MRI EXAM CPT CODE REFERENCE - Wake …

1 STUDYCPT DESCRIPTIONCPT CODEINDICATIONS FOR EXAM OR STUDYCONTRASTREQUIRED?SPECIALTYMRI BRAIN MRIMRI Brain without contrast70551 Alzheimer s Stroke/CVAM ental status change TIA (transient ischemic attack)Confusion TraumaDementia Dizziness/VertigoMemory Loss HeadachesSuspected MSNoNeurologyMRI Brain with and without contrast70553 Tumor/Mass/Cancer Pituitary lesionCranial nerve lesions Acoustic neuromaHIV/AIDS Syringomyelia (Syrinx)Infection Visual changeMS (Multiple Sclerosis) MetastasesNeurofibromatosis Vascular lesions (AVM)Hearing loss/IAC mass Bell s palsy (facial weakness)Ye sNeurologyMRA BRAIN Arterial CirculationCircle of Willis (COW)

2 MRA Brain without contrast70544 Aneurysm, family historyTransient ischemic attack (TIA)Stroke/CVA (cerebrovascular accident)NoNeurologyMRA BRAINV enous circulationMRA Brain with and without contrast70546 Venous/Sinus thrombosis Vascular lesion (AVM) Venous circulatory symptomsDetermined by radiologistNeurologyMRA NECKMRA Neck with and without contrast70549 Bruit DizzinessStroke CVA (cerebrovascular accident)Transient ischemic attack (TIA) Abnormal dopplerYe sNeurologyMRI ORBITSI ncludes brain plus cuts thru the orbitsMRI Brain with and without contrast70553 Trauma PseudotumorGrave s disease Tumor/Mass/Cancer/MetsExopthalmos/Propto sis Vascular lesions (Hemangioma)Ye sNeurologyMRI NECKSoft TissueMRI Orbits/Face/Neck with and without contrast70543 Infection Tumor/Mass/Cancer/MetsPain Vocal cord paralysisYe sNeurologyMRI SPINE CervicalMRI Cervical Spine without contrast72141 Neck pain NumbnessArm/Shoulder pain Degenerative disk diseaseDisk herniation (HNP) RadiculopathyNoNeurologyMRI Cervical Spine with and without contrast72156 Syringomyelia (Syrinx) MyelopthyDiscitis (disk infection) Multiple Sclerosis (MS)Osteomyelitis Tumor/Mass/Cancer/MetsYe sNeurologyMRI SPINE ThoracicMRI Thoracic Spine without contrast72146 Back Pain TraumaDegenerative disk disease Compression fractureDisk herniation (HNP)

3 (no history of malignancy) Radiculopathy NoNeurologyMRI Thoracic Spine with and without contrast72157 Syringomyelia (Syrinx) MyelopthyDiscitis (disk infection) Multiple Sclerosis (MS)Osteomyelitis Tumor/Mass/Cancer/MetsYe sNeurologyMRI SPINE LumbarMRI Lumbar Spine without contrast72148 Back/leg pain Sciatica/radiculopathyDegenerative disk disease SpondylolisthesisDisk herniation (HNP) Spinal stenosisRadiculopathy Compression fractureTrauma ScoliosisNoNeurologyMRI Lumbar Spine with and without contrast72158 Discitis (disk infection) Post-op hx of back surgeryOsteomyelitis Tumor/Mass/Cancer/MetsYe sNeurologyMRI LUMBOSACRAL PLEXUSMRI Pelvis without contrast72195 Leg pain/Sciatica Lumbar plexopathyRadiculopathy Sacral/Coccyx painNoNeurologyMRI BRACHIAL PLEXUSMRI Upper Extremity Non-joint with and without contrast73220 Shoulder injury Brachial plexopathyNerve avulsionDetermined by RadiologistNeurologyMRI CHESTM ediastinumMRI Chest/Mediastinum with and without contrast71552 Tumor/Mass/Cancer/MetsYe sBodyMRA CHESTT horacic aortaMRA Chest with and without contrast71555 Long-term surveillance of type B dissectionYe sBodyMRA ABDOMENA ortaMRA Abdomen with or without contrast74185 Chronic known abdominal aneurysmYe sBodyMRA AORTAWith peripheral runoffMRA Abdomen with and without contrast MRA

4 Lower Extremity with or without contrast74185 73725 Peripheral vascular disease ClaudicationYe sBodyMRA ABDOMENR enal arteryMesenteric arteriesMRA Abdomen with and without contrast74185 Uncontrollable hypertension Renal artery stenosis Mesenteric arterial stenosisYe sBodyMRI ABDOMEN MRI Abdomen with or without contrast74183 Tumor/Mass/Cancer/Mets Organ must be specified Abdominal pain at time of schedulingYe sBodyMRI ABDOMEN Liver - routineMRI Abdomen with or without contrast74183 Hepatitis Abnormal liver function testHemangioma Characterization of any liverlesion seen on other imagingYe sBodyMRI ABDOMEN Liver - EovistMRI Abdomen with or without contrast74183 CirrhosisHepatoma surveillanceEmbolization plannng and post therapy surveillanceYe sBodyMRI ABDOMEN KidneysMRI Abdomen with or without contrast74183 Hematuria (blood in urine) Renal mass (cyst or solid) Transitional cell carcinoma of kidneyAbnormal findings on other imaging studiesYe sBodyMRI ABDOMEN AdrenalMRI Abdomen with and without contrast74183 Adrenal mass or lesion HypertensionPheochromocytomaDetermined by RadiologistBodyMRI ABDOMEN MRCP - BiliaryMRI Abdomen with and without contrast74183 Abdominal pain JaundiceBiliary obstruction Abnormal enzymesDuctal stonesYe sBodyMRI ABDOMEN MRCP - PancreasMRI Abdomen with and without contrast74183 Pancreatitis Increased liver function testsPancreas mass Painless jaundiceCholangiocarcinoma Ampulla evaluationPrimary Sclerosing Cholangitis (PSC)

5 Ye sBodyMRA PELVISI liac vesselsMRA Pelvis with and without contrast72198 Pelvic venous thrombosisYe sBodyMRI PELVIS Soft tissueMRI Pelvis with and without contrast72197 Fibroid Pre/Post-Uterine Fibroid Embolization (UFE)Adenomyosis EndometriomaInfertility Ovarian massYe sBodyMR ENTEROGRAPHYDual Study:MRI Abdomen with and without contrastMRI Pelvis with and without contrast7418372197 Crohn s disease Crohn s fistulous diseaseCeliac disease (Sprue) Small bowel tumor Yes and glucagonBodyBREAST MRIMRI Breast Bilateral with and/or without contrastCAD for Breast MRI770590159 TNewly diagnosed breast cancer Family history of breast cancerBRCA1 or BRCA2 genes (Some criteria may apply)Ye sBreastIMPLANT BREAST MRIMRI Breast Bilateral with and/or without contrast77059 Silicone implant surveillance/RuptureNoBreastMRI EXTREMITY,NON-JOINT:ForearmHumerusLower Leg/CalfFemur/ThighMRI Non-Joint without contrast:Upper ExtremityLower Extremity7321873718 FractureStress fractureMuscle or tendon tearNoOrthopedicMRI Non-Joint with and without contrast.

6 Upper ExtremityLower Extremity7322073720 Abscess MyositisUlcer OsteomyelitisTumor/Mass/Mets Cellulitis Soft tissue tumor or mass Ye sOrthopedicMRI EXTREMITYJOINT: UPPERHandWristElbowShoulderSC Joint LOWERFootAnkleKneeHipMRI Joint without contrast:Upper ExtremityLower Extremity7322173721 Arthritis Meninscal tearAvascular necrosis (AVN) Muscle tearStress fracture Ligament tearInternal derangement Cartilage tearJoint pain Ostochondritis dissecans (OCD)Labral tearNoOrthopedicMRI Joint with and without contrast:Upper ExtremityLower Extremity7322373723 Abscess OsteomyelitisUlcer Inflammatory arthritisCellulitis Septic arthritisPlantar fasciitis Tumor/Mass/MetsMyositis Morton s neuromaYe sOrthopedicMRI PELVIS/HIP(BONY)

7 MRI Pelvis without contrast72195 Fracture TraumaHip/Pelvis pain Muscle/Tendon tearNoOrthopedicMRI Pelvis with and without contrast72197 Tumor/Mass/Cancer/Mets Septic arthritisOsteomyelitis AbscessYe sOrthopedicMRA UPPER EXTREMITYMRA Upper Extremity with and without contrast73225 Subclavian TendernessRedness or swellingYe sOrthopedicBodyMRA LOWER EXTREMITYMRA Lower Extremity with and without contrast73725 Peripheral vascular diseaseYe sOrthopedicBodyMR ARTHROGRAMU pper ExtremityShoulderElbow WristMRI Upper Extremity Joint with contrast73222 Slap tear Ligament InjuryLoose body Tunnel syndromeTFCC tearLabral tear (contrast given at ordering provider s discretion) Ye sOrthopedicMR ARTHROGRAML ower ExtremityHipKneeAnkleMRI Lower Extremity Joint with contrast73722 Labral tear (contrast given at ordering providers discretion)Femoroacetabular impingement (FAI)Loose bodyOsteochondritis dissecans lesion (OCD)Ye sOrthopedicMRI EXAM CPT code REFERENCEUse this REFERENCE to quickly determine the correct exam for your patients based on the indications described herein and the CPT for the review the MRI safety checklist with each patient.

8 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.