WHY THIS GUIDE IS IMPORTANT TO YOU AND YOUR PATIENTS

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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.

WHY THIS GUIDE IS IMPORTANT

TO YOU AND YOUR PATIENTS

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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

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

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

NEED HELP OR HAVE QUESTIONS

ABOUT WHAT TO ORDER?

CLINICAL REVIEW Tel: (520) 545-1819 Fax: (520) 545-1844

SPECIALTY SCHEDULING

BREAST BIOPSY Tel: (520) 901-6792 Fax: (520) 545-1848 BREAST MRI Tel: (520) 901-6631 Fax: (520) 901-6746 INTERVENTIONAL COORDINATION Tel: (520) 545-1906 Fax: (520) 545-1898 PET / CT Tel: (520) 545-1906, opt. 3 Fax: (520) 545-1898

IMPORTANT CONTACT INFORMATION

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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 INTERVENTIONAL Minimally Invasive Diagnostic Procedures... 35

Pain Management... 37

Vascular Services... 39

Drainage Tube / Stent Placement... 40

ICD-9 CODES 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 CODES ICD-10 Codes Notes... 57

PREFERRED PROVIDER INFORMATION Major Insurance Plans... 59

Major Network Plans... 59

IMAGING CENTERS Locations... 60 TECHNOLOGY

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DIGIT

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PROCEDURE DESCRIPTION CPT CODE

• 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

4

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.

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DIGIT

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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.

• 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

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DIGIT

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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.

• 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

Our care is unsurpassed, with

physicians available 24 hours a day,

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DEX

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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 CODE

• 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

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BREAST IM

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8 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 ULTRASOUND 76641 - UNILATERAL COMPLETE 76642 - UNILATERAL LIMITED 76882 - AXILA ALONE STEROTACTIC LOCALIZATION GUIDANCE FOR BREAST BIOPSY

ULTRASOUND GUIDED NEEDLE CORE BREAST BIOPSY

BONE DENSITY SCAN

77080 - DEXA SCAN

77086 - DEXA WITH VERTEBRAL FRACTURE ASSESSMENT

BREAST MRI

77059 & 0159T - BILATERAL BREAST MRI

UTERINE FIBROID EMBOLIZATION (UFE)

For more information on exam codes

and pricing, please contact the Radiology Ltd.

Coding and Pricing Hotline at (520) 545-1818.

CPT CODES for WOMEN’S IMAGING

This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change.

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BREAST IM

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MAMMOGRAPHY ORDERING

DECISION TREE

Does the patient have a problem?

Palpable

lesion / focal pain Negative

Annual screening mammogram ≥30 years old Nipple discharge (reproducible, single duct, bloody or serous)

Extra views needed (call back) per radiologist recommendation:

Diagnostic order required

Diagnostic mammogram w/breast ultrasound, if clinically indicated SUSPICIOUS: Order breast biopsy PROBABLY BENIGN: Order 6 month follow-up diagnostic mammogram NEGATIVE: Return to annual screening mammogram Cyst aspiration (can be performed at time of exam w/ referring provider approval) Order diagnostic mammogram w/breast ultrasound Order diagnostic mammogram w/ breast ultrasound SUSPICIOUS: Order breast biopsy NEGATIVE: Surgical consultation to consider need for ductography YES DIAGNOSTIC MAMMOGRAPHY ± 3D Tomosynthesis NO

SCREENING MAMMOGRAPHY (beginning at age 40) ± 3D Tomosynthesis <30 years old breast ultrasound only

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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

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)

SPECIAL CIRCUMSTANCES • ≤ 3 years lumpectomy • Suspected leakage implant • Skin thickening or retraction • Six month follow-up

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:

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.

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BREAST IM

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BREAST IMAGING: Screening and

Diagnostic Mammography

PATIENT SYMPTOMS &

CODES PARAMETERS PERFORMORDER /

SUGGESTED TEXT FOR ORDER

• Asymptomatic Annual Screening (G0202)

• CAD for Screening (77052)

• Screening Breast 3D Tomosynthesis (77063)

• Annual after age 40 (12 months and 1 day since last screening exam)

• Screening

Mammogram • Screening Mammogram

(specify baseline or annual exam)

• Implants

(G0202)

• CAD for Screening

(77052)

• Annual after age 40 (12 months and 1 day since last screening exam)

• Screening Mammogram

• Screening Mammogram (specify patient has implants and is NOT symptomatic but needs extra time for exam)

• Mastectomy

Annual Screening (G0202-52)

• CAD for Screening (77052)

• Annual Screening of untreated breast (12 months and 1 day since last exam)

• Screening

Mammogram • Unilateral Screening Mammogram

• History of Breast Cancer

(G0204 / Bilateral) (G0206 / Unilateral)

• CAD for Diagnostic (77051)

• Unilateral Breast 3D Tomosynthesis (77061) • Bilateral Breast 3D Tomosynthesis (77062) • Lumpectomy • 6 months post surgery • Annual ≤ 3 years • Diagnostic Mammogram • Diagnostic Mammogram: Personal History of Breast Cancer— Lumpectomy • Clinical Findings— Symptoms (G0204 / Bilateral) (G0206 / Unilateral) • CAD (77051) • Mass • Diagnostic

Mammogram • Diagnostic Mammogram: With

Ultrasound (identify area of mass) • Pain—Localized • Diagnostic Mammogram • Diagnostic Mammogram: Pain (identify area of pain) With Ultrasound (localized pain)

• Under 30 Years of Age— Order Ultrasound (76641 / Unilateral, Complete) • Mass Discharge— Localized pain • Diagnostic Ultrasound • Diagnostic Breast Ultrasound With Mammogram (if

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BREAST IMAGING: Additional Imaging

and Procedures

PATIENT SYMPTOMS PARAMETERS _PERFORMORDER / SUGGESTED TEXT FOR ORDER

• Short Term Follow-Up Exam

• Recommendation of Additional Imaging (Callback or Recall Exam)

• Recommendation of Previous Exam (3-6 months) • Diagnostic Mammogram • Diagnostic Mammogram: Short-Term Follow-Up • Post Biopsy Exam

(1-11 months after previous mammogram) • Diagnostic Mammogram • Diagnostic Mammogram: Post Biopsy • Mammography • Mammogram Additional Exam • 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)

• Nipple Discharge • Unilateral • Reproducible • Single Duct Discharge (patient must be able to express discharge at time of ductogram) • Diagnostic Mammogram First • Diagnostic Mammogram: Discharge (identify breast and describe discharge) • Left / Right Ductogram • Ductogram for Nipple Discharge

• Indeterminate Lesion • Found on Ultrasound • Ultrasound Visualizing Solid Lesion • Ultrasound Guided Core Biopsy • Left / Right Indeterminate Lesion / Mass 12

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BREAST IM

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BREAST IMAGING: Breast MRI

PATIENT SYMPTOMS PARAMETERS _PERFORMORDER / SUGGESTED TEXT FOR ORDER

• Cystic Mass / Lesion Found on Previous Breast Ultrasound

• Previous

Ultrasound Report Indicating Need for Aspiration

• Left / Right Cystic Aspiration

• High Risk Patient • See high risk patient parameters on page 10

• Bilateral Breast MRI

• Pre-Operative Staging • Recent Diagnosis of Breast Cancer

• Bilateral Breast MRI (and Chest MRI, if necessary)

• Silicone Implants and Palpable Lump, Pain or Abnormal Mammogram

• Suspected Silicone Implant Leak

• Bilateral Breast MRI “Implant Protocol” • Indeterminate Clinical or Imaging Results • Further Evaluation of Indeterminate Clinical or Imaging Results (“radiologist recommendation”) • Bilateral Breast MRI

• Follow-Up for Chemotherapy Treatment • Follow-Up for Neo-Adjuvant Chemotherapy • 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.

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PE

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PET / CT: Bone Scan

BODY PART REQUESTED TEXT CODE

• Skull Base to Mid-Thigh

• PET / CT Skull Base to Mid-Thigh (all other diagnoses) 78815

• Whole Body • PET / CT Whole Body (Diagnosis: Melanoma, Myeloma, Sarcoma, & Merkel Cell Carcinoma, Cutaneous Lymphoma)

78816

• Brain • PET / CT Brain 78608

• Myocardium • PET / CT Myocardium

(Cannot be done if patient is diabetic)

78459

BODY PART REQUESTED TEXT CODE

• Breast • Lung • Prostate • Thyroid

• 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: General

Our PET services are centrally located at our

Camp Lowell site. To schedule a PET exam,

please call (520) 545-1906, opt. 3.

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UL

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ULTRASOUND: General

BODY PART REASON FOR EXAM PROCEDURE CODE

• Abdomen • Abdominal Pain Above Umbilicus • Abnormal LFT’s • Cirrhosis • Hepatitis C • Hepatomegaly • Polycystic Disease • Splenomegaly • Abdominal Ultrasound 76700 • Pelvic Area (Non-OB) • 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)

• Pelvic Ultrasound 76856 Trans Abdominal 76830 Trans Vaginal • Aorta (Seen to Iliacs) • AAA

• Abd Bruit / Pulsatile Mass • Aortic Dissection

• Abdominal Aorta Ultrasound

76775

• 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, hyper-tension, cerebrovascular disease

• Abdominal Aorta Ultrasound

–Medicare screening

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UL

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ULTRASOUND: General

Locally owned and operated, Radiology Ltd. offers

seven imaging centers to patients across southern Arizona.

• Kidneys • Flank / Back Pain • Hematuria

• Incomplete Bladder Emptying • Neurogenic Bladder

• Polycystic Kidneys • Renal Cyst / Mass • Renal Disease (CKD) • UTI

• Renal Ultrasound 76770

• Bladder • Bladder Mass / Stone • Check Post Void Residual • Hematuria • Bladder Ultrasound 76857 • Thyroid or Soft Tissue Neck

• Enlarged Lymph Node • Enlarged Thyroid / Fullness • Goiter

• Hypo- / Hyper-Thyroid • Nodules

• Palpable Mass on Neck • Thyroiditis • Thyroid Ultrasound 76536 • Testicles • Epididymitis • Hydrocele • Orchalgia • Pain / Swelling • Torsion • Varicocele • Testicular Ultrasound 76870 16

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UL

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ULTRASOUND: Vascular

• Carotid • Amaurosis Fugax • Arterial Vascular Disease • Ataxia • HTN • Hyperlipidemia • Stenosis • Stroke • TIA • Carotid Duplex / Doppler 93880 • Venous • Upper and Lower Extremity • DVT • Redness • Reflux

• Upper and Lower Extremity Swelling / Pain • Valvular Incompetency

• Venous Duplex /

Doppler 93971 Unilat 93970 Bilat

• Abdominal • Portal HTN

• Portal Venous Thrombosis • Liver Transplant

• TIPS

• Abdominal

Duplex / Doppler 93975

• Renal Artery • Abd Bruit

• Renal Artery Stenosis • Uncontrolled HTN

• Renal Artery

Duplex / Doppler 93975Dup 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.

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ULTRASOUND: MSK/Extremity

• Neck / Head • Lymphadenopathy

• Palpable Abnormality • Soft Tissue Ultrasound Neck / Head 76536

• Hands / Wrists • Foreign Body • Ganglion Cyst • Pain / Swelling • Palpable Abnormality • Radial / Ulnar Nerve

• Rheumatoid Arthritis / Arthritis

• Soft Tissue Hands / Wrists Ultrasound

76881

• Foot • Foreign Body • Ganglion Cyst • Morton’s Neuroma • Pain

• Palpable Abnormality • Plantar Fasciitis • Plantar Plate Tear

• Soft Tissue Foot Ultrasound 76881

• Ankle • Achilles Tendon • Ganglion Cysts • Foreign Body • Pain / Swelling • Palpable Abnormality • Tendonitis (Anterior Tibialis,

Posterior Tibialis, Peroneals)

• Soft Tissue Ankle Ultrasound

76881

• Knee • Baker’s Cyst • Pain / Swelling • Palpable Abnormality • Patellar Tendon • Quadriceps Tendon

• Soft Tissue Knee Ultrasound 76881

• Elbow • Biceps Rupture • Bursitis • Pain / Swelling • Palpable Abnormality • Ulnar Nerve

• Soft Tissue Elbow Ultrasound

76881

• Groin • Inguinal Hernia • Lymphadenopathy • Palpable Abnormality

• Soft Tissue Groin Ultrasound 76881

• Unlisted • Palpable Abnormality on the Back or Torso • Chest Wall • Upper Back • Lower Back 76604 76604 76705 18

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CT / C

TA

CPT CODES for CT SCANS

ORBIT / FACE

70480 - W/O CONTRAST 70481 - W/ CONTRAST 70482 - W/O & W/ CONTRAST

MAXILLOFACIAL

SOFT TISSUE NECK

70491 - W/ CONTRAST

UPPER EXTREMITY

LOWER EXTREMITY

BRAIN

70450 - W/O CONTRAST 70460 - W/ CONTRAST 70470 - W/O & W/CONTRAST

CERVICAL SPINE

CHEST

THORACIC SPINE

ABDOMEN PELVIS COMBINATION

LUMBAR SPINE

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CT / C

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CERVICAL SPINE 72125 - W/O CONTRAST 72126 - W/ CONTRAST 72127 - W/O & W/ CONTRAST

• Chest • Lung Nodules (1st_exam) • CT Chest Without and With

Contrast

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

• CT Chest With Contrast 71260

• Chest, High Resolution • Asbestosis • Bronchiectasis • Fibrosis

• Interstitial Lung Disease • Pleural Plaques • Sarcoidosis

• CT Chest Without Contrast, High-Resolution 71250 • CTA Chest (PE Study) • Pulmonary Embolism • Shortness of Breath • Vascular Evaluation • CTA Chest 71275 • CTA Chest & Abdomen • Aortic Dissection

• Thoracic Aortic Aneurysm • CTA Chest and Abdomen 71275 74175

• Neck • Cancer Workups • Dysphagia • Infection

• Infection of Parotid Gland • Infection of Submandibular Gland • Lymphadenopathy • Mass • Parotid Mass • Parotid Stone • Submandibular Stone

• CT Neck With Contrast 70491

CT / CTA: General

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CT / C

TA

• Pelvis (Soft Tissue) • Cancer Staging • Cysts • Hernia • Infection • Mass • Pain

• CT Pelvis With Contrast 72193

• Pelvis (Bone)

• Fracture, Non-Arthritis Union • CT Pelvis Without Contrast 72192 • Bone Infection

• Cancer / Mass / Mets / Tumor • CT Pelvis With Contrast 72193

• Abdomen / Pelvis

• Stone (Stone protocol) • CT Abdomen and Pelvis Without Contrast (Stone protocol)

74176

• Abdominal Pain • Abscess

• Hernia (ie, ventral, umbilical, inguinal)

• Mass

Area of Concern: Above Iliac Crest (hip bone)

• CT Abdomen With Contrast

Below Iliac Crest (hip bone)

• CT Pelvis With Contrast

Location unknown or both areas apply

• CT Abdomen and Pelvis With Contrast

74160 72193 74177

• Any Cancer Staging • Appendicitis

• Crohns / Ulcerative Colitis • Diarrhea

• Diverticulitis • IBD

• CT Abdomen and Pelvis With Contrast

74177

• Adrenal • Adrenal Mass • CT Abdomen With and

Without Contrast

74170

• Liver • Hepatoma, Hepatitis, Cirrhosis • Liver Hemangioma

(MR preferred)

• CT Abdomen With and Without Contrast (Liver protocol)

74170

CT / CTA: General

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CT / C

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• 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)

74170

• CT Urogram / CT IVP

• Transitional Cell Carcinoma of Kidney and/or Bladder • Hematuria • CT IVP or CT Urogram 74178 • CTA Abdomen & Run Off

• Claudication

• Peripheral Artery Disease (PAD) • CTA Abdomen and Run Off 75635

• Abdominal Aorta • Mesenteric Vessels • Renal Arteries • Stent • Mesenteric Ischemia

• Renal Artery Stenosis • CTA Abdomen 74175 • AAA

• Crossing Vessels

• Stent Obstruction / Leak / Malfunction

• CTA Abdomen and Pelvis 74174

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.

CT / CTA: General

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CT / C

TA

• Head / Brain

• Alzheimer’s • CVA

• Headache Less Than 7 Days • Hydrocephalus

• Memory Loss, Confusion • Shunt Check

• Stroke / Bleed • Trauma

• CT Head / Brain Without Contrast

70450

• Headache More Than 7 Days • HIV • Infection • Mass / Tumor • Meningioma • Meningitis • Metastatic Staging • Seizures • Toxoplasmosis • Vertigo / Dizziness / Mastoiditis

• CT Head / Brain With Contrast 70460

• CTA Brain • Aneurysm

• AVM (Arterio / Venous Malformation) • Bruit • CVA • Stroke • TIA • Vascular Tumor

• CTA Head / Brain (Reconstruction)

and/or

(If both ordered, please authorize both codes)

70496 • CTA Neck, Carotid Artery • Bruit • Carotid Stenosis • CVA • TIA

• AVM (Arterio / Vascular Malformation) • Vascular Tumor • Stroke

• CTA Neck 70498

• Vertebrobasilar Insufficiency • CTA Head, Neck

CT / CTA: Head and Spine

(25)

CT / C

TA

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For more information on exam codes

and pricing, please contact the Radiology Ltd.

Coding and Pricing Hotline at (520) 545-1818.

• Orbit • Foreign Body • Fracture • Trauma

• CT Orbit Without Contrast 70480

• Cellulitis • Exophthalmos • Graves Disease • Mass • Pain • Pseudo Tumor

• CT Orbit With Contrast 70481

• Sinus / Face • Functional Endoscopic Sinus Surgery

• Ostiomeatal Complex • Sinusitis

• CT Sinus Without Contrast 70486

• Spine: Cervical

• MR Recommended for Disc Herniation, Mets, Infection • Trauma, Fracture, Fusion

• CT Cervical Spine Without Contrast

72125

• Spine: Thoracic

• Assess Bony Degenerative Changes

• MR Recommended for Disc Herniation, Mets, Infection

• CT Thoracic Spine Without Contrast

72128

• Spine: Lumbar / Sacral

• MR Recommended for Disc Herniation, Mets, Infection • Trauma, Fracture, Fusion,

Pars Defect

• CT Lumbar Spine Without Contrast

72131

• Temporal Bone / IAC’s

• Cholesteotoma

• Trauma • CT Inner Ears, Temporal Bones Without Contrast

70480

• Pituitary • MRI Unless Contraindicated • CT Brain Without and With Contrast

70470

CT / CTA: Head and Spine

(26)

CT / C

TA

• Upper Extremity –Arm –Finger –Forearm –Hand –Wrist –Humerus

• All Bone Exams Ordered Without Contrast Except for Tumor Evaluations

• CT Without Contrast Upper Extremity (mention part)

73200 • Lower Extremity –Ankle –Calf –Foot –Hip –Knee –Thigh

• All Bone Exams Ordered Without Contrast Except for Tumor Evaluations

• CT Without Contrast Lower Extremity (mention part)

73700

• Extremities • Tumor / Mass / Cancer / Mets • CT With Contrast—Upper

• CT With Contrast—Lower 7320173701 • Ischemia (Lower Extremity) • Arterial Stenosis (Lower Extremity)

• Peripheral Artery Disease • CTA Lower Extremity

73706

CT / CTA: Musculoskeletal

(27)

CT / C

TA

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BODY

PART REASON FOR EXAM PROCEDURE CODE

• Colon • Failed Colonoscopy • Patients Taking Blood

Thinners Who Are Not Candidates for Routine Colonoscopy

• Screening

• CT Colonography With 3D Rendering (Virtual Colonoscopy)

NOTE: Cleansing prep to be given at facility 74263 Screening 74261 Diagnostic • Renal Artery (or Mesenteric Artery) • Hypertension

• Renal Artery Stenosis • CTA Abdomen For Renal Arteries

74175

• Small Intestine (Bowel)

• Crohn’s Disease

• Small Bowel Related Issues –Abscess –Bleeding Sources –Bowel Obstruction –Fistula –Inflammation –Tumor • CT Enterography 74177 • Urinary Bladder • Bladder Cancer • Bladder Polyps • Bleeding • Hydronephrosis • Vesicoureteral Reflux • CT Cystogram

(Please authorize BOTH codes)

72192 51600

• CT Heart • Screening, Hyperlipidemia • CT Calcium Score Without Contrast

75571

• 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

CT / CTA: Specialty

(28)

MRI / MR

A

CPT CODES for MRI SCANS

ORBIT, FACE & NECK

TMJ

70336

SHOULDER, ELBOW OR WRIST (UPPER EXTREMITY, JOINT)

HUMERUS, FOREARM OR NON-JOINT (UPPER EXTREMITY, JOINT)

HIP, KNEE OR ANKLE (LOWER EXTREMITY, JOINT)

THIGH, LOWER LEG OR FOOT (LOWER EXTREMITY, NON-JOINT)

BRAIN

CERVICAL SPINE

CHEST (CLAVICLE)

BREAST

77059 - W/O & W/ CONTRAST

THORACIC SPINE

ABDOMEN

LUMBAR SPINE

PELVIS

(29)

MRI / MR

A

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• Heart • Congenital Defect & Heart Valve Issues

• Past MI - Other Cardiac Issues

• MRI Heart 75557 & 75561

• TMJ • Internal Derangement

• Joint Dysfunction

• MRI TMJ 70336

• Urogram • Hematuria - Congenital Abnormalities

• Urinary Tract Obstruction

• MRI Urogram 74183 & 72197

• Ear

Brain (IAC) • Hearing Loss • MRI Brain 70553

• Enterography • Crohn’s Disease

• Inflammatory Bowel Disease

• MRI Enterography 74183 72197

MRI / MRA: General

• Breast (Pre-Operative Staging)

• Recent Diagnosis of Breast Cancer

• Bilateral Breast MRI (and Chest MRI, if necessary)

77059 (71552)

• Breast (Silicone Implants)

• Suspected Silicone Implant Leak

• Palpable Lump

• Pain

• Bilateral Breast MRI in Addition to “Implant Protocol” 77059 • Breast (Indeterminate Clinical or Imaging Results) • Further Evaluation of Indeterminate Clinical or Imaging Results (Radiologist recommendation)

• Bilateral Breast MRI 77059

• Follow-Up for Chemotherapy Treatment

• Follow-Up for Neo-Adjuvant Chemotherapy

• Bilateral Breast MRI 77059

Please note: Breast MRI does not replace screening mammography.

MRI: Breast

(30)

MRI / MR

A

• Abdomen • Adrenal

• MRCP (Biliary / Pancreatic Ducts) • MRI Abdomen Without Contrast (MRCP)

74181 • Liver Eval

• Pancreas Eval • All Other Reasons

• MRI Abdomen Without and With Contrast

74183

• Brachial Plexus

• Brachial Plexus Injury • Nerve Avulsion

• Tumor / Mass / Cancer / Mets

• MRI Chest / Mediastinum Without and With Contrast (Specify Brachial Plexus)

71552

• Chest Mediastinum

• Tumor / Mass / Cancer / Mets • MRI Chest Without and With Contrast 71552 • Neck (Soft Tissue) • Infection • Pain

• Tumor / Mass / Cancer / Mets • Vocal Cord Paralysis

• MRI Neck Without and With Contrast

70543

• Pelvis • Adenomyosis

• Fracture

• Muscle / Tendon Tear

• MRI Pelvis Without Contrast

72195

• Pelvic Organ Prolapse • Pelvic Floor Dysfunction • Outlet Obstruction • Incontinence

• MRI Dynamic Pelvis 72195

• Abscess • Fibroid • Osteomyelitis

• Pre / Post Fibroid Embolization • Septic Arthritis

• Tumor / Mass / Cancer / Mets • Urethral Diverticulum

• MRI Pelvis Without and With Contrast

72197

• Prostate • Benign Prostatic Hyperplasia (BPH)

• Enlarged Prostate

• Evaluation of Prostate Cancer • Infection (Prostatitis) • Prostate Abscess

• MRI Prostate 72197

MRI / MRA: General

(31)

MRI / MR

A

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• Abdomen • AAA (Abdominal Aortic Aneurysm)

• Abdominal Aorta Dissection • Mesenteric Ischemia • Renal Artery Stenosis

• MRA Abdomen 74185

• Pre Liver Transplant • Pre Kidney Transplant • Renal Mass-Evaluation /

Pre-Op

• Order 2 Exams: –MRA Abdomen AND

–MRI Abdomen Without and With Contrast

74185

74183

• Chest • Subclavian Vessels

• Thoracic Aorta (other than dissection) • Vascular Anomalies

• MRA Chest 71555

• Aortic Dissection • Order 2 Exams: –MRA Chest AND

–MRA Abdomen

71555 74185

• Pelvis • AVM

• May Thurner • MRA Pelvis 72198

• MRA Abd/Pel

w/Run Off • Peripheral Vascular Insufficiency • MRA Abdomen, Pelvis and Lower Extremities 74185, 72198, 73725 (x2) • Peripheral

Run-Off

• 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 73725 73725 72198

MRI / MRA: General

(32)

MRI / MR

A

• Pituitary Protocol

• Elevated Prolactin • MRI Brain

Att: Pituitary 70553

• Spine: Cervical

• Arm / Shoulder Pain and/or Weakness

• Chiari Malformation • Degenerative Disease • Disc Herniation • Neck Pain

• Post-Op Fusion Radiculopathy

• MRI Cervical Spine Without Contrast 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

• MRI Thoracic Spine Without and With Contrast

72157

MRI / MRA: Head and Spine

(33)

MRI / MR

A

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• Spine: Lumbar • 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)

• MRI Lumbar Spine Without Contrast 72148 72195 • Compression Fx (hx malig / mets) • Discitis • Osteomyelitis • Post-Op

• Tumor / Mass / Cancer / Mets • Vertebroplasty (with hx malig)

• MRI Lumbar Spine Without and With Contrast

72158

• Brain • Alzheimer’s, Confusion, Dementia, Hydrocephalis, Memory Loss, Mental Status Changes

• MRI Brain Without Contrast

70551

• Headache • Pseudotumor • Seizures

• Tumor / Mass / Cancer / Mets • Vascular Lesions

• All other reasons

• MRI Brain Without and With Contrast

70553

• MRI Head

NeuroQuant • Dementia• Memory Loss • Seizures

• MRI Brain with NeuroQuant 70551, 76377

MRI / MRA: Head and Spine

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.

(34)

MRI / MR

A

• 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

• MRI—Non Joint Without and With Contrast

–Upper Extremity –Lower Extremity

73220 73720

• Brain / Orbits / Face

• 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)

70553 70543 • MRA –Arch & Great Vessels –Brain –Neck • Stroke / CVA • TIA • Vertebrobasilar Insufficiency

• MRA Brain Without Contrast

• MRA Neck With Contrast

70544 70548

• MRV –Brain

• Venous Thrombosis • MRV Without Contrast 70544

MRI / MRA: Head and Spine

MRI: Musculoskeletal

(including Arthrography)

(35)

MRI / MR

A

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• Shoulder • Elbow • Wrist • Finger • Hip • Knee • Ankle • Toe • Scapula (Not Included In Shoulder)

• 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

• MRI—Joint Without Contrast –Upper Extremity –Lower Extremity 73221 73721 • Abscess • Arthritis • Cellulitis • Fasciitis • Inflammatory Arthritis (pannus eval) • Myositis • Osteomyelitis • Septic Arthritis • Tumor / Mass / Cancer /

Mets • Ulcer

• MRI Lower Extremity—Joint Without and With contrast

–Upper Extremity –Lower Extremity 73223 73723 • Pain • Sprain / Strain • Tear

• MRI Chest Without and With Contrast 71552 • MRI Arthrography –Elbow –Wrist –Hip –Knee –Ankle –Shoulder • Labral Tear • Loose Bodies • OCD Stability • Post-Op Meniscus Evaluation

• 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 73722 73222 77002 23350 & 73040 24220 & 73085 25246 & 73115 27093 & 73525 27370 & 73580 27648 & 73615

MRI: Musculoskeletal

(including Arthrography)

(36)

INTER

VENTIONAL

M inimally I nv asiv e D iagnostic P ro cedur es ter ven tional S er vic e M odalit y CPT C ode(s) Per formed B y Ev alua tion Requir ed Labs Requir ed Seda tion Requir ed houlder , Elbo w , W rist , , and A nk le) Fluor oscop y o the ye is injec ted and e obtained . I n most cases e then obtained T. Fluor oscop y; then MRI or CT Upper Join ts Shoulder: 73222, 23350, 73040, 77002 Elbo w : 73222, 24220, 73085, 77002 W rist: 73222, 25246, 73115, 77002 Lo w er Join ts H ip: 73722, 27093, 73525, 77002, 27095 K nee: 73722, 27370, 73580, 77002 A nk le: 73722, 27648, 73615, 77002 Int er ventional , Body , or M usculosk eletal Radiolog ist No

Only if patient is tak

ing

Coumadin

No

Upper Join

ts

Replace code 73222 with 73201 Low

er Join

ts

Replace code 73722 with 73701

Thor acic , L umbar) y is used t o place a thin

o the spinal canal

. D ye is e obtained . I n e then T. Fluor oscop y; then C T T-Spine: 62303, 72129 L-Spine: 62304, 72132 Use 62305 f or 2 or 3 le vels Neur oradiolog ist No

ing Coumadin No tesis ( Join t F luid A spir ation, , S yno vial F luid A spir ation)

o a joint space and

ved f or diag nostic analysis elie ve pain and pr essur e on Fluor oscop y or CT Small Join t or Bursa (fingers , t oes): 20600, 77002 Intermedia te Join t or Bursa (TMJ , acr omiocla vicular , wr ist, elbo w , ank le ,

olecranon bursa): 20605, 77002 Major Join

t or Bursa (shoulder , hip , knee , subacr omial bursa): 20610, 77002 Int er ventional or Body Radiolog ist No No Local anesthetic Small Join t or Bursa (fingers , t oes): 20600, 77012 Intermedia te Join t or Bursa (TMJ , acr omiocla vicular , wr ist, elbo w , ank le ,

olecranon bursa): 20605, 77012 Major Join

t or Bursa (shoulder , hip , knee , subacr omial bursa): 20610, 77012

INTERVENTIONAL RADIOLOGY SERVICES

(37)

37 To schedule an interventional procedure, please call (520) 545-1906or fax(520) 545-1898.

INTER

VENTIONAL

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M inimally I nv asiv e D iagnostic P ro cedur es In ter ven tional S er vic e M odalit y CPT C ode(s) Per formed B y Ev alua tion Requir ed Labs Requir ed Seda tion Requir ed Par ac en tesis

A thin needle or tube is placed int

o the abdomen in or der t o r emo ve fluid f or diag nosis and/or r educe discomf or t. Ultrasound or CT 49083 Int er ventional _{or B}ody Radiolog ist No Ye s, call f or specifics No 49083 Thor ac en tesis

A thin needle or tube is placed int

o the chest in or der t o r emo ve fluid f or diag nosis and/or t o r educe discomf or t. Ultrasound or CT 32555 Int er ventional _{or B}ody Radiolog ist Ye s Ye s, call f or specifics Ye s 32555 Image -G uided P er cutaneous Biopsy

A needle is placed in a desir

ed

location using imag

ing guidance in

or

der t

o obtain a small piece of

tissue so that it can be examined by a patholog

ist. Cer tain biopsies ma y need t o be per for

med at the hospital due t

o their r isk of complications . C T, Ultrasound or Fluor oscop y Th yr oid: 60100, 77012 Lung/M ediastinum: 32405, 77012 Liv er: 47000, 77012 Renal: 50200, 77012 A bdominal/R etr operit oneal M ass: 49180, 77012 Int er ventional _{or B}ody Radiolog ist Ye s Ye s, call f or specifics Ye s Th yr oid: 60100, 76942 Lung/M ediastinum: 32405, 76942 Liv er: 47000, 76942 Renal: 50200, 76942 A bdominal/R etr operit oneal M ass: 49180, 76942 Thyr oid: 60100, 77002 Lung/M ediastinum: 32405, 77002 Liv er: 47000, 77002 Renal: 50200, 77002 A bdominal/R etr operit oneal M ass: 49180, 77002

INTERVENTIONAL RADIOLOGY SERVICES

(38)

INTER

VENTIONAL

INTERVENTIONAL RADIOLOGY SERVICES

Pain M anagemen t ter ven tional S er vic e M odalit y CPT C ode(s) Per formed B y Ev alua tion Requir ed Labs Requir ed Seda tion Requir ed tion (Epidur al , Ner ve R oot , acr oiliac)

Anesthetics and/ e injec

ted in

o r

educe back and/or leg

nostic and

, ner

ve

oiliac joint injec

tions . Fluor oscop y or CT Epidur al: L -Spine: 62311, 77003 Ner ve R oot/Block (per le vel/per side) L-Spine: 64483, 64484 Neur oradiolog ist Ye s

ing Coumadin No Epidur al: L -Spine: 77012, 62311 SI: 77012, 62311 Ner ve R oot/Block (per le vel/per side) L-Spine: 64483, 64484 tion (L umbar F ac et and St er

oid medication is injec

ted omatic joint t o decr ease elling . Fluor oscop y or CT Lumbar F ac et: 64493 (1st), 64494 (2nd), 64495 (3r d) Int er ventional , Body , or M usculosk eletal Radiolog ist Ye s

ing Coumadin No Sacr oiliac (SI): 64493 (1st), 64494 (2nd), 64495 (3r d) unc tur e (Spinal Tap , tur e, Thecal P unc tur e, tesis) Local anesthesia is o the lumbar r eg ion of the ted int o the . C er ebr ospinal fluid ( CSF) can ved f or t esting . Fluor oscop y 62270, 77003 Neur oradiolog ist Yes , ma y requir e a consult. M ust ha ve either MRI or C T.

ing Coumadin No

D

ue t

o the sensitiv

e na

tur

e of some in

ter

ven

tional pr

oc

edur

es

, the f

ollo

wing

ser

vic

es ar

e usually p

er

formed b

y R

adiolo

gy L

td

. staff in a hospital setting:

ng iog ram ng ioplast y tag ram rt er iog ram y T ube Change • Biliar y Dila tion w/o or w/S ten t • Biliar y Dr ain • Biopsy (R enal / L ung) • Ca thet er P lac emen t (R enal / P elvis) • Ca thet er S tr ipping • Cholang iog ram ( T-Tube) • Fistulog ram (dialy sis or other than dialy sis) • G astr ic Empt ying S tudy • IVC F ilt er P lac emen t • Loopog ram • Shun tog ram • Ste nt • Ur et er al C athet er or S ten t • Venog ram

(39)

39 To schedule an interventional procedure, please call (520) 545-1906or fax(520) 545-1898.

INTER

VENTIONAL

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INTERVENTIONAL RADIOLOGY SERVICES

Pain M anagemen t In ter ven tional S er vic e M odalit y CPT C ode(s) Per formed B y Ev alua tion Requir ed Labs Requir ed Seda tion Requir ed Ver tebr oplast y ( Thor acic , L umbar) Fluor oscop y or C T guidance is used t o

place a needle int

o a frac

tur

ed v

er

tebra.

Bone cement is then injec

ted t o stabiliz e the frac tur e. Fluor oscop y or CT T-Spine: 22510, each add ’l le vel use 22512

(if biopsy is per

formed on separ at e v er tebr ae , use 20225) L-Spine: 22511, each add ’l le vel use 22512

(if biopsy is per

formed on separ at e v er tebr ae , use 20225) Int er ventional Radiolog ist or Neur oradiolog ist Yes , ma y requir e a consult. _Must ha ve either MRI _{or C}T+ B one Scan pr ior t o evaluation. Ye s, call f or specifics Ye s Kyphoplast y ( Thor acic , L umbar) Fluor oscop y or C T guidance is used t o

place a needle int

o a frac

tur

ed v

er

tebra.

Bone cement is then injec

ted t o stabiliz e the frac tur e. T-Spine: 22513, each add ’l le vel use 22515

(if biopsy is per

formed on separ at e v er tebr ae , use 20225) L-Spine: 22514, each add ’l le vel use 22515

(if biopsy is per

formed on separ at e v er tebr ae , use 20225) Sacr oplast y C T is used t o guide t w o needles int o a frac tur ed sacrum. A mix tur

e of bone cement and contrast is

then injec ted int o the sacrum thr ough the needles t o stabiliz e the frac tur e. CT Unila ter al: 0200T , 72292 Bila ter al: 0201T , 72292 Int er ventional Radiolog ist or Neur oradiolog ist Yes , ma y requir e a consult. _Must ha ve either MRI _{or C}T+ B one Scan pr ior t o evaluation. Ye s, call f or specifics Ye s Epidur al Blood P at ch Epidural Blood P at ch (EBP) is used t o tr

eat spinal headaches that ar

e most commonly encount er ed af ter dural punc tur e.

The blood pat

ch ac

ts as

a gelatinous glue which pr

ev ents cer ebr ospinal fluid ( CSF) leak age and allo

ws the dural hole t

o heal . Fluor oscop y 62273, 77003 Neur oradiolog ist Sometimes

ing

Coumadin

No

(40)

INTER

VENTIONAL

Vascular S er vic es ter ven tional S er vic e M odalit y CPT C ode(s) Per formed B y Ev alua tion Requir ed Labs Requir ed Seda tion Requir ed ein, and e tak en while dy e is der t o det ec t ein. Fluor oscop y Unila ter al: 75820, 36005 Bila ter al: 75822, 36005 (x2) (F oot and lo w er leg Venog rams ar e per for med on sit e. All other v enog rams ar e per for

med in a hospital setting

.) Int er ventional Radiolog ist Ye s

ing Coumadin Ye s lac emen t y and ultrasound ar e er thr ough a

m and then int

o the The cathet er is used f or y and eliminat es y f or multiple needle . Fluor oscop y & Ultrasound 36569, 77001, 76937 Int er ventional Radiolog ist Ye s