Joint or Bursa (TMJ, acromioclavicular, wrist, elbow, ankle, olecranon bursa): 20605, 77012 Major Joint or Bursa (shoulder, hip, knee, subacromial bursa): 20610, 77012 3635 To schedule an interventional procedure, please call (520) 545-1906 or fax (520) 545-1898.

Minimally Invasive Diagnostic Procedures Sedation Required Labs Required Evaluation Required Interventional Service Modality CPT Code(s) Performed By 49083 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 49083 CT 32555 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. 32555 CT Thyroid: 60100, 77012 Lung/Mediastinum: 32405, 77012 Liver: 47000, 77012 Renal: 50200, 77012 Abdominal/Retroperitoneal Mass: 49180, 77012 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, 76942 Lung/Mediastinum: 32405, 76942 Liver: 47000, 76942 Renal: 50200, 76942 Abdominal/Retroperitoneal Mass: 49180, 76942 Ultrasound or Thyroid: 60100, 77002 Lung/Mediastinum: 32405, 77002 Liver: 47000, 77002 Renal: 50200, 77002 Abdominal/Retroperitoneal Mass: 49180, 77002 Fluoroscopy INTERVENTIONAL www.radltd.com To schedule an interventional procedure, please call (520) 545-1906 or fax (520) 545-1898. 3637

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, 77003 Nerve Root/Block (per level/per side) L-Spine: 64483, 64484 Fluoroscopy No Only if patient is taking Coumadin Neuroradiologist Yes Epidural: L-Spine: 77012, 62311 SI: 77012, 62311 Nerve Root/Block (per level/per side) L-Spine: 64483, 64484 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: 64493 (1st), 64494 (2nd), 64495 (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): 64493 (1st), 64494 (2nd), 64495 (3rd) CT No Only if patient is taking Coumadin Yes, may require a consult. Must have either MRI or CT. Fluoroscopy 62270, 77003 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) 545-1906 or fax (520) 545-1898.

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 22512 (if biopsy is performed on separate vertebrae, use 20225) L-Spine: 22511, each add l level use 22512 (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 22515 (if biopsy is performed on separate vertebrae, use 20225) L-Spine: 22514, each add l level use 22515 (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, 72292 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, 72292 No Only if patient is taking Coumadin Fluoroscopy 62273, 77003 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 www.radltd.com To schedule an interventional procedure, please call (520) 545-1906 or fax (520) 545-1898. 3839

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, 36005 Bilateral: 75822, 36005 (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, 76937 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. 4039 To schedule an interventional procedure, please call (520) 545-1906 or fax (520) 545-1898.

Drainage Tube / Stent Placement Sedation Required Labs Required Evaluation Required Interventional Service Modality CPT Code(s) Performed By Yes Yes, call for specifics Yes Interventional Radiologist Fluoroscopy 47505, 74305 / 47525, 75894 Biliary Tube Injection / Stent Exchange Fluoroscopy is used to guide a catheter and/or stent into the biliary ducts of the liver. This is performed to relieve the buildup of bile caused by an obstruction. INTERVENTIONAL RADIOLOGY SERVICES This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Placement (performed in a hospital setting): 74425, 50390, 74475, 50392 Yes Yes, call for specifics Yes Interventional Radiologist Check and Change: 50394, 74425 50398, 75984 Fluoroscopy Nephrostomy / Ureteral Tube Placement & Exchange Fluoroscopy is used to guide a catheter into the kidney. This is performed to relieve the buildup of urine caused by an obstruction. Tube placements are performed in a hospital setting. Peritoneal / Retroperitoneal Abscess: 49406 Visceral (e.g. kidney, liver, spleen, lung / mediastinum): 49405 Modality not specified for these procedures Percutaneous Abscess Drainage A needle or catheter is placed through the skin to drain an infected collection in the body. 77012, 10160 (subcutaneous, deep tissue, location site not specified) CT, Percutaneous Abscess Aspiration A needle or catheter is placed through the skin to drain an infected collection in the body. Yes Yes, call for specifics Yes Interventional Radiologist 76942, 10160 (subcutaneous, deep tissue, location site not specified) Ultrasound or 77002, 10160 (subcutaneous, deep tissue, location site not specified) Fluoroscopy INTERVENTIONAL www.radltd.com To schedule an interventional procedure, please call (520) 545-1906 or fax (520) 545-1898. 4041

ICD-9 S ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. REQUESTED TEXT REQUESTED TEXT Neoplasms Skin, Uncertain Behavior 238.2 Bladder, 188.9 Breast, Female, 174.9 Colon, 153.9 Female Genital,, CIS Excluded Gastrointestinal Tract, 184.9 159.0 Hodgkin s, NOS 201.90 Leukemia, Without Remission, NOS 208.90 Lung, 162.9 Male Genital, 187.9 Prostate 185 Respiratory Tract, NOS 165.9 Malignant Neoplasm Skin, 173.99 199.1 Urinary, 189.9 Benign Neoplasms Colon 211.3 Benign Neoplasms (cont d) Lipoma, Any Site 214.9 Neoplasm, 239.9 Skin, Soft Tissue Neoplasm, 239.2 Skin, 216.9 229.9 Uterus (leiomyoma, unspecified) Endocrine, Nutritional & Metabolic Disorders B12 Deficiency Without Anemia BMI < 5th Percentile, Pediatric BMI 95th Percentile, Pediatric 218.9 266.2 V85.51 V85.54 Dehydration 276.51 Diabetes I, Uncomplicated 250.01 Diabetes I, With Complications 250.91 Diabetes II, Uncomplicated 250.00 Diabetes II, With Complications 250.90 Diabetic Ketoacidosis 250.13 Glucose Intolerance 271.9 4241

REQUESTED TEXT Endocrine, Nutritional & Metabolic Disorders (cont d) Goiter, 240.9 Gout, 274.9 Hypercalcemia 275.42 Hypercholesterolemia, Pure 272.0 Hyperkalemia 276.7 Hyperlipidemia, Mixed 272.2 Hyperlipidemia, 272.4 Hypernatremia 276.0 Hyperparathyroidism, ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. 252.00 Hyperthyroidism, NOS 242.90 Hypocalcemia 275.41 REQUESTED TEXT Endocrine, Nutritional & Metabolic Disorders (cont d) Obesity, NOS 278.00 Overweight 278.02 Thyroid Nodule 241.0 Blood Diseases Abnormal White Blood Cells, 288.9 Anemia, Acute Blood Loss 285.1 Anemia, Chronic Disease, Other Anemia, Chronic Kidney Disease Anemia, Chronic Neoplastic Disease Anemia, Iron Deficiency, 285.29 285.21 285.22 280.9 Anemia, Other, 285.9 INTERVENTIONAL ICD-9 S www.radltd.com Hypoglycemia, DM, Uncontrolled Hypoglycemia, Nondiabetic, 250.80 251.2 Hypokalemia 276.8 Hyponatremia 276.1 Hypothyroidism, 244.9 Nutritional Deficiencies, 269.9 Anemia, Pernicious 281.0 Blood Disease, 289.9 Hemorrhagic Conditions, Hypercoagulable State, Primary Leukocytopenia, 287.9 289.81 288.50 Lymphadenitis, Chronic 289.1 4243

ICD-9 S ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. REQUESTED TEXT REQUESTED TEXT Blood Diseases (cont d) Pancytopenia 284.1 Polycythemia Vera 238.4 Sickle-Cell Disease, 282.60 Sickle-Cell Trait 282.5 Mental Disorders Adjustment Reaction, 309.9 Alcohol Abuse, 305.00 Alcoholism, 303.90 Alzheimer s 331.0 Anorexia Nervosa 307.1 Anxiety State, 300.00 Attention Deficit, With Hyperactivity Attention Deficit, Without Hyperactivity 314.01 314.00 Bulimia Nervosa 307.51 Conduct Disorder, 312.9 Delirium, Acute 293.0 Dementia, Senile, Uncomplicated 290.0 Mental Disorders (cont d) Dementia, Vascular, Uncomplicated 290.40 Depressive Disorder, NOS 311.0 Drug Abuse, 305.90 Insomnia, Sleep Disorder, Learning Disability / Development Delay, NOS Mental Retardation, 307.40 315.9 319.0 Neurosis, NOS 300.9 Panic Disorder, No Agoraphobia Personality Disorder, 300.01 301.9 Psychosis, 298.9 Schizophrenia, 295.90 Sexual Dysfunction, Situational Disturbance, Acute 302.70 308.3 Tension Headache 307.81 Tobacco Abuse 305.1 Nervous System & Sense Organ Disorders Nervous System Diseases Bell s Palsy 351.0 443

REQUESTED TEXT Nervous System & Sense Organ Disorders Nervous System Diseases (cont d) Carpal Tunnel 354.0 Cerebral Artery Occlusion, With Infarction, 434.91 Cognitive Impairment, Mild 331.83 CVA, Late Effect, 438.9 Epilepsy,, Not Intractable Intracranial Hemorrhage, NOS 345.90 432.9 Meningitis, 322.9 Migraine,, Not Intractable Movement Disorder, ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. 346.90 333.90 Multiple Sclerosis 340 REQUESTED TEXT Nervous System & Sense Organ Disorders Nervous System Diseases (cont d) Tremor / Spasms, NOS 781.0 Trigeminal Neuralgia 350.1 Nervous System & Sense Organ Disorders Eye Diseases Blepharitis, 373.00 Cataract, 366.9 Chalazion 373.2 Conjunctivitis, 372.30 Corneal Abrasion 918.1 Corneal Ulcer, 370.00 Eye Disorder, 379.90 INTERVENTIONAL ICD-9 S www.radltd.com Myopathy, 359.9 Nervous System, NOS 349.9 Neuropathy, 357.9 Parkinsonism, Primary 332.0 Restless Legs Syndrome 333.94 Sleep Apnea, Obstructive 327.23 Eye Foreign Body, External, Eye Movement Disorder, 930.9 378.9 Glaucoma, 365.9 Hordeolum (stye) 373.11 Refractive Errors, 367.9 Retinal Disorder, 362.9 Tremor, Essential / Familial 333.1 Visual Disturbance, 368.10 445

ICD-9 S ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. REQUESTED TEXT Nervous System & Sense Organ Disorders Eye Diseases (cont d) Visual Loss, 369.9 REQUESTED TEXT Circulatory System (cont d) Angina, Unstable 411.1 Nervous System & Sense Organ Disorders Ear Diseases Cerumen Impaction 380.4 Ear Disorder, 388.9 Eustachian Salpingitis, 381.50 Hearing Loss, 389.9 Aortic Aneurysm, Arterial Disorder, Other, Atherosclerosis, NOS (not heart / brain) 441.9 447.9 440.9 Atrial Fibrillation 427.31 Cardiac Contusion 861.01 Otitis Externa, 380.10 Otitis Media, Acute 382.00 Otitis Media, Acute With Rupture of TM 382.01 Otitis Media, Chronic Serous 381.10 Vertigo, Central 386.2 Vertigo, Peripheral, Circulatory System 386.10 Abnormal Electrocardiogram 794.31 Left Heart Failure With Acute Pulmonary Edema Acute Pulmonary Edema, 428.1 518.4 Angina Pectoris, NOS 413.9 Chronic Ischemic Heart Disease, Circulatory Disorder, Conduction Disorder, Elevated BP Without Hypertension Heart Disease, Other, Heart Failure, Combined, Heart Failure, Congestive, Heart Failure, Diastolic, Heart Failure, Systolic, Heart Valve, Aortic, Not Rheumatic Heart Valve, Mitral, Not Rheumatic 414.9 459.9 426.9 796.2 429.9 428.40 428.0 428.30 428.20 424.1 424.0 4645

REQUESTED TEXT Circulatory System (cont d) Heart Valve, Pulmonary, Not Rheum. Heart Valve, Tricuspid, Not Rheum. 424.3 424.2 Hypertension, Benign 401.1 Hypertension, Malignant 401.0 Hypertension, 401.9 Hypertensive Chronic Kidney Disease, With Chronic Kidney Disease, Hypertensive Heart Disease,, With Heart Failure 403.90 402.91 Long QT Syndrome 426.82 Myocardial Infarction, NOS (to 8 weeks) Myocardial Infarction, NSTEMI (to 8 weeks) 410.90 410.70 Myocardial Infarction, Old 412 Orthostatic Hypotension 458.0 Paroxysmal Supraventricular Tachycardia Pericarditis, Acute, Nonspecific Peripheral Vascular Disease, Phlebitis, Deep, Lower Extremity, Other ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. 427.0 420.91 443.9 451.19 REQUESTED TEXT Circulatory System (cont d) Premature Beats, Pulmonary Embolism, Not Iatrogenic Pulmonary Heart disease, Chronic, Rheumatic Heart Disease, 427.60 415.19 416.9 398.90 Sick Sinus Syndrome 427.81 Thrombophlebitis, Transient Ischemic Attack, Varicose Veins, Asymptomatic Venous Insufficiency, Respiratory System 451.9 435.9 454.9 459.81 Abscess / Ulcer of Nose 478.19 Asthma, Extrinsic, Acute Exacerbation Asthma, Intrinsic, Acute Exacerbation 493.02 493.12 Asthma, 493.90 Bronchiolitis, Acute, Due to RSV 466.11 Bronchitis, Acute 466.0 Bronchitis, Chronic, 491.9 INTERVENTIONAL ICD-9 S www.radltd.com 4647

ICD-9 S ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. REQUESTED TEXT REQUESTED TEXT Respiratory System (cont d) Bronchospasm, Acute 519.11 Bronchospasm, Exercise Induced 493.81 COPD, NOS 496 Croup 464.4 Emphysema 492.8 Laryngitis, Acute, No Obstruction 464.00 Peritonsillar Abscess 475 Pharyngitis, Acute 462 Pleural Effusion, NOS 511.9 Pleurisy, NOS 511.0 Pneumonia, 486 Pneumothorax, 512.89 Respiratory Disease, Other, NOS Rhinitis, Allergic, Cause 519.9 477.9 Rhinitis, Chronic 472.0 Sinusitis, Acute, Frontal 461.1 Sinusitis, Acute, Maxillary 461.0 Respiratory System (cont d) Sinusitis, Acute, NOS 461.9 Sinusitis, Chronic, Frontal 473.1 Sinusitis, Chronic, Maxillary 473.0 Sinusitis, Chronic, NOS 473.9 Tonsil / Adenoid Disease, Chronic, 474.9 Tonsillitis, acute 463 Upper Respiratory Infection, Acute, NOS Digestive System 465.9 Anal Fissure, Nontraumatic 565.0 Appendicitis, 540.9 Cholecystitis, Acute 575.0 Cholelithiasis, NOS 574.20 Chronic Liver Disease, 571.9 Cirrhosis, NOS 571.5 Constipation, 564.00 Crohn s Disease, NOS 555.9 Dental Abscess 522.5 4847

REQUESTED TEXT Digestive System (cont d) Dental Caries, 521.00 Dental, 525.9 Diverticulitis of Colon, NOS 562.11 Diverticulosis of Colon 562.10 Dyspepsia 536.8 Esophageal Disease, 530.9 Esophagitis, 530.10 Functional Disorder Intestine, Gallbladder Disease, Gastritis,, Without Hemorrhage ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. Gastroenteritis, Noninfectious, Gastroesophageal Reflux, No Esophagitis 564.9 575.9 535.50 558.9 530.81 Hemorrhoids, NOS 455.6 REQUESTED TEXT Digestive System (cont d) Intestinal Obstruction, 560.9 Irritable Bowel Syndrome 564.1 Mucositis, Stomatitis,, NOS Oral, Soft Tissue Diseases, Oral, Tongue Diseases, 528.00 528.9 529.9 Pancreatitis, Acute 577.0 Peptic Ulcer Disease,, Without Obstruction 533.90 TMJ Disorder, 524.60 Ulcerative Colitis, Genitourinary System Urinary System Diseases 556.9 Cystitis, Acute 595.0 Cystitis, Interstitial, Chronic 595.1 INTERVENTIONAL ICD-9 S www.radltd.com Hernia, Hiatal, Noncongenital 553.3 Hernia, Inguinal, NOS 550.90 Hernia, Other, NOS 553.9 Glomerulonephritis, Acute, Glomerulonephritis, Chronic, 580.9 582.9 Hematuria, 599.7 Ileus 560.1 Proteinuria, Nonpostural, Nonobstetric 791.0 4849

ICD-9 S REQUESTED TEXT Genitourinary System Urinary System Diseases (cont d) Pyelonephritis, Acute, No Necrosis Renal Failure, Acute, ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. Renal Failure / Insufficiency, Chronic, 590.10 584.9 585.9 Renal Insufficiency, Acute 593.9 REQUESTED TEXT Genitourinary System Male Genital Organ Diseases (cont d) Orchitis / Epididymitis, 604.90 Phimosis 605 Prostatitis, NOS 601.9 PSA, Elevated 790.93 Urethral Syndrome, Non-VD, NOS Urinary Calculus, Urinary Obstruction, Urinary Tract Infection, / Pyuria Genitourinary System Male Genital Organ Diseases 597.81 592.9 599.60 599.0 Balanitis 607.1 BPH / LUTS With Obstruction 600.01 BPH / LUTS Without Obstruction 600.00 Hematospermia 608.82 Urethritis, Nongonococcal, 099.40 Varicocele 456.4 Genitourinary System Breast Diseases Breast Disease, 611.9 Breast Lump 611.72 Dense Breasts 793.82 Fibroadenosis 610.2 Fibrocystic Disease 610.1 Galactorrhea 611.6 Hydrocele, 603.9 Impotence, Organic 607.84 Impotence, Psychosexual Dysfunction Male Genital Disease, Other, 302.72 608.9 Mammogram, Abnormal, Mastitis, Lactating, Visit us online at radltd.com 793.80 675.90 5049

REQUESTED TEXT Mastitis, NOS 611.0 Genitourinary System Female Genital Organ Diseases Bartholin Cyst 616.2 Cervical Polyp, NOS 622.7 Cervicitis 616.0 Cystocele / Rectocele / Prolapse, 618.9 Cyst of Ovary, Follicular 620.0 Dyspareunia 625.0 Endometriosis, 617.9 Female Genital Disease, Pelvic Onflammatory Disease, ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. 629.9 614.9 Stress Incontinence, Female 625.6 REQUESTED TEXT Painful Menstruation 625.3 Genitourinary System Disorders of Menstruation (cont d) Pelvic Pain 625.9 Premenstrual Tension Syndrome Genitourinary System Fertility Problems Infertility, Female, 625.4 628.9 Infertility, Male, 606.9 Musculoskeletal & Connective Tissue Acquired Deformity, Limb, 736.9 Arthropathy, 716.90 Back Pain With Radiation, 724.4 Cervical Disorder, NOS 723.9 INTERVENTIONAL ICD-9 S www.radltd.com Vaginitis / Vulvitis, Genitourinary System Disorders of Menstruation 616.10 Amenorrhea 626.0 Connective Tissue Disease, Disc Syndrome, No Myelopathy, NOS 710.9 722.2 Ganglion, 727.43 Menopausal Disorders, Menstruation, Excessive / Frequent 627.9 626.2 Metrorrhagia 626.6 Internal Derangement, Knee, Kyphosis / Scoliosis, Muscle Weakness, Generalized 717.9 737.9 728.87 5051

ICD-9 S REQUESTED TEXT Myalgia / Myositis, ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. Musculoskeletal & Connective Tissue (cont d) 729.1 Osteoarthritis of Spine, NOS 721.90 REQUESTED TEXT Abnormal Glucose, Other 790.29 Signs & Symptoms (cont d) Abnormal Loss of Weight 783.21 Osteoarthrosis, 715.90 Osteomyelitis, Acute, Osteomyelitis, Chronic, 730.00 730.10 Osteoporosis, 733.00 Pain, Limb 729.5 Pain, Knee 719.46 Pain, Low Back 724.2 Polymyalgia Rheumatica 725 Abnormal Pap, ASC-US 795.01 Abnormal Pap, ASC, Possible HGSIL Abnormal Pap, Other and HPV 795.02 795.09 Abnormal Pap, 795.00 Abnormal Transaminase / LDH 790.4 Solitary Pulmonary Nodule 793.11 Other Abnormal Lung Findings, 793.19 Abnormalities of RBCs 790.09 Rheumatoid Aarthritis (not JRA) Shoulder Syndrome, Synovitis / Tenosynovitis, Traumatic Arthropathy, Signs & Symptoms 714.0 726.10 727.00 716.10 Anaphylaxis, NOS 995.0 Anorexia 783.0 Arthralgia, 719.40 Ascites, Malignant 789.51 Ascites, Other 789.59 Abdominal Pain, 789.00 Bleeding, Rectal 569.3 Abnormal Blood Chemistry, Other 790.6 Blood in Stool, Melena 578.1 5251

REQUESTED TEXT Blood in Stool, Occult 792.1 Signs & Symptoms (cont d) Cardiac Arrest 427.5 Chest Pain, 786.50 Chronic Fatigue Syndrome 780.71 Chronic Pain, Other 338.29 Chronic Pain, Other Post-Op 338.28 Chronic Pain, Post- Thoracotomy ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. 338.22 Chronic Pain, Trauma 338.21 Chronic Pain Syndrome, With Psychosocial Dysfunction 338.4 Colic, Infantile 789.7 REQUESTED TEXT Effusion / Swelling of Joint, Signs & Symptoms (cont d) Encopresis, NOS, Fecal Incontinence 719.00 787.6 Epistaxis 784.7 Failure to Thrive 783.41 Fatigue and Malaise, Other 780.79 Feeding Problem, Infant /Elderly 783.3 Fever, 780.60 Gas / Bloating 787.3 Glucose Intolerance 271.9 Glycosuria 791.5 INTERVENTIONAL ICD-9 S www.radltd.com Coma, Nondiabetic / Nonhepatic 780.01 Cough 786.2 Diarrhea, NOS 787.91 Dizziness / Vertigo, NOS 780.4 Dysphagia, 787.20 Dysuria 788.1 Edema, Localized, NOS 782.3 Headache, 784.0 Heartburn 787.1 Hematemesis 578.0 Hemoptysis 786.30 Hepatomegaly 789.1 Hiccups 786.8 Hoarseness 784.49 5253

ICD-9 S ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. REQUESTED TEXT Hyperventilation 306.1 REQUESTED TEXT Other Ill-Defined Conditions 799.89 Signs & Symptoms (cont d) Hypoxemia 799.02 Incontinence / Enuresis, NOS 788.30 Infant Excessive Crying 780.92 Lack of Normal Physiological Development, 783.40 Libido, Decreased 799.81 Localized Swelling / Mass, Superficial 782.2 Lymph Nodes, Enlarged 785.6 Memory Loss 780.93 Transient Alteration of Awareness 780.02 Change in Mental Status 780.97 Movement Disorder 781.0 Murmur of Heart, Undiagnosed 785.2 Nausea With Vomiting 787.01 Nausea, Alone 787.02 Nocturia 788.43 Signs & Symptoms (cont d) Pain, Neoplasm Related 338.3 Palpitations 785.1 Polyuria 788.42 Rash, Nonvesicular, 782.1 Seizures, Convulsions, Other 780.39 Seizures, Simple, Febrile, 780.31 Semicoma, Stupor 780.09 Sensory Disturbance Skin 782.0 Shock, 785.50 Shortness of Breath 786.05 Skin, Other Symptoms 782.9 Splenomegaly 789.2 Sweating Excess 780.8 Syncope 780.2 Urinary Frequency 788.41 Other Abnormal Blood Chemistry 790.6 Urinary Urgency 788.63 5453

REQUESTED TEXT Vomiting, Alone 787.03 Signs & Symptoms (cont d) Walking Difficulty 719.7 Wheezing 786.07 Injuries & Adverse Effects Fracture (cont d) Fracture: Ankle, Closed, Fracture: Carpal, Closed, Fracture: Clavicle, Closed, Fracture: Femur / Hip, Closed, Fracture: Femur / Shaft, Closed Fracture: Fibula, Closed, Fracture: Foot, Closed, (not toes) Fracture: Forearm, Closed, Fracture: Humerus, Closed, Fracture: Mandible, Closed, Fracture: Metacarpal, Closed, 824.8 814.00 810.00 820.8 821.01 823.81 825.20 813.80 812.20 802.20 815.00 Fracture: Nose, Closed 802.0 Fracture: Other Sites, Closed, ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. 829.0 REQUESTED TEXT Fracture: Pelvic, Closed, Injuries & Adverse Effects Fracture (cont d) Fracture: Phalanges, Foot, Closed Fracture: Phalanges, Hand, Closed, Fracture: Ribs, Closed, Fracture: Skull, Closed, Fracture: Tibia, Closed, Fracture: Tibia / Fibula, Closed, Fracture: Vertebral, Closed, 808.8 826.0 816.00 807.00 803.00 823.80 823.82 805.8 Fracture, Stress: Metatarsals 733.94 Fracture, Stress: Other bone 733.95 Fracture, Stress: Tibia or Fibula Healed Fracture, Follow-Up Exam 733.93 V67.4 Injuries & Adverse Effects Dislocations, Sprains & Strains Dislocation: Other, Closed, Dislocation: Shoulder, Closed, Knee Meniscus Injury, Sprain / Strain: Ankle, 839.8 831.00 836.2 845.00 INTERVENTIONAL ICD-9 S www.radltd.com 5455

ICD-9 S REQUESTED TEXT Sprain / Strain: Foot, 845.10 Injuries & Adverse Effects Dislocations, Sprains & Strains (cont d) Sprain / Strain: Hand, Sprain / Strain: Knee / Leg, Sprain / Strain: Neck, Sprain / Strain: Other Site, Sprain / Strain: Shoulder / Arm, Sprain / Strain: Vertebral, Sprain / Strain: Wrist, 842.10 844.9 847.0 848.9 840.9 847.9 Injuries & Adverse Effects Other Trauma, Adverse Effects 842.00 Abrasion, 919.0 Adult Physical Abuse 995.81 Burn, Degree 949.0 Child Abuse, 995.50 Cold Injury, 991.9 Concussion, LOC Less Than 30 Minutes ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. 850.11 Concussion, 850.9 Contusion, 924.9 REQUESTED TEXT Crushing Injury, 929.9 Injuries & Adverse Effects Other Trauma, Adverse Effects (cont d) Exhaustion Due to Exposure 994.4 Foreign Body, Digestive System, 938 Foreign Body, Ear 931 Foreign Body, Nose 932 Foreign Body, Skin, Superficial, 919.6 Head Injury, NOS 959.01 Heat Injury, 992.9 Insect Bite 919.4 Late Effects of Injury, Medication, Adverse Effects, Open Wound, Head / Neck / Trunk, Open Wound, Lower Limb, Open Wound, Upper Limb, 908.9 995.20 879.8 894.0 884.0 Other Trauma, 959.9 Poisoning, Medicine Overdose, 977.9 Poisoning, 989.9 5655

ICD-9 S Note: Codes that include NOS (not otherwise specified) or unspecified have alternative diagnosis codes that are more specific. These alternatives can be found in or near the section of ICD-9-CM that deals with the relevant three-digit codes. REQUESTED TEXT Please use the spaces below for notes or additional codes common in your practice. REQUESTED TEXT Please use the spaces below for notes or additional codes common in your practice. INTERVENTIONAL ICD-9 S www.radltd.com 5657

ICD-10 S ICD-10 S NOTES REQUESTED TEXT Please use the spaces below for notes or additional codes common in your practice. REQUESTED TEXT Please use the spaces below for notes or additional codes common in your practice. 57

REQUESTED TEXT ICD-10 S NOTES Please use the spaces below for notes or additional codes common in your practice. REQUESTED TEXT Please use the spaces below for notes or additional codes common in your practice. INTERVENTIONAL ICD-9 ICD-10 S www.radltd.com 5859

RADIOLOGY LTD. IS A PREFERRED PROVIDER FOR THE FOLLOWING INSURANCES 59 MAJOR INSURANCE PLANS AARP Medicare Complete (Formally Secure Horizons) Aetna US Healthcare: not contracted with Aetna Sr AHCCCS (All Plans) Banner Health Plus Blue Cross/Blue Shield including BCBS Advantage Care1st HealthPlan (AHCCCS) CareMore Health Plan Cigna Cochise Health System EverCare and Community Plan UHC (Formally EverCare Select) GEHA Health Choice Arizona Health Choice Generations Health Net / Health Net Medicare Advantage Humana Humana Community HMO Humana Gold Indian Health Services Logistics Health Inc. (LHI) Mail Handlers Benefit Plan (MHBP) Mayo Health Plan Arizona MDIA (Medrisk Data) Medicare Mercy Care Healthcare Group OneCare One Call Medical UHC West (Formally Pacificare) Preferred Medical Claim Solutions State Compensation Fund United Medical Resources (UMR) United Healthcare United Healthcare Community Plan (Formally APIPA) United Healthcare Medicare Complete United Military West VA University Family Care (AHCCCS) University Physician Advantage MAJOR NETWORK PLANS Accountable Health Plans Ancillary Care Services Arizona Foundation for Medical Care Beech Street CCN Coventry National First Health (Individual Provider Contracts) Health Management Network MultiPlan PHCS If you need further assistance with insurances, please call our Insurance Billing Representative at (520) 296-0278.

WE HAVE 7 IMAGING CENTERS TO SERVE YOU CAMP LOWELL IMAGING CENTER 4640 E. Camp Lowell Dr. Tucson, AZ 85712 Tel: (520) 318-6144 LA CHOLLA CENTER FOR DIAGNOSTIC IMAGING & TREATMENT LA CHOLLA CENTER FOR WOMEN S IMAGING 5960 N. La Cholla Blvd. Tucson, AZ 85741 Tel: (520) 797-3439 MIDVALE IMAGING CENTER 1598A W. Commerce Court Tucson, AZ 85746 Tel: (520) 290-4842 RADIOLOGY LTD. CARONDELET IMAGING CENTER 6567 E. Carondelet Dr., Suite 105 Tucson, AZ 85710 Tel: (520) 751-3096 RANCHO VISTOSO DIAGNOSTIC IMAGING 2551 E. Vistoso Commerce Loop Rd. Oro Valley, AZ 85755 Tel: (520) 825-1990 ST. JOSEPH S IMAGING CENTER 330 N. Wilmot Rd. Tucson, AZ 85711 Tel: (520) 290-4840 WILMOT CENTER FOR DIAGNOSTIC IMAGING & TREATMENT WILMOT CENTER FOR WOMEN S IMAGING 677 N. Wilmot Rd. Tucson, AZ 85711 Tel: (520) 722-1832 60

MODALITY LOCATIONS MRI (High-field) MRI (Espree X-Large Opening) CAMP LOWELL LA CHOLLA LA CHOLLA WOMEN S MIDVALE RADIOLOGY LTD. CARONDELET RANCHO VISTOSO ST. JOSEPH S WILMOT X X X X X X X X X WILMOT WOMEN S CT X X X X X X PET / CT X Interventional X X Ultrasound X X X X X X X X Digital Mammography X X X X 3D Mammography X X Breast Biopsy X X X Breast MRI X X Breast Interventional X X DEXA (Bone Densitometry) X X X Digital X-ray X X X X X X X 61

TECHNOLOGY Radiology Ltd. has a nearly paperless and fully electronic workflow residing on state-of-the-art infrastructure, allowing for rapid and seamless communication across all locations throughout the enterprise. This allows us to route all imaging studies to the most appropriate location, ensuring the most accurate and timely interpretations and the highest level of patient care. We focus on technological improvements that help us both practice better medicine and optimize customer service. advision (Provider Portal) - Images are available to the referring community within minutes of exam completion and can be viewed anywhere, anytime. Our systems are also Meaningful Use certified and enable our referring providers to: Use different viewers to access images on any platform (one viewer is for power users; the other is a zero client viewer that can be used with any browser) Access current and historical reports Find status of patient exams Order patient exams View new services and products, including Clinical Decision Support, Mobile Report Viewer, and Alert Application 62

677 N. Wilmot Rd., Tucson, AZ 85711. www.radltd.com Radiology Ltd. 2015