2021 CPT Code Exam Ordering Guide

1 Everyone s choice for CPT Code ExamOr dering GuideT 858 658 6500F 866 558 4329IH S Radiology Medical Group - Tax ID# 47-3394746 EXAM TO ORDECRPT CODESYMPTOMS/CONCERNSMRI brain - post fossa w/ & w/o contrast (IAC w/ & w/o) Bell s Palsy Hearing loss Vertigo70553 MRI brain (pituitary protocol) w/ & w/o contrast Hormone abnormalities Pituitary70553 MRI brain (seizure protocol) w/ & w/o contrast Seizures - multiple early onset70553 MRI brain and orbits w/ & w/o contrast Loss of vision Ocular mass or tumor Optic neuritis Visual disturbance70553, 7 054 3 MRI brain w/ & w/o contrast Brain tumor Dizziness Headaches (depends on Meningitisassociated clinical history) Metastatic brain disease Multiple sclerosis Seizures70553 MRI brain w/o contrast Ataxia CVA Dementia Headaches (depends on Traumatic brain injury associated clinical history)(chronic)

2 70551 MRI brain w/o contrast and MRA or MRV Personal or family history of aneurysm Severe headache Subarachnoid hemorrhage70551, 7054 4 MRI (facial bones, orbits, neck soft tissue) w/ & w/o contrast Tumor, mass, swelling, or infection of the soft tissue neck7054 3 HEAD/NECK & NEUROMRIEXAM TO ORDECRPT CODESYMPTOMS/CONCERNSABDOMEN & PELVISMRI abdomen w/ & w/o contrast MRA abdomen w/ or w/o contrast Abdominal pain Any complaint related to liver, spleen, pancreas or kidneys Hypertension Renal artery stenosis74183 74185 MRI abdomen w/ & w/o contrast w/ MRCP Gall stones Cholangitis Biliary tumor or pancreatitis Common bile duct or gallbladder concerns Pancreatic duct74183.

3 7 6377 MRI abdomen and pelvis w/ & w/o contrast Crohn s disease Inflammatory bowel disease Ischemic bowel disease74183 Abdomen w/ & w/o 72197 Pelvis w/ & w/oMRI pelvis w/o contrast Coccyx fracture Pelvic fracture Pubic arthralgia Sacral fracture Sacroiliitis Sports hernia Stress fracture (Pelvis)72195 MRI pelvis and prostate gland w/ & w/o contrast Prostate cancer screening, staging or follow up72197 EXAM TO ORDECRPT CODESYMPTOMS/CONCERNSMRI pelvis female GYN w/ & w/o contrast Adenomyosis Cervical cancer Dermoid Family history of uterine Fibroid or ovarian malignant tumor Infection or tumor Ovarian disease Post menopausal bleeding UFE planning Uterine mass Vaginal cancer72197 MRI pelvis w/ & w/o contrast Non-gynecological tumor or infection Non-specific pelvic pain72197 MRI cervical spine w/ & w/o contrast Demyelination.

4 Infection MS Suspected tumor of cervical spinal cord72156 MRI cervical spine w/o contrast Benign cervical spine Cervical neck pain Compression fracture (Cervical Spine) Degenerative disc disease Disk herniation 72141 MRI lumbar spine w/ & w/o contrast Malignancy Failed back syndrome Pathologic compression fracture (Lumbar Spine)72158 PELVISSPINE*If prior lumbar surgery (within 10 years), r/oinfection, or bone mets then MRI lumbar spinew/ & w/o contrast. Radiculopathy EXAM TO ORDECRPT CODESYMPTOMS/CONCERNSMRI lumbar spine w/o contrast Compression fracture Degenerative disk disease Disk herniation Low back pain > 6 weeks Radiculopathy Sciatica 72148 MRI thoracic spine w/o contrast Compression fracture benign (Thoracic Spine)

5 Degenerative disk disease Disk herniation Thoracic back pain72146 MRI thoracic spine w/o & w/contrast Demyelinating disease Thoracic tumor Infection 72157 MRI arthrogram , Knee Knee pain with concern for unstable osteochondral lesion Knee pain with prior arthroscopy73722 MRI joint LOWER extremity w/ contrast27369 Arthro injection77002 Fluoro guidanceMRI arthrogram , Shoulder Shoulder pain after disl ocation or concern for labral tear Shoulder pain after rotator cuff or labral repair73222 MRI joi nt UPPER extremity w/ contrast23350 Arthro injection77002 Fluoro guidanceSPINEARTHROGRAMMRI (joint) UPPER extremity w/o contrast Evaluate for bony or soft tissue pathology Internal derangement occult Joint pain73221 MRI (non joint) UPPER extremity w/o contrast Fracture to non-joint extr emity Lipoma Myositis Nonspecific pain Soft tissue injury Stress response73218 MRI (non joint)

6 UPPER extremity w/ & w/o contrast Contrast indicated for tumor or infection of extremity only73220 EXTREMITY UPPEREXAM TO ORDERCPT CODESYMPTOMS/CONCERNSMRI (joint) LOWER extremity w/o contrast Evaluate for bony or soft tissue pathology Internal derangement occult Joint pain73721 MRI (non joint) LOWER extremity w/o contrast Fracture to non-joint extremity Lipoma Myositis Nonspecific pain Soft tissue injury Stress response73718 MRI (non joint) LOWER extremity w/ & w/o contrast Contrast indicated for tumor or infection of extremity only73720 EXTREMITY LOWERBRAIN wo 70551w/wo 70553 Brain MRA (wo) 70544 ORBITS/FACE (PITUITARY, IACS)wo 70540w/wo 70543 TMJ (wo) 70336 PETROUS/TEMPORAL BONE (IAC)wo 70480 SPINE, CERVICALwo 72141w/wo 72156 SPINE, THORACICwo 72146w/wo 72157 SPINE, LUMBARwo 72148w/wo 72158 CHESTwo 71550w/wo 71552 Chest MRA (for Brachial Plexus) 71555 ABDOMENwo 74181w/wo 74183 Abdomen MRA (w/wo) 74185 UPPER EXTREMITYNON JOINT(HUMERUS, FOREARM, HAND)wo 73218w/wo 73220 JOINT(SHOULDER, ELBOW, WRIST)

7 Wo 73221w/wo 73223 MRI ARTHROGRAMSh oulder 23350, 77002, 73222 Elbow 24220, 77002, 73222 Wrist 25246, 77002, 73222LO WER EXTREMITYNON JOINT(THIGH, CALF, FOOT)wo 73718w/wo 73720 JOINT(HIP, KNEE, ANKLE)wo 73721w/wo 73723 MRI ARTHROGRAMHip 27093, 77002, 73722Kn ee 27370, 77002, 73722 Ankle 27648, 77002, 73722 NECK, SOFT TISSUEwo 70540w/wo 70543MR Angio (w/) 70549 COMBINATION CODESB rain MRI & MRA 70553, 70544 Brain & Orbi ts w/wo 70553, 70543 PELVISwo 72195w/wo 72197 BREASTw/wo Unilateral 77048 Bilateral 77049 ABBREVIATION KEYwo = without IV contr astw/ = with IV contr astw/wo = with & without IV contrast *These CPT codes represent the most commonly ordered CT exams.

8 For any coding inquiry not listed please call your Marketing Team Member at 858 658 6500. MRI ANATOMY - CPT CODESCTEXAM TO ORDERCPT CODESYMPTOMS/CONCERNSCT head, brain w/ & w/o contrast Ataxia Brain tumor CVA Dementia Headaches(Contrast - depends on associated cli nical history)70470CT head, brain w/o contrast Ataxia CVA Dementia Headaches Normal pressure Traumatic brain injury hydrocephalus (NPH) (acute)(Contrast - depends on associated cli nical history)70450CT maxillofacial w/o contrast Possible fracture Trauma70486CT orbit w/o contrast Fracture Swelling Trauma70480CT sinus w/o contrast Facial pain Sinusitis70486CT soft tissue neck w/ contrast Lymphadenopathy Mass Swelling 70491CT soft tissue neck w/o contrast Contraindication to iodine (consider MRI)

9 Salivary gland stone70490CT temporal bones w/o contrast Earache Cholesteatoma Hearing loss70480 HEAD/NECK & NEUROEXAM TO ORDERSYMPTOMS/CONCERNSCPT CODECT angiography chest Pulmonary embolism Aneurysm Chest pain Dyspnea Elevated D-Dimer Ascending aorta or aortic arch dissection71275CT chest high-resolution chest w/ o contra st Interstitial lung dis ease71250CT low dose lung screening Low dose lung cancer screening Asymptomatic patients only Patient age between 55-77 years Less than 15 years since quit smokingCT chest w/ contrastPreferred Abnormal chest x-ray Adenopathy Chest pain Cough Pleural effusion Pneumonia Foll ow up for known neoplasm Lung cancer Dyspnea Pulmonary mass 71260CT chest w/o contrast Nodule follow-up Contraindication to iodine71250CT abdomen w/ & w/o contrast Adrenal mass Hepatic mass (dedicated liver study) Pancreatic mass Renal mass74170 Pancreatitis Upper abdominal painCT abdomen w/o contrast Contraindication to iodine (consider MRI)

10 74150 CHESTABDOMEN Minimum 30-Pack Year smoker Requires completion of CT Low Dose Screening Request Form71271 EXAM TO ORDECRPT CODESYMPTOMS/CONCERNSCT abdomen/pelvis w/ contrast (w/ oral contrast, unless specified)Preferred Abdominal distension Abdominal pain (upper or lower) Adenopathy Appendicitis Bowel obstruction Cancer or perforation Constipation Diverticulitis Lymph node enlargement Mass Pelvic pain74177CT abdomen/pelvis w/o contrast (w/ oral contrast, unless specified) Abdominal or pelvic pain Contraindication to iodine (consider MRI)74176CT abdomen/pelvis w/o contrast (w/o oral contrast) - renal ston e study Flank pain Suspected renal stones or follow-up 74176CT colonography diagnostic Failed or contraindication to traditional colonoscopy due to: - Rectal bleeding, tortuous colon, or