ORDERING GUIDE - Radiology Ltd.

1 ORDERING GUIDEThis ORDERING GUIDE is meant to assist you when ORDERING a study with Radiology Ltd. The GUIDE includes common indications as well as recommendations for the most appropriate is our goal to provide you and your patients with the most appropriate and complete imaging examination. After the correct order is placed, examinations are further tailored to each patient s specific condition. Thus, it is very important for the radiologist to be aware of the clinical question or specific condition in question so that the appropriate imaging can be ORDERING an examination please include pertinent history as well as signs or symptoms. Please refrain from ORDERING r/o exams such as rule out tumor or rule out anomaly unless history and signs/symptoms are included as well.

2 Feel free to specify a particular entity or condition you would like the Radiologist to comment upon in the have also included a list of most commonly used ICD-9 codes. Please note that this is not a complete list so you may need to refer to your most current ICD-9-CM and ICD-10-CM code book for the most appropriate code. The note section at the end of the ICD-9 codes list allows you to add additional codes that are commonly used in your the back of the GUIDE , you will find a list of our contracted insurance and network plans as well as our imaging centers, addresses and phone numbers. Radiology Ltd. also has a Professional Relations Department with field representatives dedicated to serving your needs. If you have any questions or concerns, please contact the Professional Relations Department at (520) 901-6614 or at you,The Physicians and Staff of Radiology THIS GUIDE IS IMPORTANTTO YOU AND YOUR PATIENTS1 PATIENT BILLING Tel: (520) 296-0278 Secure Online Bill Pay: RELATIONS Tel: (520) 901-6614 Fax: (520) 545-1726 Email: Supplies: Tel: (520) 733-4104 Email: Tel: (520) 901-6747 Fax: (520) 901-6634 Toll Free Tel: (866) 386-9459 Website: Hours Tech Support: Tel: (520) 545-1720 OTHER IMPORTANT NUMBERSAUTHORIZATION VERIFICATION Tel: (520) 901-6767 Fax: (520) 545-1981 CODING & PRICING HOTLINE Tel: (520) 545-1818 Online Requests: HOTLINE Tel: (520) 545-1969 Toll Free Tel: (866) 683-2199 MEDICAL RECORDS Tel: (520) 545-1822 Fax.

3 (520) 326-7989 Online Requests: SCHEDULING Tel: (520) 733-7226 Fax: (520) 290-8377 STAT Hotline: (520) 545-1919 Toll Free: (866) 565-2220 Toll Free Fax: (866) 707-0750 NEED HELP OR HAVE QUESTIONS ABOUT WHAT TO ORDER?CLINICAL REVIEW Tel: (520) 545-1819 Fax: (520) 545-1844 specialty SCHEDULINGBREAST BIOPSY Tel: (520) 901-6792 Fax: (520) 545-1848 BREAST MRI Tel: (520) 901-6631 Fax: (520) 901-6746 INTERVENTIONAL COORDINATION Tel: (520) 545-1906 Fax: (520) 545-1898 PET / CT Tel: (520) 545-1906, opt. 3 Fax: (520) 545-1898 IMPORTANT CONTACT INFORMATION2 Digital X-rays are done on a walk-in CONTENTSDIGITAL IMAGINGCPT Codes for Women s ORDERING Decision & Diagnostic Imaging & / / CTACPT Codes for CT & / MRACPT Codes for MRI & (including Arthrography).

4 33 INTERVENTIONALM inimally Invasive Diagnostic Tube / Stent , Nutritional & System & SenseOrgan & Connective & & Adverse Codes CODESICD-10 Codes PROVIDER INFORMATIONM ajor Insurance Network X-rays are done on a walk-in DESCRIPTIONCPT CODE Chest 1 View71010 Chest 2 Views71020 Chest Minimum 4 Views71030 Chest Special Views71035 Ribs Unilateral 2 Views71100 Ribs Unilateral 2 Views with PA CXR71101 Ribs Bilateral 3 Views71110 Sternum Minimum 2 Views71120 Sternoclavicular Joints 3 Views71130 Abdomen 1 View74000 Abdomen AP, Additional Oblique + Cone Views74010 Abdomen Complete74020 Abdomen Complete + PA CXR74022 Hip Unilateral 1 View73500 Hip Unilateral Minimum 2 View73510 Hips Bilateral 2 Views + AP Pelvis73520 Pelvis 1 or 2 Views72170 Pelvis Minimum 3 Views72190 Pelvis & Hips Infant / Child up to 11 years old73540 Sacrum & Coccyx Minimum 2 Views72220 Sacroiliac Joints 3+ Views72202 Finger(s) Minimum 2 Views73140 Hand 2 Views73120 Hand Minimum 3 Views73130 Wrist 2 Views73100 Wrist Minimum 3 Views73110 Forearm 2 Views730904 DIGITAL X-RAY: GeneralDigital X-rays are done on a walk-in basis.

5 The digital X-ray CPT codes are for reference only. This does not imply protocol standards for all Radiology facilities. Information is subject to X-RAYD igital X-rays are done on a walk-in X-rays are done on a walk-in X-RAY: GeneralDigital X-rays are done on a walk-in basis. The digital X-ray CPT codes are for reference only. This does not imply protocol standards for all Radiology facilities. Information is subject to DESCRIPTIONCPT CODE Upper Extremity Infant (up to 364 days old) Minimum 2 Views73092 Elbow 2 Views73070 Elbow Minimum 3 Views73080 Humerus Minimum 2 Views73060 Shoulder 1 View73020 Shoulder Minimum 2 Views73030 Acromioclavicular Joints Bilateral73050 Clavicle Complete73000 Scapula Complete73010 Toe(s) Minimum 2 Views73660 Foot 2 Views73620 Foot Minimum 3 Views73630 Calcaneus Minimum 2 Views73650 Ankle 2 Views73600 Ankle Minimum 3 Views73610 Tibia & Fibula 2 Views73590 Lower Extremity Infant (up to 364 days old) 2+ Views73592 Knee 1 or 2 Views73560 Knee 3 Views73562 Knee 4 or More Views73564 Both Knees Standing AP73565 Femur 2 Views73550 Bone Age Studies77072 Bone Length Studies77073 Osseous Complete (Bone Survey)

6 77075 Mandible < 4 Views70100 Mandible 4 Views70110 DIGITAL X-rays are done on a walk-in X-rays are done on a walk-in X-RAY: GeneralDigital X-rays are done on a walk-in basis. The digital X-ray CPT codes are for reference only. This does not imply protocol standards for all Radiology facilities. Information is subject to DESCRIPTIONCPT CODE Screening Orbit (Pre MRI)70030 Facial Bones < 3 Views70140 Facial Bones Minimum 3 Views70150 Nasal Bones Minimum 3 Views70160 Orbits Minimum 4 Views70200 Sinuses Paranasal < 3 Views70210 Sinuses Paranasal Minimum 3 Views70220 Skull < 4 Views70250 Skull Minimum 4 Views70260 Neck Soft Tissue70360 C-Spine 2 or 3 Views72040 C-Spine Minimum 4-572050 C-Spine Complete 6 or more72052 T-Spine 2 Views72070 T-Spine 3 Views72072 L/S Spine 2 or 3 Views72100 L/S Spine Minimum 4 Views72110 L/S Spine Complete With Bending Views (Minimum 6 Views)72114 L/S Spine Bending Views (Only 2-3 Views)72120 Spine, Entire, AP & Lateral72010 Thoracolumbar Spine Standing (Scoliosis)

7 72069 Scoliosis Study Including Supine and Erect 72090 Thoracolumbar AP & Lateral72080 Our care is unsurpassed, withphysicians available 24 hours a day,7 days a week, 365 days a schedule an appointment, call (520) 733-7226 or fax (520) schedule an appointment, call (520) 733-7226 or fax (520) : Bone DensitometryThis is for reference only. This does not imply protocol standards for all Radiology facilities. Information is subject to INDICATIONSPROCEDURECODE Post Menopause Early Surgical Menopause Long-Term Current Use of Other Medication Long-Term Current Use of Steroid Treatment Vertebral Abnormalities Follow-Up Treatment for Prevention /Monitoring of OsteoporosisDEXA 77080 Hips, Spine (axial skeleton) DEXA with Vertebral Fracture AssessmentDEXA77085 Vertebral Fracture AssessmentDEXA77086 DEXA Body Composition StudyDEXA76499 Radiology Ltd.

8 Is committed tothe health of southern Arizonaby providing the most comprehensiveimaging and interventional services. 7 BREAST schedule an appointment, call (520) 733-7226 or fax (520) VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED MAMMOGRAPHYG0202 - DIGITAL SCREENING77052 - CAD FOR SCREENING77063 - SCREENING BREAST 3D TOMOSYNTHESISDIAGNOSTIC MAMMOGRAPHYUNILATERALG0206 - UNILATERAL DIGITAL DIAGNOSTIC77051 - CAD FOR DIAGNOSTIC77061 - UNILATERAL BREAST 3D TOMOSYNTHESISDIAGNOSTIC MAMMOGRAPHYBILATERALG0204 - BILATERAL DIGITAL DIAGNOSTIC77051 - CAD FOR DIAGNOSTIC77062 - BILATERAL BREAST 3D TOMOSYNTHESISULTRASOUND76641 - UNILATERAL COMPLETE76642 - UNILATERAL LIMITED76882 - AXILA ALONESTEROTACTIC LOCALIZATIONGUIDANCE FOR BREAST BIOPSYCODING VARIES DEPENDING ON THE PROCEDURE.

9 PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED GUIDED NEEDLECORE BREAST BIOPSYCODING VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED DENSITY SCAN77080 - DEXA SCAN77086 - DEXA WITH VERTEBRALFRACTURE ASSESSMENTBREAST MRI77059 & 0159T - BILATERAL BREAST MRIUTERINE FIBROID EMBOLIZATION (UFE)CODING VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED more information on exam codesand pricing, please contact the Radiology and Pricing Hotline at (520) CODES for WOMEN S IMAGINGThis is for reference only. This does not imply protocol standards for all Radiology facilities. Information is subject to IMAGINGTo schedule an appointment, call (520) 733-7226 or fax (520) schedule an appointment, call (520) 733-7226 or fax (520) ORDERINGDECISION TREEDoes the patient have a problem?

10 Palpable lesion / focal painNegativeAnnual screening mammogram 30 years old Nipple discharge (reproducible, single duct, bloody or serous) Extra views needed (call back)per radiologist recommendation: Diagnostic order requiredDiagnostic mammogramw/breastultrasound, if clinicallyindicatedSUSPICIOUS:Order breast biopsyPROBABLYBENIGN:Order 6 monthfollow-up diagnostic mammogramNEGATIVE: Return to annual screening mammogramCyst aspiration (can be performed at time of examw/ referring providerapproval)Order diagnostic mammogramw/breast ultrasoundOrder diagnostic mammogram w/ breast ultrasoundSUSPICIOUS: Order breast biopsy NEGATIVE: Surgical consultation to consider need for ductographyYESDIAGNOSTIC MAMMOGRAPHY 3D TomosynthesisNOSCREENING MAMMOGRAPHY (beginning at age 40) 3D Tomosynthesis<30years old breast ultrasound only 9 BREAST schedule an appointment, call (520) 733-7226 or fax (520) ORDERINGDECISION TREEHIGH RISK PATIENTHigh risk patients including those who: Have a known BRCA1 or BRCA2 gene mutation Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves Have a lifetime risk of breast cancer of 20% to 25% or greater.