Transcription of Contrast vs. No Contrast Reference Sheet Head/Neck
1 Scheduling: or Fax: Web Site: Contrast vs. No Contrast Reference Sheet Head/Neck Body Part Reason for Exam Procedure to Pre-Cert CPT. Code Brain Alzheimer's/Confusion/Dementia MRI Brain without Contrast 70551. Headache/Migraine Memory Loss Mental Status Changes Seizures Stroke, CVA, TIA. Trauma Brain Cranial Nerve Lesions MRI Brain without and with 70553. F/U Lesion/Mass Contrast IAC/Hearing Loss/Tinnitus/Vertigo Infection Metastatic Disease Multiple Sclerosis Neurofibromatosis Pituitary Brain Fiducials MRI Brain with Contrast 70552. Gamma Knife Planning Circle of Willis Stroke/CVA/TIA MRA Head without Contrast 70544. (COW) Aneurysm Carotid Stroke/CVA/TIA MRA neck without Contrast 70547. Carotid Stenosis > 60% on Doppler MRA neck without and with 70549. Ultrasound Contrast Intracranial Venous Thrombosis MRV Head without and with 70546.
2 Venous Sinus Contrast Orbits Optic Neuritis MRI Orbits/Face/ neck without 70543. Exophthalmos, Proptosis and with Contrast Pseudotumor/Mass/Cancer/Mets Vascular Lesions Visual Disturbances neck -Soft Tissue Infection MRI Orbits/Face/ neck without 70543. Tumor/Mass/Cancer/Mets and with Contrast Vocal Cord Paralysis 6/14. Scheduling: or Fax: Web Site: Contrast vs. No Contrast Reference Sheet Spine Body Part Reason for Exam Procedure to Pre-Cert CPT. Code Spine: Cervical Degenerative Disease MRI Cervical Spine without Contrast 72141. Disc Herniation Extremity Pain/Weakness neck Pain Radiculopathy Trauma Spine: Cervical Discitis MRI Cervical Spine without and with 72156. Mass/Lesion Contrast Osteomylitis Spine: Thoracic Back Pain MRI Thoracic Spine without Contrast 72146.
3 Compression Fx Disc Herniation Radiculopathy Trauma Spine: Thoracic Discitis MRI Thoracic Spine without and with 72157. Mass/Lesion Contrast Osteomylitis Spine: Lumbar Back Pain MRI Lumbar Spine without Contrast 72148. Compression Fx Disc Herniation Radiculopathy Stenosis Trauma Spine: Lumbar Discitis MRI Lumbar Spine without and with 72158. Mass/Lesion Contrast Osteomylitis Post Lumbar Surgery (<10. yrs). 6/14. Scheduling: or Fax: Web Site: Contrast vs. No Contrast Reference Sheet MSK. Body Part Reason for Exam Procedure to Pre-Cert CPT. Code Extremity, Non Fracture/Stress Fracture MRI Non-Joint without Contrast Joint: Muscle/Tendon Tear Upper Extremity 73218. Forearm Lower Extremity 73718. Hand/Finger Humerus Foot/Toes Lower Leg Thigh Extremity, Non (Venous Injection) MRI Non-Joint without and with Contrast Joint: Abscess Upper Extremity 73220.
4 Forearm Cellulitis Lower Extremity 73720. Hand/Finger Morton's Neuroma Humerus Osteomylitis Foot/Toes Soft Tissue Tumor/Mass Lower Leg Ulcer Thigh Extremity, Joint: Arthritis MRI Joint without Contrast Elbow Cartilage Tear Upper Extremity 73221. Shoulder Fracture/Stress Fracture Lower Extremity 73721. Wrist Internal Derangement Ankle Joint Pain Hip Ligament Tear Knee Meniscal Tear Muscle/Tendon Tear Extremity, Joint: (Venous Injection) MRI Joint without and with Contrast Elbow Abscess Upper Extremity 73223. Shoulder Cellulitis Lower Extremity 73723. Wrist Osteomylitis Ankle Tumor/Mass Hip Ulcer Knee Joint: Arthrogram Intra-articular Injection MRI Joint with Contrast Upper Extremity 73222. Lower Extremity 73722. Pelvis - MSK Muscle/Tendon Tear MRI Pelvis without Contrast 72195.
5 Pelvic Pain Sacrum/ Coccyx SI Joints Pelvis MSK Abscess/Ulcer MRI Pelvis without and with Contrast 72197. Osteomylitis Scheduling: or Fax: Web Site: Contrast vs. No Contrast Reference Sheet Body Body Part Reason for Exam Procedure to Pre-Cert CPT. Code Abdomen MRCP MRI Abdomen without Contrast 74181. Adrenals Abdomen Kidneys MRI Abdomen without and with Contrast 74183. Liver Mass MRE. Abdomen MRA Renal Arteries MRA Abdomen without and with Contrast 74185. Mesenteric Ischemia Brachial Plexus Brachial Plexus Neuropathy MRI Chest without Contrast 71550. Chest MRA Thoracic Aorta MRA Chest without and with Contrast 71555. Vascular Anomalies Subclavian Vessels Chest Mediastinum Hilar/mediastinal adenopathy MRI Chest without Contrast 71550. AC Joint Pain SC Joint Pain Scapula Sternum Chest Mediastinum Infection MRI Chest without and with Contrast 71552.
6 Mass Metastatic Disease Pelvis - Female Adenomyosis MRI Pelvis without Contrast 72195. Endometriomas Menses Problems Pelvic Pain Uterine Anomalies Pelvis - Female Adnexal Mass MRI Pelvis without and with Contrast 72197. Endometrial CA. Known Fibroids Ovarian CA. Ovarian Cysts Pre-embolization work-up Uterine Artery Embolus 6/14.
