MRI EXAM CPT CODE REFERENCE

1 MRI EXAM CPT CODE REFERENCE . Use this REFERENCE to quickly determine the correct exam for your patients based on the indications described herein and the CPT for the order. Please review the MRI safety checklist with each patient. Notify WR Express Scheduling if your patient has a history of renal failure. Creatinine levels can be obtained prior to contrasted studies, if needed, at most Wake Radiology MRI locations. Call if you have any questions 919-232-4700. For their comfort, IV sedation is available for your patients upon request. Patients receiving sedation cannot drive drive after the appointment and must be accompanied by a driver or make arrangements to be driven home.

2 CPT CONTRAST. STUDY CPT DESCRIPTION. CODE. INDICATIONS FOR EXAM OR STUDY SPECIALTY. REQUIRED? MRI BRAIN MRI MRI Brain without contrast 70551 Alzheimer's Stroke/CVA No Mental status change TIA (transient ischemic attack). Confusion Trauma Dementia Dizziness/Vertigo Neurology Memory Loss Headaches Suspected MS. MRI Brain with and without contrast 70553 Tumor/Mass/Cancer Pituitary lesion Yes Cranial nerve lesions Acoustic neuroma HIV/AIDS Syringomyelia (Syrinx). Infection Visual change Neurology MS (Multiple Sclerosis) Metastases Neurofibromatosis Vascular lesions (AVM). Hearing loss/IAC mass Bell's palsy (facial weakness).

3 MRA BRAIN MRA Brain without contrast 70544 Aneurysm, family history No Arterial Circulation Transient ischemic attack (TIA) Neurology Circle of Willis (COW) Stroke/CVA (cerebrovascular accident). MRA BRAIN MRA Brain with and without contrast 70546 Venous/Sinus thrombosis Vascular lesion (AVM) Determined by Neurology Venous circulation Venous circulatory symptoms radiologist MRA NECK MRA Neck with and without contrast 70549 Bruit Dizziness Yes Stroke CVA (cerebrovascular accident). Neurology Transient ischemic attack (TIA). Abnormal doppler MRI ORBITS MRI Brain with and without contrast 70553 Trauma Pseudotumor Yes Includes brain plus Grave's disease Tumor/Mass/Cancer/Mets Neurology cuts thru the orbits Exopthalmos/Proptosis Vascular lesions (Hemangioma).

4 MRI NECK MRI Orbits/Face/Neck with and without 70543 Infection Tumor/Mass/Cancer/Mets Yes Neurology Soft Tissue contrast Pain Vocal cord paralysis MRI SPINE MRI Cervical Spine without contrast 72141 Neck pain Numbness No Cervical Arm/Shoulder pain Degenerative disk disease Neurology Disk herniation (HNP) Radiculopathy MRI Cervical Spine with and without 72156 Syringomyelia (Syrinx) Myelopthy Yes contrast Discitis (disk infection) Multiple Sclerosis (MS) Neurology Osteomyelitis Tumor/Mass/Cancer/Mets MRI SPINE MRI Thoracic Spine without contrast 72146 Back Pain Trauma No Thoracic Degenerative disk disease Compression fracture Neurology Disk herniation (HNP) (no history of malignancy).

5 Radiculopathy MRI Thoracic Spine with and without 72157 Syringomyelia (Syrinx) Myelopthy Yes contrast Discitis (disk infection) Multiple Sclerosis (MS) Neurology Osteomyelitis Tumor/Mass/Cancer/Mets MRI SPINE MRI Lumbar Spine without contrast 72148 Back/leg pain Sciatica/radiculopathy No Lumbar Degenerative disk disease Spondylolisthesis Disk herniation (HNP) Spinal stenosis Neurology Radiculopathy Compression fracture Trauma Scoliosis MRI Lumbar Spine with and without 72158 Discitis (disk infection) Post-op hx of back surgery Yes Neurology contrast Osteomyelitis Tumor/Mass/Cancer/Mets MRI LUMBOSACRAL MRI Pelvis without contrast 72195 Leg pain/Sciatica Lumbar plexopathy No Neurology PLEXUS Radiculopathy Sacral/Coccyx pain MRI BRACHIAL MRI Upper Extremity Non-joint with and 73220 Shoulder injury Brachial plexopathy Determined by Neurology PLEXUS without contrast Nerve avulsion Radiologist MRI CHEST MRI Chest/Mediastinum with and without 71552 Tumor/Mass/Cancer/Mets Yes Body Mediastinum contrast MRA CHEST MRA Chest with and without contrast 71555 Long-term surveillance of type B dissection Yes Body

6 Thoracic aorta MRA ABDOMEN MRA Abdomen with or without contrast 74185 Chronic known abdominal aneurysm Yes Body Aorta MRA AORTA MRA Abdomen with and without contrast 74185 Peripheral vascular disease Yes With peripheral MRA Lower Extremity with or without 73725 Claudication Body runoff contrast MRA ABDOMEN MRA Abdomen with and without contrast 74185 Uncontrollable hypertension Yes Renal artery Renal artery stenosis Body Mesenteric arteries Mesenteric arterial stenosis MRI ABDOMEN MRI Abdomen with or without contrast 74183 Tumor/Mass/Cancer/Mets Organ must be specified Yes Abdominal pain at time of scheduling Body MRI ABDOMEN MRI Abdomen with or without contrast 74183 Hepatitis Abnormal liver function test Yes Liver - routine Hemangioma Body Characterization of any liverlesion seen on other imaging MRI ABDOMEN MRI Abdomen with or without contrast 74183 Cirrhosis Yes Liver - Eovist Hepatoma surveillance Body Embolization plannng and post therapy surveillance MRI ABDOMEN MRI Abdomen with or without contrast 74183 Hematuria (blood in urine) Renal mass (cyst or solid)

7 Yes Kidneys Transitional cell carcinoma of kidney Body Abnormal findings on other imaging studies MRI ABDOMEN MRI Abdomen with and without contrast 74183 Adrenal mass or lesion Hypertension Determined by Body Adrenal Pheochromocytoma Radiologist MRI ABDOMEN MRI Abdomen with and without contrast 74183 Abdominal pain Jaundice Yes MRCP - Biliary Biliary obstruction Abnormal enzymes Body Ductal stones MRI ABDOMEN MRI Abdomen with and without contrast 74183 Pancreatitis Increased liver function tests Yes MRCP - Pancreas Pancreas mass Painless jaundice Cholangiocarcinoma Ampulla evaluation Body Primary Sclerosing Cholangitis (PSC).

8 MRA PELVIS MRA Pelvis with and without contrast 72198 Pelvic venous thrombosis Yes Body Iliac vessels MRI PELVIS MRI Pelvis with and without contrast 72197 Fibroid Pre/Post-Uterine Fibroid Embolization (UFE) Yes Soft tissue Adenomyosis Endometrioma Body Infertility Ovarian mass MR Dual Study: enterography MRI Abdomen with and without contrast 74183 Crohn's disease Crohn's fistulous disease Yes Body MRI Pelvis with and without contrast 72197 Celiac disease (Sprue) small bowel tumor and glucagon BREAST MRI MRI Breast Bilateral with and/or without 77059 Newly diagnosed breast cancer Yes contrast Family history of breast cancer Breast CAD for Breast MRI 0159T BRCA1 or BRCA2 genes (Some criteria may apply).

9 IMPLANT BREAST MRI Breast Bilateral with and/or without 77059 Silicone implant surveillance/Rupture No MRI contrast Breast MRI EXTREMITY, MRI Non-Joint without contrast: Fracture No NON-JOINT: Upper Extremity 73218 Stress fracture Orthopedic Forearm Lower Extremity 73718 Muscle or tendon tear Humerus Lower Leg/Calf MRI Non-Joint with and without contrast: Abscess Myositis Yes Femur/Thigh Upper Extremity 73220 Ulcer Osteomyelitis Orthopedic Lower Extremity 73720 Tumor/Mass/Mets Cellulitis Soft tissue tumor or mass MRI EXTREMITY MRI Joint without contrast: Arthritis Meninscal tear No JOINT: Upper Extremity 73221 Avascular necrosis (AVN) Muscle tear UPPER Lower Extremity 73721 Stress fracture Ligament tear Hand Internal derangement Cartilage tear Wrist Orthopedic Joint pain Ostochondritis dissecans (OCD).

10 Elbow Labral tear Shoulder SC Joint MRI Joint with and without contrast: Abscess Osteomyelitis Yes LOWER Upper Extremity 73223 Ulcer Inflammatory arthritis Foot Lower Extremity 73723 Cellulitis Septic arthritis Orthopedic Ankle Plantar fasciitis Tumor/Mass/Mets Knee Myositis Morton's neuroma Hip MRI PELVIS/HIP MRI Pelvis without contrast 72195 Fracture Trauma No (BONY) Hip/Pelvis pain Muscle/Tendon tear Orthopedic MRI Pelvis with and without contrast 72197 Tumor/Mass/Cancer/Mets Septic arthritis Yes Orthopedic Osteomyelitis Abscess MRA UPPER MRA Upper Extremity with and without 73225 Subclavian Tenderness Yes Orthopedic EXTREMITY contrast Redness or swelling Body MRA LOWER MRA Lower Extremity with and without 73725 Peripheral vascular disease Yes Orthopedic EXTREMITY contrast Body MR ARTHROGRAM MRI Upper Extremity Joint with contrast 73222 Slap tear Ligament Injury Yes Upper Extremity Loose body Tunnel syndrome Shoulder TFCC tear Orthopedic Elbow Labral tear