ordering guide - radltd.com · 01 why this guide is important to you and your patients this...

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ORDERING GUIDE

01

WHY THIS GUIDE IS IMPORTANTTO 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.

Our goal is 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.

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. 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 [email protected].

Thank you,The Physicians and Staff of Radiology Ltd.

02

IMPORTANT CONTACT INFORMATION

For Supplies: Tel: (520) 733-4104 Email: [email protected]

RADVISION Tel: (520) 901-6747 Fax: (520) 901-6634 Toll Free Tel: (866) 386-9459 Website: radltd.com/for-providersAfter Hours Tech Support: Tel: (520) 545-1720

TAX ID AND NPI INFORMATIONRadiology Ltd. Tax ID86-0423896

Radiology Ltd. - Carondelet Tax ID26-2750704 (for CT, Ultrasound and X-ray only; for MRI use Radiology Ltd. Tax ID listed above)

Radiology Ltd. Group NPI#1841261989

Radiology Ltd. - Carondelet NPI#1528224904

OTHER IMPORTANT NUMBERSAUTHORIZATION VERIFICATION Tel: (520) 901-6767 Fax: (520) 545-1981

CODING & PRICING HOTLINE Tel: (520) 545-1818Online 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) 326-7989Online Requests: radltd.com/medical-record-request

PATIENT BILLING Tel: (520) 296-0278Secure Online Bill Pay: radltd.com/online-bill-pay

PROFESSIONAL RELATIONS Tel: (520) 901-6614 Fax: (520) 545-1726 Email: [email protected]

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 SCHEDULINGBREAST 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

03

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

ULTRASOUND

General....................................................................... 14

Vascular...................................................................... 17

MSK/Extremity.......................................................... 18

PET / CT

General....................................................................... 19

Bone Scan................................................................. 19

CT / CTA

CPT Codes for CT Scans........................................ 20

Lung Screening Ordering..................................... 21

General....................................................................... 22

Head & Spine............................................................ 25

Musculoskeletal...................................................... 27

Specialty.................................................................... 28

MRI / MRA

CPT Codes for MRI Scans...................................... 30

Brain............................................................................ 31

Spine........................................................................... 32

Breast.......................................................................... 33

Chest, Abdomen, and Pelvis............................... 34

Musculoskeletal...................................................... 36

INTERVENTIONAL

Minimally Invasive Diagnostic Procedures........ 38

Pain Management........................................................ 40

Vascular Services........................................................... 42

Drainage Tube / Stent Placement.......................... 43

ICD-10 CODES

ICD-10 Codes Notes................................................. 44

PREFERRED PROVIDER INFORMATION

Major Insurance Plans............................................. 47

Major Network Plans................................................ 47

IMAGING CENTERS

Locations..................................................................... 48

Modality by Location.............................................. 49

Weekend MRI............................................................. 50

TECHNOLOGY

RadVision..................................................................... 51

ACR Appropriateness Criteria.............................. 52

DIG

ITAL X-RAY

Digital X-rays can be scheduled or done on a walk-in basis.04

PROCEDURE DESCRIPTION CPT CODE• Chest 1 View 71045

• Chest 2 Views 71046

• Chest 3 Views 71047

• Chest 4 or More Views 71048

• 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 74018

• Abdomen 2 Views 74019

• Abdomen 3 or More Views 74021

• Acute Abdomen Series + PA CXR 3 Views 74022

• Pelvis 1 or 2 Views 72170

• Pelvis Minimum 3 Views 72190

• 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

• 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

DIGITAL X-RAY: GeneralDigital 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.

DIG

ITAL X-RAY

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Digital X-rays can be scheduled or done on a walk-in basis. 05

PROCEDURE DESCRIPTION CPT CODE

• 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 (Heel) 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

• Bone Age Studies 77072

• Bone Length Studies 77073

• Osseous Complete (Bone Survey) 77075

• Mandible < 4 Views 70100

• Mandible 4 Views 70110

• 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


DIG

ITAL X-RAY

Digital X-rays can be scheduled or done on a walk-in basis.06

PROCEDURE DESCRIPTION CPT CODE

• Skull < 4 Views 70250

• Skull Minimum 4 Views 70260

• Neck Soft Tissue (Not for Cervical Spine) 70360

• C-Spine 2 or 3 Views 72040

• C-Spine Minimum 4-5 Views 72050

• C-Spine Complete 6 or More Views 72052

• T-Spine 2 Views 72070



• 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

• Thoracolumbar Junction (Minimum 2 Views) 72080

• Spine, Entire Thoracic and Lumbar, Including Skull, Cervical and Sacral Spine If Performed (eg, Scoliosis Evaluation); 1 View

72081

• Spine, Entire Thoracic and Lumbar, Including Skull, Cervical and Sacral Spine If Performed (eg, Scoliosis Evaluation); 2 or 3 Views

72082

• Spine, Entire Thoracic and Lumbar, Including Skull, Cervical and Sacral Spine If Performed (eg, Scoliosis Evaluation); 4 or 5 Views

72083

• Spine, Entire Thoracic and Lumbar, Including Skull, Cervical and Sacral Spine If Performed (eg, Scoliosis Evaluation); Min. 6 Views

72084

• Hip, Unilateral, with Pelvis When Performed; 1 View 73501

• Hip, Unilateral, with Pelvis When Performed; 2 or 3 Views 73502

• Hip, Unilateral, with Pelvis When Performed; Minimum 4 Views 73503

• Hips, Bilateral, with Pelvis When Performed; 2 Views 73521

• Hips, Bilateral, with Pelvis When Performed; 3-4 Views 73522

• Hips, Bilateral, with Pelvis When Performed; Minimum 5 Views 73523

• Femur; 1 View 73551

• Femur; Minimum 2 Views 73552


DEXA

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To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 07

#StartAt40

Radiology Ltd. stands firmly behind its recommendation

that women should receive yearly mammograms starting at age 40 in

order to receive the maximum benefit from breast cancer screening.

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

CLINICAL INDICATIONS PROCEDURE CODE

Post MenopauseEarly Surgical MenopauseLong-Term Current Use of Other MedicationLong-Term Current Use of Steroid TreatmentVertebral AbnormalitiesFollow-Up Treatment for Prevention /Monitoring of Osteoporosis

Preps: See below for standard DEXA preps.

DEXA

77080 - hips, spine (axial skeleton)

DEXA with Vertebral Fracture Assessment


DEXA + VFA 77085

Vertebral Fracture Assessment


DEXA (VFA) 77086

DEXA Body Composition Study


DEXA (BCS) 76499

Standard DEXA Preps: No vitamins, calcium or mineral supplements the day of the exam. Prescribed medications are permitted. No IV or oral contrast given prior to study. Avoid clothing with metal. Arrive 30 mins prior to exam. Bring insurance cards along with doctors order to appointment.

BREAST IM

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To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377.08

*CMS determined that for several reasons related to claims processing systems, Medicare claims systems will be unable to process claims using CPT codes 77065, 77066, and 77067 for calendar year 2017. They will continue to use the existing G-codes G0206, G0204 and G0202 and anticipate adopting the 2017 codes for calendar year 2018.

BIOPSYCODING VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED EXPLANATION.

DIAGNOSTIC MAMMOGRAPHYUNILATERAL77065 - UNILATERAL DIGITAL MAMMOGRAPHY,

INCLUDING CAD77061 - UNILATERAL BREAST 3D

TOMOSYNTHESIS

DIAGNOSTIC MAMMOGRAPHYBILATERAL77066 - BILATERAL DIGITAL MAMMOGRAPHY,

INCLUDING CAD 77062 - BILATERAL BREAST 3D

TOMOSYNTHESIS

ULTRASOUND76641 - UNILATERAL COMPLETE76642 - UNILATERAL LIMITED76882 - AXILLA ALONE

BREAST MRI77059 - BILATERAL BREAST MRI

BONE DENSITY SCAN77080 - DEXA SCAN77085 - DEXA WITH VERTEBRAL

FRACTURE ASSESSMENT76499 - DEXA BODY COMPOSITION

STUDY

UTERINE FIBROID EMBOLIZATION (UFE)CODING VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR ADETAILED EXPLANATION.

For more information on exam codesand pricing, please contact the Radiology Ltd.Coding and Pricing Hotline at (520) 545-1818.

SCREENING MAMMOGRAPHY77067 - BILATERAL DIGITAL MAMMOGRAPHY,

INCLUDING CAD77063 - SCREENING BREAST 3D

TOMOSYNTHESIS

CPT CODES for WOMEN’S IMAGINGThis is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change.

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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(see below)

Diagnostic mammogram

w/breastultrasound, if clinicallyindicated

SUSPICIOUS:Order breast

biopsy

PROBABLYBENIGN:Order 6 month

follow-up diagnostic

mammogram

NEGATIVE: Return to

annual screening

mammogram

Cyst aspiration (can be performed

at time of examw/ referring

providerapproval)

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 STUDY(see below)

NO

SCREENING MAMMOGRAPHY (beginning at age 40)± 3D Tomosynthesis

<30years old

breast ultrasound

only

MAMMOGRAPHY ORDERING DECISION TREE

BREAST IM

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WHAT IS THE ARIZONA BREAST DENSITY NOTIFICATION 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 the 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.

HIGH RISK PATIENTHigh 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• Six month follow-up

Order diagnosticmammogram (± 3D Tomosynthesis) w/ultrasound, if clinically indicated

MAMMOGRAPHY ORDERING DECISION TREE

BREAST IM

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*CMS determined that for several reasons related to claims processing systems, Medicare claims systems will be unable to process claims using CPT codes 77065, 77066, and 77067 for calendar year 2017. They will continue to use the existing G-codes G0206, G0204 and G0202 and anticipate adopting the 2017 codes for calendar year 2018.

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TYPE OF EXAM PARAMETERS PROCEDURE CODE

Screening Mammography, Bilateral, Including CADPreps: See below for standard mammo preps.

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

• Screening mammogram (specify baseline or annual exam)

77067

Screening Mammography Tomosynthesis (3D)Preps: See below for standard mammo preps.

77063

Adjunctive ImagingPreps: See below for standard mammo preps.

3D is requested after full-field digital mammography to evaluate dense breasts. Please call for further information if required: (520) 901-6668.

Mastectomy Annual Screening, Including CADPreps: See below for standard mammo preps.

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

• Unilateral screening mammogram

77067-52

History of Breast CancerPreps: See below for standard mammo preps.

• Lumpectomy• 6 months post surgery• ≤ 3 years post

treatment

• Diagnostic mammogram: personal history of breast cancer - lumpectomy

77066 - bilateral 77065 - unilateral

Unilateral Mammography Tomosynthesis (3D) Preps: See below for standard mammo preps.

77061

Bilateral Mammography Tomosynthesis (3D) Preps: See below for standard mammo preps.

77062

Clinical Findings - SymptomsPreps: See below for standard mammo preps.

• Mass • Diagnostic mammogram: with ultrasound (identify area of mass)

77066 - bilateral 77065 - unilateral

• Pain - localized • Diagnostic mammogram: pain (identify area of pain) with ultrasound (localized pain)

Under 30 Years of Age - Order UltrasoundPreps: See below for standard mammo preps.

• Mass, discharge - localized pain

• Diagnostic Breast Ultrasound with Mammogram (if needed)

76641 - unilateral, complete76642 - unilateral, limited

BREAST IMAGING: Screening and Diagnostic MammographyThis is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change.

Standard Mammo Preps: Arrive 15 mins prior to exam. No fasting required. No deodorant, lotions, powder or perfumes. Bring insurance cards along with doctors order to appointment.

BREAST IM

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BREAST IMAGING: Additional Imaging and ProceduresThis is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change.


Recommendation of Additional Imaging (callback or recall exam) Short Term Follow-Up ExamPreps: See below for standard mammo preps.

• Mammography (call back) ±Ultrasound

• Mammogram additional exam ±ultrasound

77065 - unilateral76642 - unilateral77066 - bilateral76642 - RT76642 - LT

• Recommendation of previous exam (3-6 months)

• Diagnostic mammogram: short-term follow-up

77065 - unilateral77066 - bilateral

• Post biopsy exam (6 months after previous mammogram)

• Diagnostic mammogram: post biopsy

77065 - unilateral77066 - bilateral

Nipple DischargePreps: See below for standard mammo preps.

• Unilateral • Reproducible • Single duct discharge

(patient must be able to express discharge at time of ductogram)

• Diagnostic mammogram +ultrasound: discharge (identify breast and describe discharge)

77665 - unilateral76642 - unilateral77066 - bilateral76642 - RT76642 - LT

Nipple Discharge Preps: See below for standard breast preps.

• Ductogram (preferably after surgical consultation)

• Ductogram for nipple discharge

Singular Duct 1903077053Multiple Ducts 19030 - x number of ducts77054

Cystic Mass / Lesion Found on Previous Breast UltrasoundPreps: See below for standard breast preps.

• Previous ultrasound report indicating need for aspiration

• Left / right cystic aspiration

Ultrasound Guided Singular7694219000Ultrasound Guided Multiple Same Side1900019001 x number of add’l cysts76942

Indeterminate LesionPreps: See below for standard breast preps.

• Biopsy indicated on prior imaging

• Left / right indeterminate lesion / mass

Stereotactic Guided Biopsy - 19081Additional Lesion - 19082Ultrasound Guided Biopsy - 19083Additional Lesion - 19084Magnetic Resonance Guided Biopsy - 19085Additional Lesion - 19086

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.

Standard Mammo Preps: No fasting required. No deodorant, lotions, powder or perfumes. Arrive 15 mins prior to exam. Bring insurance cards along with doctors order to appointment.

Standard Breast Preps: No fasting required. No deodorant or talcum powder under arms or breast area. Arrive 30 mins prior to exam. Bring insurance cards along with doctors order to appointment.

BREAST IM

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BREAST IMAGING: MRI BreastThis is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change.


Breast (pre-operative staging) Preps: See below for standard breast MRI preps.

• Recent diagnosis of breast cancer

• Bilateral breast MRI (and chest MRI, if necessary)

77059 (71552)

Breast (high risk screening) Preps: See below for standard breast MRI preps.

• High risk breast cancer screening

• Bilateral breast MRI 77059

Breast (silicone implants) Preps: See below for standard breast MRI preps.

• Suspected silicone implant leak

• Palpable lump• Pain

• Bilateral breast MRI in addition to “implant protocol”

77059

Breast (indeterminate clinical or imaging results) Preps: See below for standard breast MRI preps.

• Further evaluation of indeterminate clinical or imaging results (radiologist recommendation)


Follow-up for Chemotherapy Treatment Preps: See below for standard breast MRI preps.

• Follow-up for neo-adjuvant chemotherapy


Please note: Breast MRI does not replace screening mammography.

Standard Breast MRI Preps: Drink plenty of fluids day before exam, nothing to eat two hours prior to exam. Do not wear hairspray, deodorant, jewelry, metal or eye makeup. Arrive 30 mins before exam. Bring insurance card to appointment.

To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377.

ULTRA

SOU

ND


TYPE OF EXAM COMMON INDICATIONS PROCEDURE CODE

Ultrasound of the Abdomen is imaging using sound waves to produce pictures of the structures within the abdomen (belly button up). It is used to help evaluate the liver, kidneys, gallbladder, pancreas, spleen and aorta. Preps: Eat a low fat meal the evening before, nothing to eat or drink anything after midnight. Prescribed medications are permitted. Arrive 30 mins before exam. Bring insurance card and doctor’s orders.

• Abdominal pain (specify right or left upper quadrant or epigastric region)

• Abnormal LFT’s• Cirrhosis• Hepatitis C• Hepatomegaly• Polycystic disease• Splenomegaly

• Abdominal ultrasound

76700

Pelvis Ultrasound is imaging using sound waves to produce pictures of structures and organs in the pelvis (belly button down). It is used to evaluate the uterus and ovaries. Radiology Ltd.’s preferred protocol is to perform both the Transabdominal and Transvaginal scans as these will give the most detailed information. If only one study is perferred, our recommendation is to order a transvaginal scan. Note that Transvaginal scans are not performed on virgins.

Preps: 1.5 hours before appointment, empty bladder. Next 30 minutes, drink 32oz of water. Finish drinking one hour before appointment. A full bladder is required. If bladder is not full, may delay exam. Arrive 30 mins before exam. Bring insurance card, and doctor’s orders.

Child Preps:Ages 3-5: 8oz of waterAges 6-10: 16oz of waterAges 11+: 32oz of water

• Endometriosis• Fibroids / enlarged uterus• Groin (MSK/extremity)• IUD• Menstrual disorders• Ovarian cysts• PCOS• Pelvic Pain (relating specifically

to uterus or ovaries; ultrasound is not the exam of choice for intestinal disorders)

• Transabdominal only

76856

• Pelvic ultrasound complete (transabdominal and transvaginal - preferred)

76856Trans Abdominal

76830Trans Vaginal

• Transvaginal only

76830

ULTRASOUND: GeneralThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.

ULTRA

SOU

ND

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Locally owned and

operated, Radiology Ltd. offers eight imaging

centers to patients across southern Arizona.


TYPE OF EXAM COMMON INDICATIONS PROCEDURE CODE

Renal Ultrasound imaging uses sound waves to produce pictures of the kidneys and bladder. Renal Ultrasound does not check post-void residual of bladder.

Preps 1 hour before appointment, drink 16oz of water. Do not empty bladder. A full bladder is required. If bladder is not full, may delay exam. Arrive 30 mins before exam. Bring insurance card and doctor’s orders. Child Preps:Ages 3-5: 8oz of waterAges 6-10: 16oz of waterAges 11+: 32oz of water

• Flank / back pain• Hematuria• Neurogenic bladder• Polycystic kidneys• Renal cyst / mass• Renal disease (CKD)• UTI

• Renal ultrasound 76770

Bladder Ultrasound imaging uses sound waves to produce pictures of the bladder.

Preps: 1 1/2 hours before appointment, empty bladder. Next 30 minutes, drink 32 oz of water. Finish drinking one hour before appointment. A full bladder is required. If bladder is not full, may delay exam. Arrive 30 mins before exam. Bring your insurance card, and doctor’s orders. Child Preps:Ages 3-5: 8oz of waterAges 6-10: 16oz of waterAges 11+: 32oz of water

• Bladder Mass / Stone• Hematuria

• Bladder ultrasound

• Renal ultrasound• Renal with

bladder ultrasound (this will assess kidneys/bladder and post-void residual)

76857

ULTRA

SOU

ND



BODY PART COMMON REASON FOR EXAM PROCEDURE CODE

Aorta (seen to iliacs)Preps: None

• 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, hyper-tension, cerebrovascular disease

• Aorta Duplex–Not screening

AAA for Medicare

–Medicare screening

93978

76706

Thyroid or Soft Tissue NeckPreps: None

• Enlarged lymph node• Palpable mass on neck

• Soft tissue neck ultrasound

76536

• Enlarged thyroid / fullness• Goiter• Hypo- / hyper-thyroid• Nodules• Thyroiditis

• Thyroid ultrasound 76536

TesticlesPreps: None

• Epididymitis• Hydrocele• Orchalgia• Pain / swelling• Palp lump• Torsion• Varicocele

• Testicular ultrasound 76870

Radiology Ltd. –the best care,

the best technology, and the best expertise,

right in your own backyard.

ULTRA

SOU

ND

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ULTRASOUND: VascularThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.


CarotidPreps: None

• Amaurosis fugax• Arterial vascular disease• Ataxia• HTN• Hyperlipidemia• Stenosis• Stroke• TIA

• Carotid duplex / doppler

93880

Venous Upper and Lower ExtremityPreps: None

• DVT• Redness• Upper and lower extremity

Swelling / pain

• Venous duplex / doppler (specify upper or lower and bilateral, right, or left with indication for each)

93971 unilat

93970 bilat

AbdominalPreps: Eat a low fat meal the evening before. Do not eat or drink anything after midnight. You may take your prescribed medications with a sip of water as needed.

• Portal HTN• Portal venous thrombosis• Liver transplant• TIPS

• Abdominal duplex / doppler

93975 Abdominal duplex

93976 TIPS

Renal ArteryPreps: Nothing to eat or drink 8-12 hours before appointment. No soda or coffee. You may take your prescribed medications with a sip of water as needed. Arrive 30 before exam.

• Abd bruit• Renal artery stenosis• Uncontrolled HTN

• Renal artery duplex / doppler

93976Duplex scan limited

Radiology Ltd. is one of the largest physician-owned group practices in southern Arizona and has been

providing diagnostic imaging services for more than eighty years.

ULTRA

SOU

ND


ULTRASOUND: MSK/ExtremityThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.


Neck / HeadPreps: None

• Lymphadenopathy• Palpable abnormality

• Soft tissue ultrasound neck / head

76536

Hands /WristsPreps: None

• Pain / swelling• Palpable abnormality• Ganglion cyst• Foreign body• Rheumatoid arthritis / arthritis• Median/ulnar/radial Neuropathy

• Soft tissue hands / wrists ultrasound

76881

FootPreps: None

• Pain• Plantar fasciitis• Morton’s neuroma• Plantar plate tear• Ganglion cyst• Palpable abnormality• Foreign body

• Soft tissue foot ultrasound 76881

AnklePreps: None

• Pain / swelling• Achilles tendinosis or tear• Tendinosis (anterior tibialis,

posterior tibialis, peroneals)• Ganglion cyst• Palpable abnormality• Foreign body

• Soft tissue ankle ultrasound 76881

KneePreps: None

• Pain / swelling• Baker cyst• Palpable abnormality• Quadriceps / patellar Tendinosis

or tear

• Soft tissue knee ultrasound 76881

ElbowPreps: None

• Pain / swelling• Biceps / triceps tendon tear• Olecranon bursitis• Palpable abnormality• Ulnar / median / radial

Neuropathy

• Soft tissue elbow ultrasound 76881

GroinPreps: None

• Inguinal hernia• Lymphadenopathy• Palpable abnormality

• Ultrasound extremity• Ultrasound soft tissue

76881

UnlistedPreps: None

• Palpable abnormality on the back or torso

• Chest wall• Upper back• Limb• Lower back

766047660476705

PET/CTw

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PET/CT ImagingOur PET services are centrally

located at our Camp Lowell site. To schedule a PET exam, please

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

PET / CT: Bone ScanThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.

BODY PART REQUESTED TEXT CODESkull 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

BreastLungProstateThyroid

• PET / CT bone scan with sodium fluoride (Sodium Fluoride PET bone scans will no longer be covered by Medicare.)

78816

PET / CT: GeneralThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.

CT / CTA


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

ORBIT70480 - W/O CONTRAST70481 - W/CONTRAST70482 - W/O & W/CONTRAST

MAXILLOFACIAL70486 - W/O CONTRAST70487 - W/CONTRAST70488 - W/O & W/CONTRAST

SOFT TISSUE NECK70490 - W/O CONTRAST70491 - W/CONTRAST70492 - W/O & W/CONTRAST

UPPER EXTREMITY73200 - W/O CONTRAST73201 - W/CONTRAST73202 - W/O & W/CONTRAST

LOWER EXTREMITY73700 - W/O CONTRAST73701 - W/CONTRAST73702 - W/O & W/CONTRAST

BRAIN70450 - W/O CONTRAST70460 - W/CONTRAST70470 - W/O & W/CONTRAST

CERVICAL SPINE72125 - W/O CONTRAST72126 - W/CONTRAST72127 - W/O & W/CONTRAST

CHEST71250 - W/O CONTRAST71260 - W/CONTRAST71270 - W/O & W/CONTRAST

THORACIC SPINE72128 - W/O CONTRAST72129 - W/CONTRAST72130 - W/O & W/CONTRAST

ABDOMEN PELVISCOMBINATION74176 - W/O CONTRAST74177 - W/CONTRAST74178 - W/O & W/CONTRAST

LUMBAR SPINE72131 - W/O CONTRAST72132 - W/CONTRAST72133 - W/O & W/CONTRAST

To schedule an appointment, call (520) 733-7226 or fax (520) 290-8377. 21.

Eligibility not verified. Reasons for ineligibility reported to your office.

If your patient does not meet these requirements, but needs a chest CT scan for another clinical indication,you can order a standard diagnostic chest CT.

CT / CTA

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CT / CTA: GeneralThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.


ChestPreps: See below for standard CT Contrast Preps.

• 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• Pain• Pneumonia• Shortness of breath• Tracheal stenosis

• CT chest with contrast 71260

Chest, High ResolutionPreps: See below for standard CT Preps.

• Asbestosis • Bronchiectasis• Fibrosis • Interstitial lung disease• Pleural plaques • Sarcoidosis

• CT chest without contrast, high-resolution

71250

CTA Chest (PE Study)Preps: See below for standard CT Contrast Preps.

• Pulmonary embolism• Shortness of breath• Vascular evaluation

• CTA chest 71275

CTA Chest & AbdomenPreps: See below for standard CT Preps.

• Aortic dissection• Thoracic aortic aneurysm

• CTA chest and abdomen

71275 74175

NeckPreps: See below for standard CT Contrast Preps.

• 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

Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment.

Standard CT Contrast Preps: Nothing to eat two hours prior to exam. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before exam.


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Pelvis (soft tissue)Preps: See below for standard CT Oral Contrast Preps.

• Cancer staging• Cysts• Hernia• Infection• Mass • Pain

• CT pelvis with contrast

72193

Pelvis (bone)Preps: See below for standard CT Preps.

• Fracture, arthritis • CT pelvis without contrast

72192

• Bone Infection, Illiac joints• Cancer / mass / mets / tumor

• CT pelvis with contrast

72193

AdrenalPreps: See below for standard CT Preps.

• Adrenal mass • CT abdomen with and without contrast

74170

Abdomen / PelvisPreps: See below for standard CT Preps.

• Stone (stone protocol) • CT abdomen with and without contrast (stone protocol)

Abdomen / PelvisPreps: See below for standard CT Oral Contrast Preps.

• 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

Abdomen / PelvisPreps: See below for standard CT Oral Contrast Preps.

• Any cancer staging• Appendicitis• Crohns / ulcerative colitis• Diarrhea• Diverticulitis• IBD

• CT abdomen and pelvis with contrast

74177



Standard CT Oral Contrast Preps: At least one day prior to exam, patient needs pick up oral contrast at any one of our locations. Further instructions will be given.

CT / CTA



LiverPreps: See below for standard CT Oral Contrast Preps.

• Hepatoma, Hepatitis, Cirrhosis• Liver hemangioma

(MR preferred)

• CT abdomen with and without contrast (liver protocol)

74170

PancreasPreps: See below for standard CT Oral Contrast Preps.

• Pancreatic Mass• Pancreatitis• Pseudocyst

• CT abdomen without and with contrast (pancreatic protocol 1st time)

74170

• CT abdomen with contrast

74160

KidneysPreps: See below for standard CT Oral Contrast Preps. Note: Diagnosis for renal calculi-no oral contrast needed, see below for standard CT prep.

• Any Renal Pathology • CT abdomen without and with contrast (kidney protocol)

74170

CT Urogram / CT IVPPreps: See below for standard CT Preps.

• Transitional Cell Carcinoma of Kidney and/or Bladder

• Hematuria

• CT IVP or CT urogram

74178

CTA Abdomen & Run OffPreps: See below for standard CT Preps.

• Claudication• Peripheral Artery Disease (PAD)

• CTA abdomen and Run off

75635

Abdominal AortaMesenteric VesselsRenal ArteriesStentPreps: See below for standard CT Preps.

• Mesenteric Ischemia• Renal Artery Stenosis

• CTA abdomen 74175

• AAA• Crossing Vessels• Stent Obstruction / Leak /

Malfunction

• CTA abdomen and pelvis

74174



Standard CT Oral Contrast Preps: At least one day prior to exam, patient needs pick up oral contrast at any one of our locations. Further instructions will be given.

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CT / CTA: Head and SpineThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.


Head / BrainPreps: See below for standard CT preps.

• Alzheimer’s• CVA• Headache Less Than 7 Days• Hydrocephalus• Memory Loss, Confusion• Shunt Check• Stroke / Bleed• Trauma

• CT Head / brain without contrast

70450

Head / BrainPreps: See below for standard CT contrast preps.

• 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 BrainPreps: See below for standard CT contrast preps.

• Aneurysm • AVM (Arteriovenous Malformation)• Bruit • CVA• Stroke• TIA• Vascular Tumor

• CTA Head / brain (reconstruction)

and/or(If both ordered, please authorize both codes)

70496

CTA Neck, Carotid ArteryPreps: See below for standard CT contrast preps.

• Bruit• Carotid Stenosis• CVA• TIA• AVM (Arteriovenous Malformation)• Vascular Tumor• Stroke

• CTA Neck 70498

• Vertebrobasilar Insufficiency • CTA Head, Neck (please authorize with both)

70498, 70496

OrbitPreps: See below for standard CT preps.

• Foreign body• Fracture• Trauma

• CT Orbit without contrast 70480

OrbitPreps: See below for standard CT contrast preps.

• Cellulitis• Exophthalmos • Graves’ disease• Mass• Pain• Pseudotumor

• CT Orbit with contrast 70481



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CT / CTA: Head and SpineThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.


Sinus / FacePreps: See below for standard CT preps.

• Functional endoscopic sinus surgery

• Ostiomeatal complex• Sinusitis

• CT Sinus without contrast

70486

Sinus / FacePreps: See below for standard CT contrast preps.

• Mass or infection • CT Sinus with contrast 70487

Spine: CervicalPreps: See below for standard CT preps.

• MR recommended for disc herniation, mets, infection

• Trauma, fracture, fusion

• CT cervical spine without contrast

72125

Spine: CervicalPreps: See below for standard CT contrast preps.

• Abscess or infection • CT cervical spine with contrast

72126

Spine: ThoracicPreps: See below for standard CT preps.

• MR recommended for disc herniation, mets, infection

• Assess bony degenerative changes

• CT thoracic spine without contrast

72128

Spine: ThoracicPreps: See below for standard CT contrast preps.

• Abscess or infection • CT thoracic spine with contrast

72129

Spine: Lumbar / SacralPreps: See below for standard CT preps.

• MR Recommended for disc herniation, mets, infection

• Trauma, fracture, fusion, pars defect

• CT lumbar spine without contrast

72131

Spine: Lumbar / Sacral Preps: See below for standard CT contrast preps.

• Abscess or infection • CT lumbar spine with contrast

72132

Temporal Bone / IAC’sPreps: See below for standard CT preps.

• Cholesteotoma• Trauma

• CT inner ears, temporal bones without contrast

70480

PituitaryPreps: See below for standard CT contrast preps.

• MRI unless contraindicated • CT brain without and with contrast

70470




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CT / CTA: MusculoskeletalThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.


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

Preps: See below for standard CT preps.

• All Bone exams ordered without contrast except for tumor evaluations

• CT without contrast upper extremity (mention part)

73200

Lower Extremity–Hip–Thigh–Knee–Calf–Ankle/Foot

Preps: See below for standard CT preps.

• All Bone exams ordered without contrast except when evaluating for mass or infection

• CT without contrast lower extremity (mention part)

73700

ExtremitiesPreps: See below for standard CT contrast preps.

• Tumor / mass / cancer / mets / infection

• CT with contrast - upper• CT with contrast - lower

7320173701

Ischemia (lower extremity)Arterial Stenosis (lower extremity)Preps: See below for standard CT contrast preps.

• Peripheral artery disease • CTA upper extremity• CTA lower extremity

73206 73706

CT Chest Screening for Lung Cancer

Early detection matters. The goal of the CT lung cancer screening program is to detect lung cancer

early, when it is easier to treat.



CT / CTA

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ColonPreps: At least three days prior to exam, patient needs pick up cleanings prep at our Camp Lowell location. Further Instructions will be given.

• Failed colonoscopy• Patients taking blood thinners

who are not candidates for routine colonoscopy

• Screening

• CT colonography with 3D rendering (virtual colonoscopy)

74263 Screening

74261Diagnostic

Renal smallArtery(or Mesenteric Artery)Preps: See below for standard CT Preps.

• Hypertension• Renal artery stenosis

• CTA abdomen for renal arteries

74175

Small Intestine (bowel)Preps: Arrive 90 mins before exam for oral prep given in office. Nothing to eat two hours prior to arrival. Patient needs to stay near a restroom after completion of exam for the remainder of the day. This exam causes a laxative effect. Drink plenty of water.

• Crohn’s disease• Small bowel related issues

–Abscess–Bleeding sources–Bowel obstruction–Fistula–Inflammation–Tumor

• CT enterography 74177

Urinary BladderPreps: See below for standard CT Preps.

• Bladder cancer• Bladder polyps• Bleeding• Hydronephrosis• Vesicoureteral reflux

• CT cystogram (please authorizeBOTH codes)

7219251600

CT HeartPreps: See below for standard CT Preps.

• Screening, hyperlipidemia • CT calcium score without contrast

75571

CTA HeartPreps: Must have a responsible driver to drive home. Nothing to eat or drink four hours before exam. No caffeine the day of the exam. Arrival time provided at the time of scheduling.

• Abnormal echo• Chest pain, sub tachycardia

• CTA coronary artery without and with contrast

75574

CT Chest Lung Cancer ScreeningPreps: See below for standard CT Preps.

• Lung cancer screening • CT chest, low-dose, lung cancer screening must meet criteria

71250 G0297 (medicare)

CT / CTA: SpecialtyThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.


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CT / CTA: SpecialtyThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.

Additional Information Required for CT Lung Cancer Screening:

• Smokers age 55-80 who have smoked 30 pack years

• Former smokers 55-80 who quit less than 15 years ago and smoked 30 pack years also

Packs/day (20 cigarettes/pack) x Years smoked = Pack Years* *Pack year calculator: http://www.shouldiscreen.com/pack-year-calculator/

For Medicare patients, the following G code should be

used by provider for the shared decision-making visit:

• G0296 - Counseling visit to discuss need for lung cancer screening (LDCT) using low-dose CT scan (service is for eligibility determination and shared decision-making)

• Medicare will deny G0296 and G0297 for claims that do not contain ICD-10 Z87.891, personal history of tobacco use/personal history of nicotine dependence


MRI / M

RA


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

ORBIT, FACE & NECK70540 - W/O CONTRAST70542 - W/CONTRAST70543 - W/O & W/CONTRAST

TMJ70336

SHOULDER, ELBOW OR WRIST(UPPER EXTREMITY, JOINT)73221 - W/O CONTRAST73222 - W/CONTRAST73223 - W/O & W/CONTRAST

HUMERUS, FOREARM OR NON-JOINT(UPPER EXTREMITY, NON-JOINT)73218 - W/O CONTRAST73219 - W/CONTRAST73220 - W/O & W/CONTRAST

HIP, KNEE OR ANKLE(LOWER EXTREMITY, JOINT)73721 - W/O CONTRAST73722 - W/CONTRAST73723 - W/O & W/CONTRAST

THIGH, LOWER LEG OR FOOT(LOWER EXTREMITY, NON-JOINT)73718 - W/O CONTRAST73719 - W/CONTRAST73720 - W/O & W/CONTRAST

BRAIN70551 - W/O CONTRAST70552 - W/CONTRAST70553 - W/O & W/CONTRAST

CERVICAL SPINE72141 - W/O CONTRAST72142 - W/CONTRAST72156 - W/O & W/CONTRAST

CHEST71550 - W/O CONTRAST71551 - W/CONTRAST71552 - W/O & W/CONTRAST

BREAST77059 - W/O & W/CONTRAST

THORACIC SPINE72146 - W/O CONTRAST72147 - W/CONTRAST72157 - W/O & W/CONTRAST

ABDOMEN74181 - W/O CONTRAST74182 - W/CONTRAST74183 - W/O & W/CONTRAST

LUMBAR SPINE72148 - W/O CONTRAST72149 - W/CONTRAST72158 - W/O & W/CONTRAST

PELVIS72195 - W/O CONTRAST72196 - W/CONTRAST72197 - W/O & W/CONTRAST

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Brain Preps: See below for standard MRI Brain Preps.

• Alzheimer’s, confusion, dementia, hydrocephalus, memory loss, mental status changes

• MRI brain without contrast 70551

Brain Preps: See below for standard MRI Brain Contrast Preps.

• Headache• Pseudotumor• Seizures• Tumor / mass / cancer / mets• Vascular lesions• All other reasons

• MRI brain without and with contrast

70553

BrainPreps: See below for standard MRI Brain Contrast Preps.

• Mass / tumor• Metabolic abnormality• Demyelinating disease

• MRI brain without and with contrast, with spectroscopy

70553, 76390

Brain NeuroQuantPreps: See below for standard MRI Brain Contrast Preps.

• Dementia• Memory loss• Seizures

• MRI Brain without contrast to include NeuroQuant (3D volumetric analysis)

70551, 76377

Brain / Orbits / FacePreps: See below for standard MRI Brain Contrast Preps.

• 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 & with contrast) (please authorize BOTH codes)

7055370543

PituitaryPreps: See below for standard MRI Brain Preps.

• Elevated prolactin • MRI brain without and with contrast

Att: pituitary

70553

Ear (IAC) BrainPreps: See below for standard MRI Brain Contrast Preps.

• Hearing loss • MRI brain without and with contrast

70553

Cranial Nerve SeriesPreps: See below for standard MRI Brain Preps.

• Bell’s palsy• Trigeminal neuralgia

• MRI brain without and with contrast Att: cranial nerves

70553

MRV –BrainPreps: See below for standard MRI Brain Preps.

• Venous thrombosis • MRV without contrast 70544

TMJPreps: See below for standard MRI Brain Contrast Preps.

• Internal derangement• Joint dysfunction

• MRI TMJ without contrast 70336

MRA –Arch & Great Vessels –Brain –NeckPreps: See below for standard MRI Brain Preps.

• Stroke / CVA• TIA• Vertebrobasilar insufficiency

• MRA brain without contrast 70544

MRA –Arch & Great Vessels –Brain –NeckPreps: See below for standard MRI Brain Preps.

• Stroke / CVA• TIA• Vertebrobasilar insufficiency

• MRA neck with contrast (please authorize BOTH codes)

70548

MRI / MRA: BrainThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.

Standard MRI Brain Preps: Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment.

Standard MRI Brain Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment.

MRI / M

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Neck (soft tissue)Preps: See below for standard MRI Contrast Preps.

• Infection• Pain• Tumor / mass / cancer / mets• Vocal Cord Paralysis

• MRI neck without and with contrast

70543

Spine: Cervical Preps: See below for standard MRI Preps.

• Arm / shoulder pain and/or weakness• Chiari malformation• Degenerative disease• Disc herniation• Neck pain• Post-op fusion radiculopathy

• MRI cervical spine without contrast

72141

Spine: Cervical Preps: See below for standard MRI Contrast Preps.

• Discitis• Multiple sclerosis• Myelopathy• Osteomyelitis • Syrinx• Tumor / mass / cancer / mets• Vascular lesions, AVM

• MRI cervical spine without and with contrast

72156

Spine: ThoracicPreps: See below for standard MRI Preps.

• Back pain• Compression fx (with hx of malig / mets)• Degenerative disease• Disc herniation• Radiculopathy• Trauma• Vertebroplasty planning (with hx of no malig)

• MRI thoracic spine without contrast

72146

Spine: ThoracicPreps: See below for standard MRI Contrast Preps.

• AVM • Compression fx (with hx of malig / mets)• Discitis• Multiple sclerosis• Myelopathy• Osteomyelitis• Syrinx• Tumor / mass / cancer / mets• Vascular lesions• Vertebroplasty planning (with hx of malig)

• MRI thoracic spine without and with contrast

72157

32

MRI / MRA: SpineThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.

Standard MRI Preps: Depending on the exam, may be asked to change into gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment.

MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment.


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Breast (pre-operative staging)Preps: See below for standard MRI Breast Preps.

• Recent diagnosis of breast cancer • Bilateral breast MRI (and chest MRI, if necessary)

77059 (71552)

Breast (high risk screening) Preps: See below for standard MRI Breast Preps.

• High risk breast cancer screening • Bilateral breast MRI 77059

Breast (silicone implants) Preps: See below for standard MRI Breast Preps.

• Suspected silicone implant leak• Palpable lump• Pain

• Bilateral breast MRI in addition to “implant protocol”

77059

Breast (indeterminate clinical or imaging results) Preps: See below for standard MRI Breast Preps.

• Further evaluation of indeterminate clinical or imaging results (radiologist recommendation)


Follow-up for Chemotherapy Treatment Preps: See below for standard MRI Breast Preps.

• Follow-up for neo-adjuvant chemotherapy


Please note: Breast MRI does not replace screening mammography.

MRI: BreastThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.


Spine: LumbarPreps: See pg. 32 for standard MRI Preps.

• Back pain• Compression fx (with hx of no malig / mets) • Degenerative disease• Disc herniation• Radiculopathy• Sacrum / SI joints• Sciatica• Spondylolisthesis• Stenosis• Trauma• Vertebroplasty planning (with hx of no malig)

• MRI lumbar spine without contrast

72148

72195

Sacrum / SI joints Preps: See pg. 32 for standard MRI Preps.

• When including Sacurm/SI Joints • MRI Lumbar Spine to Include Sacrum/SI Joints (please authorize BOTH codes)

72148,72195

Spine: LumbarPreps: See pg. 32 for standard MRI Contrast Preps.

• Compression fx (with hx of malig / mets)• Discitis• Osteomyelitis• Post-op• Tumor / mass / cancer / mets• Vertebroplasty (with hx of malig)

• MRI lumbar spine without and with contrast

72158

MRI / MRA: SpineThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.

Standard BREAST MRI Preps: Drink plenty of fluids day before exam, nothing to eat two hours prior to exam. Do not wear hairspray, deodorant, jewelry, metal or eye makeup. Arrive 30 mins before exam. Bring insurance card to appointment.

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Chest MediastinumPreps: See below for standard MRI Contrast Preps.

• Tumor / mass / cancer / mets • MRI chest without and with contrast

71552

HeartPreps: See below for standard MRI Contrast Preps.

• Congenital defect and heart valve issues

• Past MI - other cardiac issues

• MRI heart 75557 & 75561

Brachial PlexusPreps: See below for standard MRI Contrast Preps.

• Brachial Plexus Injury• Nerve Avulsion• Tumor / mass / cancer / mets

• MRI chest / mediastinum without and with contrast (specify brachial plexus)

71552

AbdomenPreps: Nothing to eat six hours prior to exam, fluid will interfere with the exam. Avoid wearing jewelry or metal. Will be asked to change into a gown or scrubs. Arrive 30 min before exam. Bring insurance card to appointment.

• Adrenal• MRCP (biliary / pancreatic ducts)

• MRI abdomen without contrast (MRCP)

74181

• Kidney Eval• Liver Eval• Pancreas Eval• All Other Reasons

• MRI abdomen without and with contrast

74183

Abdomen Preps: Nothing to eat six hours prior to exam, fluid will interfere with the exam. Avoid wearing jewelry or metal. Will be asked to change into a gown or scrubs. Arrive 30 min before exam. Bring insurance card to appointment.

• 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

(please authorize BOTH codes)

74185

74183

Standard MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment.

Radiology Ltd. Offers 3T MRI!This technology provides clinical advantages for certain exams like

prostate, abdominal imaging, small joints, and research studies. This machine is centrally located at our Camp Lowell site.

MRI / MRA: Chest, Abdomen, and Pelvis This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change.


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MRI / MRA: Chest, Abdomen, and PelvisThis is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change.


EnterographyPreps: Arrive 90 minutes before exam. Nothing to eat six hours prior to exam. Avoid wearing jewelry or metal. Will be asked to change into a gown or scrubs. Stay near a restroom after completion of exam for remainder of the day. This exam causes a laxative affect. Bring insurance card to appointment.

• Crohn’s disease• Inflammatory bowel disease

• MRI enterography without and with contrast

7418372197

PelvisPreps: See below for standard MRI Contrast Preps.

• 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

UrogramPreps: Nothing to eat four hours prior to exam. Avoid wearing jewelry or metal. Will be asked to change into a gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment.

• Hematuria - congenital abnormalities

• Urinary tract obstruction

• MRI urogram 74183 & 72197

ProstatePreps: See below for standard MRI Contrast Preps.

• Benign prostatic hyperplasia (BPH)• Enlarged prostate• Evaluation of prostate cancer• Infection (prostatitis)• Prostate abscess

• MRI prostate (best on 3T scanner)

• MRI prostate with multiparmetric reconstructions

72197

76377



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MRI: MusculoskeletalThis is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.


Arm HandLegFootPreps: See below for standard MRI Preps.

• Fracture• Muscle / tendon tear• Stress Fracture

• MRI - non joint without contrast

–Upper extremity–Lower extremity

73218 73718

Arm HandLegFoot Preps: See below for standard MRI Contrast Preps.

• Abscess• Arthritis (special protocol - please specify)• Bone tumor / mass / cancer / mets• Cellulitis• Fasciitis• Myositis• Morton’s neuroma• Osteomyelitis• Soft tissue tumor / mass / cancer / mets• Ulcer

• MRI - non joint without and with contrast


7322073720

ShoulderElbowWristFingerHipKneeAnkleToePreps: See below for standard MRI Preps.

• Joint pain (specify joint)• Internal derangement, labral tear, ligament

tear, meniscal tear• Articular cartilage injury• Osteochondritis dissecans (OCD)• Stress fracture / fracture• Avascular necrosis (AVN)• Tendinosis / tendon tear• Plantar fasciitis• Muscle strain

• MRI - joint without contrast


73221 73721

ShoulderElbowWristFingerHipKneeAnkleToePreps: See below for standard MRI Contrast Preps.

• Infection• Tumor / mass / cancer / mets• Inflammatory arthritis• Myositis

• MRI lower extremity - joint without and with contrast


7322373723

Standard MRI Preps: Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment.



MRI / M

RAw

ww

.radltd.com

37

MRI: Musculoskeletal (including Arthrography)This is for reference only. This does not imply protocol standardsfor all radiology facilities. Information is subject to change.


Scapula (not included in shoulder)Preps: See below for standard MRI Contrast Preps.

• Pain• Mass

• MRI chest without and with contrast

71552

MRI Arthrography –Shoulder –Elbow –Wrist –Hip –Knee –AnklePreps: See below for standard MRI Contrast Preps.

• Labral tear• TFCC/tear scapholunate

ligament• Loose bodies• OCD• Post-op meniscus evaluation

• MRI joint with contrast - order with 3 codes:

1–Upper extremity with contrast OR lower extremity with contrast

2–Fluoro guided arthrogram

3–Choose body part:–Shoulder–Elbow–Wrist–Hip–Knee–Ankle

73222 73722 77002

23350 & 73040 24220 & 7308525246 & 7311527093 & 7352527370 & 7358027648 & 73615


Radiology Ltd. offers a better choice inopen MRI called Espree X-Large MRI.

The open design of the Magnetom Espree accommodatespatients of all sizes and helps eliminate anxiety and claustrophobia.

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

INTERV

ENTIO

NA

L

38

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

Min

imally Invasive D

iagn

ostic Procedures

Interventional ServiceM

odality

CPT Cod

e(s)Perform

ed

By

EvaluationReq

uiredLab

sReq

uiredSed

ationReq

uired

ParacentesisA

thin needle or tub

e is placed

into the abd

omen to rem

ove fluid for

diagnosis and

/or reduce d

iscomfort.

Preps: Off C

oumad

in/Asp

irin/Ag

grenox/Pradaxa for 5 d

ays (exam

scheduled

on 6th day) . O

ff Plavix/Effient for 7 d

ays (exam sched

uled

on 8th day). O

ff Pletal for 24 hours (restart the day after the exam

). Off

Xarelto or Eliquis(Ap

ixaban) for 24 hours. O

btain p

rescribing

doctor’s

app

roval to hold m

eds . STAT lab

s draw

n the day b

efore proced

ure if on C

oumad

in. If not on blood

thinners w/in 30 and

must b

e received

two d

ays prior to p

rocedure. PTT, PT/IN

R, CBC

w/Platelets. C

lear liquid

s are perm

itted up

until 2 hrs before exam

. Arrive 30 m

inutes early. M

ust have a responsib

le driver

Ultrasound

or

CT

49083

Interventionalor Bod

yRad

iologistN

oYes,

call forsp

ecificsN

o

49083

ThoracentesisA

thin needle or tub

e is placed

into the chest to remove fluid

for d

iagnosis and/or to red

uce discom

fort. Preps: O

ff Coum

adin/A

spirin/A

ggrenox/Prad

axa for 5 days (exam

sched

uled on 6th d

ay) . Off Plavix/Effi

ent for 7 days (exam

scheduled

on 8th d

ay). Off Pletal for 24 hours (restart the d

ay after the exam). O

ff Xarelto or Eliquis(A

pixab

an) for 24 hours. Ob

tain prescrib

ing d

octor’s ap

proval to hold

med

s . STAT labs d

rawn the d

ay before p

rocedure if

on Coum

adin. If not on b

lood thinners w

/in 30 and m

ust be received

tw

o days p

rior to proced

ure. PTT, PT/INR, C

BC w

/Platelets. Clear

liquids are p

ermitted

up until 2 hrs b

efore exam. A

rrive 30 minutes

early. Must have a resp

onsible d

river

Ultrasound

or

CT

32555


yRad

iologistYes

Yes,call for

specifics

No

32555

Image-G

uided Percutaneous BiopsyA

needle is p

laced in a d

esired location using

imaging

guid

ance in

order to ob

tain a small p

iece of tissue so that it can be exam

ined b

y an outsid

e pathologist. C

ertain biop

sies may need

to be p

erformed

at the hosp

ital due to risk of com

plications.

Preps: No solid

food 6 hours b

efore exam. C

lear liquids are p

ermitted

up

until 2 hours before exam

. Must have a resp

onsible d

river to drive

you home. A

rrive 60 mins b

efore exam. Screen for all anticoag

ulants listed, and

schedule ap

pointm

ent based

on the recomm

ended

days

off of med

ication. Send lab

request for PTT, PT/INR, C

BC w

/platelets

to ordering

provid

er. C

oumad

in/Asp

irin/Ag

grenox/Pradaxa-off for 5 d

ays, exam on 6th

d

ay. (Labs d

rawn d

ay before exam

if on Coum

adin/W

arfarin). Plavix/Effi

ent-off for 7 days, exam

on 8th day. Xarelto/Pletal for 24 hrs (restart

24 hours after the exam). **O

btain p

rescribing

doctor`s ap

proval to

hold m

eds**

Ultrasound

Thyroid: 60100, 77012


yRad

iologistYes

Yes,call for

specifics

No

CT,

Ultrasound

or

Fluoroscopy

Lung/Mediastinum

: 32405, 77012Liver: 47000, 77012Renal: 50200, 77012A

bdominal/Retroperitoneal M

ass:49180, 77012

Yes

Lung/Med

iastinum: 32405, 76942

Liver: 47000, 76942Renal: 50200, 76942A

bd

ominal/Retrop

eritoneal Mass:

49180, 76942

Lung/Med

iastinum: 32405, 77002

Liver: 47000, 77002Renal: 50200, 77002A

bd

ominal/Retrop

eritoneal Mass:

49180, 77002

41

INTERV

ENTIO

NA

Lw

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


Min

imally Invasive D

iagn

ostic Procedu

res


odality

CPT Cod

e(s)Perform

ed B

yEvaluationR

equired

Labs

Req

uiredSed

ationR

equired

Arthrogram

(shoulder, elbow

, wrist, hip, knee, and

ankle) Fluoroscop

y is used to p

lace a thin needle into

the symp

tomatic joint. D

ye is injected and

imag

es are ob

tained. In most cases ad

ditional im

ages are then

ob

tained using

MRI or C

T.Preps: N

o solid food or liquids 1 hour before exam. A

driver is recom

mended but not required. A

rrive 30 mins before exam

. Screen for all anticoagulants listed, and schedule appointm

ent based on the recom

mended days off of m

edication.

Coum

adin/Aspirin/A

ggrenox/Pradaxa-off for 5 days, exam on

6th day. PPT/PT/IN

R only needed if patient is on Coum

dain and

must be draw

n the STAT the day before exam.

Plavix/Effient-off for 7 days, exam

on 8th day.Xarelto/Pletal for 24 hrs (restart 24 hours after the exam

). **O

btain prescribing doctor`s approval to hold meds**

Fluoroscopy;

then MRI

or

CT

Up

per Joints

Shoulder: 73222, 23350, 73040, 77002Elb

ow: 73222, 24220, 73085, 77002

Wrist: 73222, 25246, 73115, 77002

Lower Joints

Hip

: 73722, 27093, 73525, 77002, 27095K

nee: 73722, 27370, 73580, 77002A

nkle: 73722, 27648, 73615, 77002

Interventional,Bod

y, orM

usculoskeletalRad

iologist

No

Only if

patient

is takingb

lood

thinners

No

Up

per Joints

Replace cod

e 73222 with

73201Low

er JointsRep

lace code 73722 w

ith 73701

Myelogram

(thoracic, lumb

ar) Fluoroscopy is used

to p

lace a thin needle into the sp

inal canal. Dye is injected

and

imag

es are obtained. In m

ost cases add

itional im

ages are then ob

tained using

CT.

Preps: No solid food or liquids 1 hour before exam

. A driver is

recomm

ended but not required. Arrive 30 m

ins before exam.

Screen for all anticoagulants listed, and schedule appointment

based on the recomm

ended days off of medication.

Fluoroscopy;

then CT

T-Spine: 62303, 72129

L-Spine: 62304, 72132

Use 62305 for 2 or 3 levels

Neurorad

iologistN

o

Only if

patient

is takingb

lood

thinners

No

Arthrocentesis (joint fluid asp

iration, joint tap, synovial fluid asp

iration) A need

le is placed

into a joint sp

ace and fluid

is removed

for diagnostic analysis or to

help relieve p

ain and p

ressure on the joint.Preps: N


driver is recom






edication.

Coum

adin/Aspirin/A

ggrenox/Pradaxa-off for 5 days, exam on

6th day. PPT/PT/IN

R only needed if patient is on Coum

dain and

must be draw

n the STAT the day before exam.

Plavix/Effient-off for 7 days, exam

on 8th day.Xarelto/Pletal for 24 hrs (restart 24 hours after the exam

). **O

btain prescribing doctor`s approval to hold meds**

Fluoroscopy

or

CT

Small Joint or Bursa (fing

ers, toes):20600, 77002Interm

ediate Joint or Bursa (TMJ,

acromioclavicular, w

rist, elbow

, ankle,olecranon b

ursa): 20605, 77002M

ajor Joint or Bursa (shoulder, hip,

knee, subacrom

ial bursa): 20610, 77002

Interventionalor

Body

Radiologist

No

No

No

Small Joint or Bursa (fing

ers, toes): 20600, 77012Interm

ediate Joint or Bursa (TMJ,

acromioclavicular, w

rist, elbow

, ankle,olecranon b

ursa): 20605, 77012M

ajor Joint or Bursa (shoulder, hip,

knee, subacrom

ial bursa): 20610, 77012


INTERV

ENTIO

NA

L

40

Pain Managem

ent


odalityCPT Code(s)

Performed By

EvaluationRequired

LabsRequired

SedationRequired

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.

Preps: All appointments m

ust have had a consult prior to exam. N

o solid food 6 hours before exam

, but clear liquids are permitted up until 2 hours before exam

. Must have

a responsible driver to drive you home. Arrive 60 m

ins before exam. Screen for all

anticoagulants listed, and schedule appointment based on the recom

mended days off

of medication. Send lab request for PTT,PT/IN

R, CBC w/ platelets to ordering provider.

Coumadin/Aspirin/Aggrenox/Pradaxa-off for 5 days, exam

on 6th day. (Labs drawn day

before exam if on Coum

dain/Warfarin). Plavix/Effi

ent-off for 7 days, exam on 8th day.

Xarelto/Pletal for 24 hrs (restart 24 hours after the exam). O

btain prescribing doctor`s approval to hold m

eds.Fluoroscopy

orC

T

T-Spine: 22510, each ad

d’l level

use 22512 (if biopsy is performed

on separate vertebrae, use 20225)L-Sp

ine: 22511, each add

’l level use 22512 (if biopsy is perform

ed on separate vertebrae, use 20225)

InterventionalRadiologist

Yes, may

require a consult.

Must have

either MRI

or CT+

Bone Scan p

rior to evaluation.

Yes,call for

specifics

YesKyphoplasty (thoracic, lum

bar) Fluoroscopy or CT guidance is used to place a needle into a fractured vertebra. Bone cem

ent is then injected to stabilize the fracture. Preps: All appointm

ents must have had a consult prior to exam

. No solid food 6 hours

before exam, but clear liquids are perm

itted up until 2 hours before exam. M

ust have a responsible driver to drive you hom

e. Arrive 60 mins before exam


ent based on the recomm

ended days off of m

edication. Send lab request for PTT,PT/INR, CBC w

/ platelets to ordering provider. Coum

adin/Aspirin/Aggrenox/Pradaxa-off for 5 days, exam on 6th day. (Labs draw

n day before exam

if on Coumdain/W

arfarin). Plavix/Effient-off for 7 days, exam

on 8th day. Xarelto/Pletal for 24 hrs (restart 24 hours after the exam

). Obtain prescribing doctor`s

approval to hold meds.

T-Spine: 22513, each ad

d’l level

use 22515 (if biopsy is performed

on separate vertebrae, use 20225)L-Sp

ine: 22514, each add

’l level use 22515 (if biopsy is perform

ed on separate vertebrae, use 20225)

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. Preps: All appointm

ents must have had a consult prior to exam

. No solid food 6 hours

before exam, but clear liquids are perm

itted up until 2 hours before exam. M


e. Arrive 60 mins before exam



ended days off of m

edication. Send lab request for PTT,PT/INR, CBC w

/ platelets to ordering provider. Coum

adin/Aspirin/Aggrenox/Pradaxa-off for 5 days, exam on 6th day. (Labs draw

n day before exam

if on Coumdain/W

arfarin). Plavix/Effient-off for 7 days, exam


). Obtain prescribing doctor`s

approval to hold meds.

CT

Unilateral: 0200T

Bilateral: 0201T


Yes, may

require a consult.

Must have

either MRI

or CT+

Bone Scan p

rior to evaluation.

Yes,call for

specifics

Yes

Epidural Blood PatchEpidural Blood Patch (EBP) is used to treat spinal headaches that are m

ost comm

only encountered after dural puncture. The blood patch acts as a gelatinous glue w

hich prevents cerebrospinal fluid (CSF) leakage and allow

s the dural hole to heal. Preps: N

o solid food or liquids 1 hour before exam. M

ust have a responsible driver. Arrive 30 m

ins before exam. Screen for all anticoagulants listed, and schedule appointm



edication.

Fluoroscopy62273, 77003

Neuroradiologist

Sometim

es, contact

interventional scheduling for

more info.

(520) 545-1906

Only if

patient

is takingb

lood

thinners

No


43

INTERV

ENTIO

NA

Lw

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Pain Managem

ent


odalityCPT Code(s)

Performed By

EvaluationRequired

LabsRequired

SedationRequired

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.

Preps: No solid food or liquids 1 hour before exam

. Must have a responsible

driver. Arrive 30 m

ins before exam. Screen for all anticoagulants listed, and

schedule appointm



Fluoroscopy

or

CT

Epidural: L-Spine: 62323N

erve Root/Block (per level/per side)L-Spine: 64483, 64484

Neuroradiologist

Yes

Only if

patientis taking

blood thinners

No

Epidural: L-Spine: 62323SI: 62323N

erve Root/Block (per level/per side)L-Spine: 64483, 64484

Joint Injection (lumbar facet and sacroiliac) Steroid m

edication is injected into the sym

ptomatic joint to decrease pain and sw

elling. Preps: N


driver is recom



. Screen

for all anticoagulants listed, and schedule appointment based on the

recomm


Fluoroscopy

or

CT

Lumbar Facet: 64493 (1st), 64494

(2nd), 64495 (3rd)Interventional

or BodyRadiologist

Yes

Only if

patientis taking

blood thinners

No

Sacroiliac (SI): 64493 (1st), 64494 (2nd), 64495 (3rd)

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 rem

oved for testing. Preps: N


driver is recom



. Screen

for all anticoagulants listed, and schedule appointment based on the

recomm


Fluoroscopy62270, 77003

Neuroradiologist

Yes, may

require aconsult. M

usthave eitherM

RI or CT.

Only if

patientis taking

blood thinners

No


Due to the sensitive nature of som

e interventional procedures, the following

services are usually performed by Radiology Ltd. staff

in a hospital setting:

• Angiogram

• Angioplasty

• Aortagram• A

rteriogram• Biliary Tube Change

• Biliary Dilation w

/o or w/Stent

• Biliary Drain

• Biopsy (renal / lung)• Catheter Placem

ent (renal / pelvis)• Catheter Stripping

• Cholangiogram (T-Tube)

• Fistulogram (dialysis or other

than dialysis)• G

astric Emptying Study

• IVC Filter Placement

• Loopogram

• Shuntogram• Stent• U

reteral Catheter or Stent • Venogram


INTERV

ENTIO

NA

L

42

Vascular Services


odalityCPT Code(s)

Performed By

EvaluationRequired

LabsRequired

SedationRequired

PICC Line Placement

Fluoroscopy and ultrasound areused to guide a catheter through avein in the arm

and then into theupper chest. The catheter is used forlong term

IV therapy and eliminates

the necessity for multiple needle

punctures.

Preps: Nothing to eat 2 hours before

exam. M


e. Arrive 30 mins

before exam. N

o labs required, and anticoagulants are ok.

Fluoroscopy&

Ultrasound

36569, 77001, 76937Interventional Technologist,

RN, or M

.D.

Yes

Only if

patientis taking

blood thinners

No

Radiology Ltd. offers tw

o interventional out-patient facilities in Tucson:

Radiology Ltd. La Cholla Center for D

iagnostic Imaging and Treatm

ent 5960 N

. La Cholla Blvd.

Radiology Ltd. Wilm

ot Center for D

iagnositc Imaging and Treatm

ent 677 N

. Wilm

ot Rd.


45

INTERV

ENTIO

NA

Lw

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.radltd.com


Drainage Tub

e / Stent Placement


odalityCPT Code(s)

Performed By

EvaluationRequired

LabsRequired

SedationRequired

Percutaneous Abscess D

rainageA

needle or catheter is placed through the skin to drain an infected collection in the body.

Preps: No solid food 6 hours before exam

. Clear

liquids are permitted up until 2 hours before

exam. M


e. Arrive 60 m


anticoagulants listed, and schedule appointment

based on the recomm


Send lab request for PTT, PT/INR, C

BC w

/platelets to ordering provider. Coum

adin/Aspirin/A

ggrenox/Pradaxa-off for 5 days, exam

on 6th day. (Labs drawn day before exam

if on Coum

adin/Warfarin). Plavix/Effi



). **Obtain prescribing doctor`s

approval to hold meds**

Modality

not specifiedfor these

procedures

Peritoneal / Retroperitoneal A

bscess: 49406

Visceral (e.g. kidney, liver, spleen, lung /m

ediastinum): 49405


YesYes,

call forspecifics

YesPercutaneous A

bscess Aspiration

A needle or catheter is placed through the skin to

drain an infected collection in the body.

Preps: No solid food 6 hours before exam

. Clear

liquids are permitted up until 2 hours before

exam. M


e. Arrive 60 m


anticoagulants listed, and schedule appointment

based on the recomm


Send lab request for PTT, PT/INR, C

BC w

/platelets to ordering provider. Coum

adin/Aspirin/A

ggrenox/Pradaxa-off for 5 days, exam

on 6th day. (Labs drawn day before exam

if on Coum

adin/Warfarin). Plavix/Effi



). **Obtain prescribing doctor`s

approval to hold meds**

CT,

Ultrasound

or

Fluoroscopy

77012, 10160 (subcutaneous, deep tissue, location site not specified)




ICD-10 CO

DES


REQUESTED TEXT CODEPlease use the spaces belowfor notes or additional codes

common in your practice.



ICD-10 CODES NOTES

47

INTERV

ENTIO

NA

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-9 COD

ESw

ww

.radltd.comICD

-10 COD

ESw

ww

.radltd.com


ICD-10 CODES NOTES





ICD-10 CO

DES






ICD-10 CODES NOTES

47

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

RADIOLOGY LTD. IS A PREFERRED PROVIDER FOR THE FOLLOWING INSURANCES

MAJOR INSURANCE PLANS • AARP Medicare Complete

(Formerly 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• Cenpatico• Cigna (excludes Health Springs HMO)• Cochise Health System• Department of Labor*• EverCare and Community Plan UHC*

(Formerly EverCare Select)• GEHA• Health Choice Arizona• Health Choice Generations• Health Net Allwell and Ambetter• Health Net Federal - TRICARE• Humana• Humana Community HMO• Humana Gold• Indian Health Services• Mail Handlers Benefit Plan (MHBP)• Mayo Health Plan Arizona• MDIA (Medrisk Data)*• Medicare• Mercy Care Healthcare Group• Meritain• OneCare• One Call Care Diagnostic*• UHC West (Formerly Pacificare)• Preferred Medical Claim Solutions• State Compensation Fund• United Medical Resources (UMR)• United Healthcare• United Healthcare Community Plan*

(Formerly APIPA)• United Healthcare Medicare Complete• University Family Care (AHCCCS)• University Physician Advantage• Vet 1 - TriWest (VA)

* Not contracted with Radiology Ltd. – Carondelet

If you need further assistancewith insurances, please call our

Insurance Billing Representatives at (520) 296-0278.

48

WE HAVE 8 IMAGING CENTERS TO SERVE YOU

Radiology Ltd. - Carondelet Imaging Center6567 E. Carondelet Dr., Suite 105Tucson, AZ 85710Tel: (520) 751-3096

4

Radiology Ltd. - Rincon Imaging Center10350 E. Drexel RoadTucson, AZ 85747Tel: (520) 290-4846

6

St. Joseph’s Imaging Center330 N. Wilmot Rd.Tucson, AZ 85710 Tel: (520) 290-4840

7

Wilmot Center for Diagnostic Imaging and Treatment

Wilmot Center for Women’s Imaging677 N. Wilmot Rd.Tucson, AZ 85711Tel: (520) 722-1832

8

Rancho Vistoso Diagnostic Imaging2551 E. Vistoso Commerce LoopOro Valley, AZ 85755Tel: (520) 825-1990

5La Cholla Center for Diagnostic Imaging and Treatment

La Cholla Center for Women’s Imaging5960 N. La Cholla Blvd.Tucson, AZ 85741Tel: (520) 797-3439

2

Midvale Imaging Center1598A West Commerce Ct.Tucson, AZ 85746Tel: (520) 290-4842

3

Camp Lowell Imaging Center4640 E. Camp Lowell Dr.Tucson, AZ 85712Tel: (520) 318-6144

1

ORANGE GROVE

TANGERINE

RIVERLA C

HO

LLA

LA C

AN

AD

A

OR

AC

LE

STON

E

ALV

ERN

ON

SWA

N

CR

AYCR

OFT

WILM

OT

KOLB

HO

UG

HTO

N

CAMP LOWELL

GRANT

SPEEDWAY

5TH ST.

BROADWAY

22ND ST

29TH ST

GOLF LINKS

VALENCIA

VALENCIA

IRVINGTON

IRVINGTON

OR

AC

LE

DREXEL

RANCHO VISTOSO

CA

MPB

ELL

THO

RN

YD

ALE

4

6

78

5

2

3

1

49

MODALITY BY LOCATIONC

AM

PLO

WEL

LLA

CH

OLL

ALA

CH

OLL

A

WO

MEN

’SM

IDVA

LER

AD

IOLO

GY

LTD

. -

CA

RON

DEL

ET

RA

NCH

O

VIS

TOSO

RA

DIO

LOG

Y LT

D. -

RI

NCO

N

ST.

JOSE

PH’S

WIL

MO

TW

ILM

OT

WO

MEN

’S

MRI

(H

igh-

Fiel

d)X

XX

XX

XX

MRI

(Esp

ree

X-La

rge

Ope

ning

)X

X

3T M

RIX

CTX

XX

XX

XX

PET

/ CT

X

Inte

rven

tiona

lX

X

Ultr

asou

ndX

XX

XX

XX

XX

Dig

ital

Mam

mog

raph

yX

XX

X

3D

Mam

mog

raph

yX

X

Brea

st B

iops

yX

XX

Brea

st M

RIX

X

Brea

st

Inte

rven

tiona

lX

X

DEX

A (B

one

Den

sito

met

ry)

XX

XX

Dig

ital X

-ray

XX

XX

XX

XX

X

50

WEEKEND MRI

To schedule your patient’s appointment,call (520) 733-7226.

Weekend MRIWeekend MRI is available for your patient’s

convenience at several of our Radiology Ltd. locations!

Radiology Ltd. o�ers a better choice in “open” MRIwith the Espree X-Large Opening MRI, available

at our Wilmot and La Cholla locations.

Radiology Ltd. o�ers 3T MRI3T MRI technology provides clinical advantages for prostate, abdominal imaging, small joints, and research studies. The

machine is centrally located at our Camp Lowell site.

WEEKEND MRI

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TECHNOLOGY

Radiology Ltd. has a nearly paperless and fully electronic workflow residing on state-of-the-art infrastructure, allowing rapid and seamless communication across locations throughout the organization. We 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.

CURRENT TECHNOLOGIES INCLUDE:

(Provider Portal) Images are available to the referring community within minutes of exam completion and can be viewed anywhere, anytime. Our systems 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• View new services and products,

including Clinical Decision Support and Alert Application

• Order patient exams• Access patient

reports from smartphones and tablets via our mobile app

(Patient Portal) Reports and images are available to patients 2 business days after their exam is read. Our portal is a useful and interactive tool which enables our patients to:

• Preregister for exam and fill out safety questionnaire to expedite check-in process on the day of exam

• Access reports and images• Access preparation instructions

for exam, along with the time and location of exam

• Access Continuing Care Document (CCD)

• Communicate directly with Radiology Ltd. staff in a secure, HIPAA-compliant environment

• View new services and products, including billing statements and online bill payment

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The ACR Appropriateness Criteria® (AC) are evidence-based guidelines to assist referring physicians and other providers

in making the most appropriate imaging or treatment decision for a specific clinical condition. Employing these

guidelines helps providers enhance quality of care and contribute to the most efficacious use of radiology.

The list can be found here: https://acsearch.acr.org/list

ACR Appropriateness Criteria

ordering guide - radltd.com · 01 why this guide is important to you and your patients this...

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