CT and MRI Ordering Guide
|BODY PART||SIGNS / SYMPTOMS||EXAM TO ORDER (CPT)|
|BRAIN||Trauma, CVA, Bleeding, Headache, Shunt Check, Alzheimer's, Memory Loss, TIA, Mental Status Change, Confusion||CT Head W/O Dye (70450) OR MRI Brain W/O Dye (70551) -MRI for more severe symptoms or persistent symptoms after a CT Head W/O Dye was performed-|
|BRAIN||Hearing Loss, Tumor, Elevated Prolactin Levels, Cranial Nerve Lesions, Dizziness, Vertigo, Multiple Sclerosis, AVM, Pituitary Lesions, Seizures, Infection||MRI Brain W/O & W Dye (70553)|
|BRAIN||Stroke, CVA, TIA, Aneurysm||MRI Brain W/O Dye (70551)|
|SINUSES||Pain, Congestion, Sinusitis||CT Sinuses W/O Dye (70486)|
|ORBITS||Trauma, Fracture, Foreign Body||CT Orbits W/O Dye (70480)|
|ORBITS||Infection, Mass||CT Orbits W Dye (70481)|
|ORBITS||Grave's Disease, Exophthalmos, Proptosis, Pseudotumor, Vascular Lesions, Mass||MRI Orbits W/O & W Dye (70543)|
|FACIAL BONES||Trauma, Pain||CT Maxillofacial W/O Dye (70486)|
|TEMPORAL BONES||Tinnitus, Cholesteatoma, Pain, Trauma||CT Temporal Bones W/O Dye (70480)|
|NECK||Mass, Adenopathy||CT Soft Tissue Neck W Dye (70491)|
|NECK||Infection, Pain, Vocal Cord Paralysis||MRI Soft Tissue Neck W/O & W Dye (70543) OR CT Soft Tissue Neck W Dye (70491)|
|CHEST||Hilar or Mediastinal Mass, Lung Cancer, Lymphoma, Sarcoid, Staging, Mesothelioma Metastatic Work-up||CT Chest W Dye (71260)|
|CHEST||Nodule, Cough, Pain||CT Chest W/O Dye (71250)|
|CHEST||Interstitial Lung Disease, IPF, UIP, Sarcoid||High Resolution CT Chest W/O Dye (71250)|
|CHEST||Neural Tumor, Brachial Plexus Pathology||MRI Chest W/O Dye (71550)|
|ABDOMEN & PELVIS||Pain, Colitis, IBD, Crohns, Appendicitis, Abscess, Tumor, Cancer||CT Abdomen/Pelvis W Oral & IV Dye (74177)|
|ABDOMEN & PELVIS||Hematuria With Pain, Stone Survey||CT Abdomen/Pelvis W/O Dye (74176)|
|ABDOMEN & PELVIS||Hemangioma, Hepatoma, Hepatitis, Cirrhosis, Pancreatitis, Pseudocyst||CT Abdomen W/O & W Dye (74170)|
|ABDOMEN & PELVIS||Biliary Obstruction, GB Stones, Jaundice, Abnormal Enzymes, Adrenal Mass||MRI Abdomen W/O Dye MRCP (74181)|
|ABDOMEN & PELVIS||IBD, Occult GI Bleeding, Diffuse SBD, (Gluten Enteropathy)||CT Abdomen/Pelvis W Dye Enterography (74177)|
|ABDOMEN & PELVIS||Fibroid, Ovarian Mass, Endometrioma||MRI Pelvis W/O & W Dye (72197) OR CT Abdomen/Pelvis W Dye (74177)|
|ABDOMEN & PELVIS||Incomplete Colonoscopy or Screening||CT Colonography (74261,74262,74263) OR Barium Enema (74280,74270)|
|CERVICAL, THORACIC & LUMBAR SPINE||Pain, Trauma, Fracture, Fusion||CT Cervical Spine W/O Dye (72125), CT Thoracic Spine W/O Dye (72128), CT Lumbar Spine W/O Dye (72131)|
|CERVICAL, THORACIC & LUMBAR SPINE||Radiculopathy, Disc Herniation, Degenerative Disease||MRI Cervical Spine W/O Dye (72141), MRI Thoracic Spine W/O Dye (72146), MRI Lumbar Spine W/O Dye (72148)|
|CERVICAL, THORACIC & LUMBAR SPINE||Syrinx, MS, Tumor, Cancer, Mets, Osteomyelitis, Myelopathy, Discitis, Compression Fracture w/Hx of Malignancy, Epidural Abscess||MRI Cervical Spine W/O & W Dye (72156), MRI Thoracic Spine W/O & W Dye (72157), MRI Lumbar Spine W/O & W Dye (72158)|
|UPPER & LOWER EXTREMITIES - NON JOINTS||Fracture, Fusion, Malunion||CT Upper Extremity W/O Dye (73200), CT Lower Extremity W/O Dye (73700)|
|UPPER & LOWER EXTREMITIES - NON JOINTS||Pain, Muscle/Tendon Tear||MRI Upper Extremity W/O Dye (73218), MRI Lower Extremity W/O Dye (73718)|
|UPPER & LOWER EXTREMITIES - NON JOINTS||Abscess, Cellulitis, Fasciitis, Osteomyelitis, Neuroma, Soft Tissue Tumor||MRI Upper Extremity W/O & W Dye (73220), MRI Lower Extremity W/O & W Dye (73720)|
|UPPER & LOWER EXTREMITIES - JOINTS||AVN, Internal Derangement, Labral, Meniscal Ligament & Cartilage Tears, OCD||MRI Upper Extremity Joint W/O Dye (73221), MRI Lower Extremity Joint W/O Dye (73721) -Studies can be done with intra-articular dye if indeterminate-|
|UPPER & LOWER EXTREMITIES - JOINTS||Abscess, Cellulitis, Fasciitis, Osteomyelitis, Myositis, Tumor, Mass||MRI Upper Extremity Joint W/O & W Dye (73223), MRI Lower Extremity Joint W/O & W Dye (73723)|
|PELVIS (BONY)||Pain, Fracture||CT Pelvis W/O Dye (72192)|
|PELVIS (BONY)||Muscle/Tendon Tear, AVN||MRI Pelvis W/O Dye (72195)|
|PELVIS (BONY)||Tumor, Mass, Osteomyelitis, Septic Arthritis||MRI Pelvis W/O & W Dye (72197)|
|ABDOMINAL AORTA||Aneurysm, Dissection, Post Stent Grafting, Renal Artery Stenosis, Mesenteric Stenosis||CTA Abdomen W IV Dye (74175)|
|PULMONARY ARTERIES||Aneurysm, Dissection, Chest Pain, Dyspnea, PE||CTA Chest W IV Dye (71275)|
|THORACIC AORTA||Tachypnea, Hemoptysis, SOB, Pulmonary Hypertension, Pulmonary Venous Mapping||CTA Chest W IV Dye (71275)|
|THORACIC AORTA||Aneurysm, Dissection, Post Stent Grafting, Stenosis||CTA Chest W Dye (71275)|
|THORACIC AORTA||Screening Cardiac Calcium Scoring||CT Heart W/O Dye Coronary Calcium Score (75571)|
|LOWER EXTREMITIES||Peripheral Artery Disease||CTA Abdominal Aorta and Lower Extremity Runoff W Dye (75635)|
|CAROTID||Stenosis, Bruit, TIA, CVA, Vascular Tumor||CTA Neck W Dye (70498)|
|BRAIN||Aneurysm, Stenosis, Obstruction||CTA Head W Dye (70496)|
|BRAIN||Aneurysm, Stenosis, Obstruction||MRA Head W/O Dye (70544)|
Additional Ordering Notes
1. To schedule an exam call: (928) 537-6554.
2. CT Abdomen will only include from the top of the diaphragm to the top of the iliac crest. If the patient is experiencing any diffuse or lower quadrant pain, if appendicitis is suspected or if you have concerns about the colon, small bowel, urinary tract or any pelvic organs then you must order a CT Pelvis as well.
3. Patients over 59 years of age, patients with renal disease and diabetics need to have a DOCUMENTED normal BUN and creatinine within the last 3 months.
4. Premedication is required for some patients receiving intravenous contrast, including patients with a known contrast allergy, patients with a history of severe allergic reaction and patients with asthma who use inhalers daily.
5. Pacemakers, ocular metallic foreign bodies, mechanical ear implants, non-removable TENS units, any wire loop devices are all examples of devices that are incompatible with MRI.
6. This form is only a guide to ordering CT & MRI exams. If you have any questions regarding which exam may be appropriate for your needs, please call the Radiologist. You may call the Radiology Department at the hospital (928) 537-6338, or a Radiologist may be reached at (928) 537-6569 from 7 A.M. - 9 P.M.
7. Comparison studies and x-rays are very helpful, please make sure outside exams are made available prior to exam.