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)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)

2 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, 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 )

3 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, 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.

4 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) 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)

5 UPPER extremity w/o contrast Fracture to non-joint extr emity Lipoma Myositis Nonspecific pain Soft tissue injury Stress response73218 MRI (non joint) 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)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/)

6 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. 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)

7 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)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)

8 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 inability to tolerate sedation74261CT colonography screening Colon cancer screening 74263CT small bowel w/ contrast (w/ oral contrast) Anemia Bowel obstruction Chronic GI bleed Crohn s disease Small bowel mass74177CT urogram w/ & w/o contrast Dysuria Flank pain Hematuria UTIs74178 abdomen & PELVISEXAM TO ORDERCPT CODESYMPTOMS/CONCERNSCT cervical spine w/o contrast Compression fracture Neck pain Trauma (Cervical Spine) 72125CT lumbar spine w/o contrast Compression fracture (Lumbar Spine) Low back pain Trauma (Lumbar Spine)72131CT extremity LOWER w/o contrast Fracture Pain Swelling73700CT extremity UPPER w/o contrast Fracture Pain Swelling73200 SPINEOTHERBRAIN / HEADwo 70450w/wo 70470 CTA Brain/Head (w/)

9 70496 ORBITSwo 70480w/ 70481w/wo 70482 PETROUS/TEMPORAL BONE (IAC)wo 70480 SELLA (PITUITARY)w/wo 70482 SINUSESwo 70486w/wo 70488 NECK, SOFT TISSUEwo 70490w/ 70491w/wo 704923-D RECONSTRUCTIONAdd to Any Exam76377 UPPER EXTREMITYwo 73200w/wo 73202 LOWER EXTREMITYwo 73700w/wo 73702 Angio (w/wo) 73706 CHESTw/ 71260wo 71250 Angio (w/) 71275 ABDOMENwo 74150w/wo 74170 Angio / AAA (w/) 74175 Angio Aorta Runoff (w/) 75635 COMBINATION CODESNECK, chest , abdomen , PELVISw/wo 70491, 71260, 74178 chest , abdomen , PELVISwo 71250, 74176w/wo 71260, 74178 SPINEC ervical wo 72125 Thoracic wo 72128 Lumbar wo 72131 ABBREVIATION KEYwo = without IV contrastw/ = with IV contrastw/wo = with & without IV contrastCACS = Coronary Artery Calcium ScoreCCTA = Coronary CT AngiogramLUNGLow Dose Lung Screening 71271CT COLONOGRAPHYS creening 74263 Diagnostic 74261 BONE DENSITY SCREENINGQCT 77078 HEARTCACS (wo) 75571 CCTA (w/) 75574 CACS & CCTA (wo/w) 75574 PELVISwo 72192w/ 72193 abdomen AND PELVISw/wo 74178 Renal Stone (wo) 74176 Urogram (w/wo) 74178 Small Bowel (w/wo) 74178 chest AND ABDOMENw/wo71260, 74170 abdomen AND pelvis (ANGIO)w/wo 74175, 72191 *These CPT codes represent the most commonly ordered CT exams.

10 For ancoding inquiry not li ste d please cal l for assistance 858 658 ANATOMY - CPT CODESEXAM TO ORDECRPT CODESYMPTOMS/CONCERNSUS neck soft tissue Palpable head, face or neck mass (describe area)76536US thyroid or neck Goiter Palpable neck mass (describe on head, face, or neck) Parotid, abnormal thyroid tests Thyroidmegaly76536US chest Palpable mass, chest wall and upper back (describe location) Pleura - Fluid76604 NECKCHESTABDOMENUS abdominal complete Abnormal li ver tests Ascites Epigastr ic pain Fatty liver Hepatitis Jaundice Nausea Pain Test includes the liver, pancreas, gallbladder, kidneys, aorta, and spleen. If abdominal and kidney (renal) are ordered together use abdomen (76700) and 76700US abdominal LTD Inguinal hernia Quadrant pain Single organ evaluation such as liver or gallbladder Palpable mass lower abdominal and lower back (describe location)76705 LTD (76857) to include bladder images.