Is patient diabetic or over 60 years old? If yes to either question, will need current creatinine (within 30 days). Is patient allergic to IV contrast? If yes, what is reaction? Will need patient pharmacy information. All contrast allergy patients must have creatinine results prior to exam day. All references to Contrast in procedure name refer to IV contrast. Physician orders for Abd & Pelvis exams must specify contrast: a) With oral or without oral b) With IV, without IV or with and without IV **An authorization maybe required for any Cat Scan procedures. Please call insurance to verify. CT Scan Abdomen 74150 w/oral contrast w/o oral contrast - aka Stone Protocol Abdomen w/ Contrast w/oral contrast w/o oral contrast 74160 Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast) Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast)
CT Scan Abdomen 74170 w/oral contrast w/o oral contrast Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast) Abdomen & Pelvis 74176 w/oral contrast w/o oral contrast Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast) Abdomen & Pelvis w/ Contrast Abdomen & Pelvis 74177 74178 w/oral contrast w/o oral contrast Abdomen & Pelvis w/ Contrast Enteroclysis - aka CTE No oral contrast Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast) 74251 Time: 1 Hr Prep: NPO 4 hours prior
CT Scan Abscess Drainage ALL **Request specific CPT code** Time: 1 Hr Prep: NPO 4 hrs prior No blood thinners x 5 days Biopsy ALL CT Angiogram ( CTA ) All IV Contrast only Abdomen Abdomen & Pelvis Aorta w/runoff Chest/Thorax Head Lower Extremity Neck Pelvis Thorax/Abd Aorta w/iliacs Upper Extremity **Visualizes blood flow** **Request specific CPT code** 74175 74175 + 72191 75635 71275 70496 73706 70498 72191 71275 + 75635 73206 Time: 1 ½ Hrs Prep: No blood thinners x 5 days NPO 4 hrs prior - except thyroid biopsy (no NPO) Schedule AM only M, T, Th, Fri Prep: NPO 4 hrs prior Schedule before 1PM Head 70450 Head w/ Contrast Head 70460 70470 Prep: NPO 4 hrs prior IAC 70480 IAC w/ Contrast 70481 Prep: NPO 4 hrs prior
CT Scan Joint injection/aspiration ALL **Request specific CPT code when scheduling** Time: 1 Hr Prep: No blood thinners x 5 days Lower Extremity 73700 Lower Extremity w/ Contrast Lower Extremity 73701 73702 Prep: NPO 4 hrs prior Mastoid 70480 Maxillofacial 70486 Maxillofacial w/ Contrast Maxillofacial 70487 70488 Prep: NPO 4 hrs prior Orbits Post Fossa 70480 Orbits Post Fossa w/ Contrast Orbits Post Fossa Pelvis w/oral contrast w/o oral contrast 70481 70482 72192 Prep: NPO 4 hrs prior Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast)
CT Scan Pelvis w/ Contrast 72193 Pelvis 72194 w/oral contrast w/o oral contrast Prep: NPO 4 hrs prior to scan time Arrive: 2 hrs prior to scan time (registration + drinking of oral contrast) Sinuses 70486 Sinuses w/ Contrast Sinuses 70487 70488 Prep: NPO 4 hrs prior Soft Tissue Neck **Tissue, organs, glands no views of boney structures** 70490 Soft Tissue Neck w/ Contrast Soft Tissue Neck **Tissue, organs, glands no views of boney structures** Spine Cervical Thoracic Lumbar 70491 70492 72125 72128 72131 Prep: NPO 4 hrs prior
CT Scan Spine w/ Contrast Cervical Thoracic Lumbar 72126 72129 72132 Prep: NPO 4 hrs prior Spine Cervical Thoracic Lumbar 72127 72130 72133 Thorax 71250 Thorax w/ Contrast Thorax 71260 71270 Prep: NPO 4 hrs prior Upper Extremity 73200 Upper Extremity w/ Contrast Upper Extremity 73201 73202 Prep: NPO 4 hrs prior
Tech Line- x 6190 All contrasted exams: will need current creatinine (within 30 days) if patient is diabetic or over 60 years old No nursing home patients after 3:30 PM or after 12 PM on Friday **An authorization maybe required for any MRI procedure. Please call insurance to verify. MRI ORDER CPT NOTES Abdomen (includes liver, kidneys, pancreas) 74181 74183 Time: 60 mins Arthrogram w/ MRI: Ankle Hip Knee Shoulder Wrist Brain 73723 + 73615 73723 + 73525 73723 + 73580 73223 + 73040 73223 + 73115 70551 70553 Time: 90 mins Prep: No blood thinners x 5 days **Wrist schedule in AM only** Brain & IAC S 70553 Time: 60 mins Brain & Orbits 70551 + 70540 70553 + 70543 Time: 60 mins Brain & Pituitary 70553 Time: 60 mins Brain & Sinuses 70551 + 70540 Time: 60 mins Breast all 76094 Time: 60 mins Schedule 7-10 days after 1 st day of menstrual cycle
Chest MRI ORDER CPT NOTES 71550 71552 (w/o or w) 60 mins (w/wo) Cervical Spine Lower Extremity Joint (includes ankle, knee, hip joints) Lower Extremity (includes foot, leg) Lumbar Spine 72141 72156 73721 73723 73718 73720 72148 72158 MRA Abdomen (includes Abdominal Aorta or Renal Arteries depending on DX) MRA Abdomen w/ Lower Extremity Runoff 74185 Time: 60 mins 74185 + 73725 Time: 60 mins MRA Chest (includes Thoracic Aorta) 71555 71555 **If GFR is below 30 - cannot do exam** Time: 60 mins MRA Head Circle of Willis MRA Head w/o & Neck w/wo Contrast MRA Lower Extremity w/wo Contrast 70544 70544 + 70549 Time: 60 mins 73725 Time: 60 mins
MRA Neck - Carotid MRI ORDER CPT NOTES 70547 70549 MRA Upper Extremity w/wo Contrast MRCP w/o contrast 73225 Time: 60 mins Note: Medicare will not pay for this exam 76498 Time: 60 mins Prep: NPO for 6 hrs Orbits Face Neck 70540 70543 Time: 60 mins Orbits Sinus IAC S Pituitary 70543 + 70553 Time: 60 mins Pelvis Sagittal Spinal Survey Spinal Screening (includes C,T & L spine sagittal views only) 72195 72197 72141 + 72146 + 72148 72156 + 72157 + 72158 Time: 90 mins TMJ 70336 **we do not have dedicated TMJ coil** Thoracic Spine Upper Extremity Joint (includes shoulder, elbow, wrist) 72146 72157 73221 73223
MRI ORDER CPT NOTES Upper Extremity (includes forearm, humerus, hand, scapula) 73218 73220
Bone Scans: **An authorization maybe required for any NM procedures. Please call insurance to verify. Nuclear Medicine ORDER CPT NOTES Total Body Bone Scan w/spect if indicated head to toe exam Or Limited Bone Scan w/spect if indicated one specific area of the body (i.e. L2- L4 spine) **see attached information sheet** 78306 78300 add 78320 if spect exam Time: Prep: Notes: 1 hr None Pt arrival 3 hrs prior to scan time register, inject isotope, pt released then returns at scheduled scan time Bone Scan 3-Phase w/spect if indicated 78315 add 78320 if spect exam Time: Prep: Notes: Initial 30 mins Delay images 1 hr None Scans extremities knees, hands, feet, legs Cardiac Stress Test Dobutamine Lexiscan ETT Myoview 78465 Time: Prep: 90 mins Patient arrival 45 mins prior to exam time; doctor time is 30 mins after scheduled exam time; NM tech or nurse will call patient with instructions Ceretec Whole Body Ceretec Limited (for specific area/body part) 78806 78805 **Patient must bring list of medications** Notes: Schedule time per Tech - standard is 8 AM with delayed images at 1PM **Any other exams must be scheduled 2 days post Ceretec scan** Cisternogram 78630 Time: Initial 30 mins Return scans 1 hr **Dose must be ordered 1 week in advance**
Nuclear Medicine ORDER CPT NOTES Gallium Scan (Tumor or Abscess Localization) 78806 Time: Initial 30 mins Return scans - 1 ½ hrs Prep: Per Tech Gastric Emptying 78264 Time: 2 hrs **If scheduled Thursday 7:30 time only** GI Bleed Scan, Tagged RBC 78278 Time: 2 hrs Prep: No barium 48 hrs prior to exam Hepatobiliary Scan aka HIDA/DISHIDA 78227 Time: 3 hrs Prep: NPO for 8 hrs and no barium 48 hrs prior to exam **Schedule AM only** Indium Scan Whole body Limited (scans specific site (ex: leg ulcer) Liver Hemangioma aka RBC Tagged Study 78806 78805 Time: Prep: 1 hr per visit No barium 48 hrs prior to exam **Scheduled Mon Thurs only** 78206 Time: 2 ½ hrs Prep: No Barium 48 hrs prior to exam Liver/Spleen Scan 78205 Time: 1 ½ hrs Prep: No barium 48 hrs prior to exam Lung Scan Complete Perfusion Ventilation 78582 78580 78579 Time: Prep: 1 hr CXR on day of exam **Schedule Complete unless otherwise specified; no ventilator patients** Lymphoscintograpy 78195 Time: 2 ½ hrs
Nuclear Medicine ORDER CPT NOTES Meckel s Diverticulum Adult Child 78290 Time: Prep: 1 ½ hrs adults 2 ½ hrs children Tagament 300mg (OTC) every 6 hrs for 48 hrs prior to exam; no upper gi or barium enema 3-4 days prior to exam; npo 4-6 hrs Muga Scan 78472 Time: 1 ½ hrs Parathyroid w/spect (Sest) 78070 Time: 3 hrs Peritoneal Shunt Patency 78291 **If child must be coordinated with Anesthesia** Renal Scan aka Renogram 78708 Time: 1 ½ hrs Renal Scan with Captopril 78708 Time: 2 hrs Prep: Well hydrated day before scan; no ace inhibitors x 7 days; NPO x 8 hrs; Patient must arrive 1 ½ hrs prior to exam nurse prep **Schedule AM only** Sentinel Node Injection 38792 **If breast cancer diagnosis book 2 hrs prior to surgery or; if melanoma diagnosis a Lymphoscintography needs to be done prior to the day of SNI to determine correct time to schedule SNI** Thyroid Scan (Technetium) 78010 Time: 2 hrs Prep: No thyroid medication x 3 weeks prior to exam.
Nuclear Medicine ORDER CPT NOTES Thyroid Scan I-123 78010 Time: Capsule administration - 30 minutes, 6 hr return scan - 30 minutes, 24 hr return scan - 1 hr. Prep: Check for Iodine allergy, NPO after midnight, no thyroid medications x 3 weeks prior and no iodine x 6 8 weeks (CT/IVP/Specials,etc.);.ch eck vitamins or medications for Iodine. **Scheduled on Mondays at 8:30** Tumor Localization Ask for specific CPT as the time of scheduling Time: 1 hr a day for up to 3 days. Prep: NPO 4 hrs, no barium 48 hrs prior to exam, bowl prep, and pt should be well hydrated. **Scheduled M Th only after 11 am**
**An authorization maybe required for any Routine Rad procedure. Please call insurance to verify. Routine Radiology Arthrogram w/ct Ankle, hip, knee, shoulder, wrist Barium Swallow (aka Esophogram) Ask for specific CPT as the time of scheduling Prep: No blood thinners x 5 days 74220 **Schedule AM only** **If CT ABD & PELVIS ordered also, schedule CT first, then BS 2 days after CT** Barium Swallow, Modified (MBS) 74230 Time: 60 mins **Schedule before 11 AM** **All Medicare patients will need 2 diagnosis** Barium Enema (Colon) w/air If referring physician wants to order both UGI and BE Schedule UGI with BE to follow 2 days later. The prep for BE will clean out barium from UGI. 74280 Time: 60 mins Fleets prep kit (pt. to pick up at their local pharmacy) **If patient has had recent colonoscopy must be scheduled 7 days after that procedure **Schedule AM only** **If CT ABD & PELVIS ordered also, schedule CT first, then BS 2 days after CT** Gastrografin Swallow 74220 Time: 30 minutes **Schedule AM only** Gastrografin UGI 74246 Time: 30 minutes **Schedule AM only**
Hysterosalpingogram (HSG) Routine Radiology 74740 Time: 60 mins Prep: Schedule after period but before ovulation and on the 3 rd day of an antibiotic course; serum pregnancy test same day immediately prior to exam; no sex for 7 days prior to exam; patient must arrive 45 minutes prior to exam (lab first); patient must have a designated driver if taking sedative. **Schedule before 3 pm** Intravenous Pylegram (IVP)--ALL (No tomos capability) 74400 Time: 60 mins Prep: Current creatinine (30 days or <) if patient is diabetic or 60 y/o or >. NPO after midnight with 18 hour bowel prep (pick up at local pharmacy). If the patient is Diabetic no diabetic meds the morning of the procedure. **Schedule AM only** **Non-Rockwood/Jones patients will need bowel prep instructions** Lumbar Puncture 62270 Time: 60 mins Prep: No blood thinners x 5 days **Schedule AM only** Myelogram Cervical Lumbar Thoracic 72240 72265 72255 Time: 60 mins Prep: No blood thinners x 5 days **Schedule before 11 AM**
Routine Radiology Skeletal Survey 76062 Time: 60 mins **Schedule after 2 PM only** Upper GI Series (UGI) With air W/o air - babies (includes Barium Swallow) Upper GI with Small Bowel FT With air W/o air - babies. (includes Barium Swallow) 74246 74240 74249 74245 NPO 4 hrs - babies **Schedule AM only; with air unless specifically ordered without** **If CT ABD & PELVIS ordered also, schedule CT first, then UGI 2 days after CT** Time: 1 24 hrs depending on patient; pt could possibly be at HCM all day and may have to return the following day **Schedule AM only; with air unless specifically ordered without** **If CT ABD & PELVIS ordered also, schedule CT first, then UGI w/sbft 2 days after CT** Voiding Cystourethrogram (VCUG) 74455 Time: 60 mins **Schedule after 2 PM** **If Renal US ordered also, schedule VCUG after US**
**An authorization maybe required for any Cath Lab or Specials procedure. Please call insurance to verify. Cath Lab/Specials ORDER Angiogram: Arteriogram NOTES Time: 2 hrs Prep: per PAT staff Vascular or Radiologist Antigrade Nephrostogram (inject contrast into existing nephrostomy tube) Biopsy Bronchoscopy Drainage: Biliary, Abscess, Pelvic, Abdominal, Pericardiocentesis Time: 1 hr Prep: No Prep Time: 1 ½ hrs Prep: NPO x 6 hrs Time: 1 ½ hrs Time: 1 ½ hrs Prep: NPO x 6 hrs EGD Embolization Chemo-Embolization ERCP Time: 1 hr Time: 2 hrs Prep: NPO 8 hrs Time: 2 hrs Prep: NPO x 8 hrs EVAR Time: 4 hrs **Mon & Thurs only - AM or PM** **if requested for other day, scheduling physician must call and clear with anesthesia before scheduling**
Cath Lab/Specials ORDER Feeding Tube: (insert feeding or peg tube) NOTES Time: 1 ½ Hours Prep: NPO x 8 hrs See Replace Duodenstomy/JEJ for replacement only procedure Filter Vena Cava IVC Filter Placement Usually done with endo docs Time: 1 ½ hrs Prep: NPO x 6 hrs if sedation Fistulogram If dialysis patient 2 hrs Procedure by vascular surgeon If abscess pt 1 hr Heart Cath Time: 1 2 hrs Prep: NPO x 6 hrs Time: 2 hrs Prep: NPO x 6 hrs ICD Gen Change Time: 1 ½ Hours Prep: NPO x 6 hrs Injection/Aspiration: Joint Injection/Aspiration Sialogram Discogram Nephrostogram (contrast used to check existing tube does not include replacing tube) Time: 1 hr Time: 1 ½ hrs Time: 1 ½ hrs Prep: NPO x 6 hrs
Cath Lab/Specials ORDER Nephrostomy (tube placement or replacement) Pacemaker Loop Recorder Pacemaker Gen Change NOTES Time: 1 ½ hr Prep: NPO x 6 hrs No blood thinners x 5 days **Urologist must call and clear with the Radiologist before procedure can be scheduled** **Schedule AM only** Time: 1 ½ Hrs Prep: NPO x 6 hrs. Time: 1 ½ Hrs Prep: NPO x 6 hrs NPO 4 hrs Pain Management: aka Nerve Root Block PICC Line: aka Central Line Placement Pleurodesis Port-a-Cath aka Port Placement Port Removal Replace Duodenostomy/JEJ: Feeding Tube Replace Time: 1 ½ hrs Prep: No blood thinners x 5 days **Schedule AM only** Time: 1 ½ hrs Prep: NPO x 6 hrs (if done w/sedation) Need creatinine and contrast allergy info. Time: 1 ½ hrs Prep: NPO x 8 hrs Time: 1 ½ hrs Prep: NPO 6 hrs Need H & P **Schedule AM only** Time: 1 hr Time: 1 hr
Cath Lab/Specials ORDER Vertebroplasty NOTES Time: 2 hrs Prep: No blood thinners x 5 days **Schedule AM only** Vertebroplasty Evaluation Time: 1 hr Prep: Prior MRI or CT + NM Bone Scan required
**An authorization maybe required for any Ultrasound procedures. Please call insurance to verify. Ultrasound Abdomen Complete 76700 No CT w/barium prior to exam Abdomen Limited (single organ, quadrant or follow-up example: liver, gall bladder or both) 76705 Abscess Drainage All **Request specific CPT** Time: 1 Hr No blood thinners x 5 days PT/INR prior to procedure Ankle/Arm Indices aka ABI s 93922 Aorta 76705 Arterial Lower Extremities Unilateral Bilateral (includes ABI s) Arterial Upper Extremities Unilateral Bilateral Biopsy All 93926 93925 93931 93930 **Request specific CPT** Time: 1 Hr Time: 1 Hr Time: 1 ½ Hr Prep: NPO 4 hours - (except thyroid; no blood thinners x 5 days; PT/INR prior to procedure Schedule M, T, TH, F AM only Bladder Residual Study 76857 Time: 1 Hr Prep: Drink 30 oz. water 1 hr prior
Ultrasound Carotid Doppler Bilateral 93880 Chest 76604 Cyst Aspiration All **Request specific CPT** Time: 1 ½ Hr Prep: No blood thinners x 5 days PT/INR prior to procedure **Schedule in AM** Duplex Abdomen Ltd (Liver Doppler includes veins and arteries) 93976 Time: 1 Hr Echocardiogram Complete 93306 Time: 1 Hr Notes: No patient s under 20 yo Echo with Bubble Study 93307 + 96374 Time: 1 Hr Echocardiogram Stress 93350 Time: 2 Hrs Prep: NPO 8 hours No Beta Blockers x 24 hrs Extremity Soft Tissue 76880 Fetal, Biophysical Profile 76818 Head & Neck Soft Tissue 76536 Hip Infant 76885 Time: 1 Hr Joint Injection/Aspiration All **Request specific CPT** Time: 1 Hr Prep: NPO 4 hours No blood thinners x 5 days
Ultrasound OB 1 st Trimester OB 2 nd Trimester NOT TWINS 76801 76805 Time: 1 Hr Prep: Full bladder OB 1 st /2 nd TWINS Trimester 76802 Time: 1 Hr Prep: Full bladder Paracentesis Pelvis Complete (includes transabdominal and transvaginal exam) 76830 + 76856 Time: 1 Hr Prep: No blood thinners x 5 days PT/INR prior to procedure Prep: Full bladder Renal Artery Renal Arteries + Kidneys Retroperitoneal Limited (includes kidneys and bladder) 93976 Time: 1 Hr 76775 Spinal Canal and Contents 76800 Time: 1 Hr Testicular 76870 Thoracentesis 32000 Time: 1 Hr Prep: No blood thinners x 5 days PT/INR prior to procedure Thyroid 76536 Time: 30 minutes Transesophageal Echocardiogram aka TEE 93312 Time: 1 Hr Prep: NPO 8 hours Venous Bilateral 93970 Time: 1 Hr Venous Unilateral 93971 Time: 30 minutes
Cardiopulmonary/RT EEG 95816 Time: 2 ½ hrs Schedule: M, T, W, F: 8:00 3:00 NOTE: No patients under age 13 Event Monitor 30 days CARD.30D Holter Monitors 24 hours CARD.24H PFT Basic RT.PFT PFT Pre/Post with Bronchodilators RT.P/PO1 Aka PFT Complete **includes DLCO** PFT Pre/Post with DLCO RT.P/PO2 Time: 30 minutes pt will need to return in 30 days to have the monitor removed. Schedule: M F: 7:00 5:00 Time: 15 minutes pt will need to return the following day at same time to return monitor Schedule: M F: 7:00 5:00 Time: 1 hour Prep: No breathing treatments or smoking 4 hours prior to exam Schedule: M, T, W, F: 8:00 4:00 Th: 8:00 11:00 Time: 1 hour Prep: No breathing treatments or smoking 4 hours prior to exam Schedule: M F: 8:00 4:00 Th: 8:00 11:00 Time: 1 hour Prep: No breathing treatments or smoking 4 hours prior to exam. Schedule: M F: 8:00 4:00 Th: 8:00 11:00
**An authorization maybe required on any of the Sleep Study procedures.. Please call insurance to verify. Sleep Studies Sleep Study Basic 95810 Time: Overnight DX: 780.57 unspecified sleep apnea 327.23 OSA Prep: Instruction packet will be mailed to patient prior to exam Sleep Study CPAP Titration 95811 Time: Overnight Prep: Instruction letter will be mailed to patient prior to study Sleep Study Split Night Basic Study + CPAP Titration VA patients schedule Split Night only Sleep Study MSLT Basic Sleep Study + MSLT 95811 Time: Overnight Prep: Instruction packet will be mailed to patient prior to exam 95805 Time: Varies Prep: Instruction letter will be mailed to patient prior to study Revised 8/17/12