Use this reference to quickly determine the correct exam ...

1 Body PartProcedure for Pre-authorizationcPt codeindication for ct exam or StudycontraStSPecct headCT Head without contrast70450 TraumaHeadachesCVAS troke/BleedAlzheimer sMemory Loss/ConfusionShunt CheckHydrocephalusTIAC hange in Mental StatusDizziness/VertigoNo ContrastneuroCT Head with and without contrast(Note: MRI Brain may be preferred study if patient is able. Consult the radiologist.)70470 Metastases/known cancer (MRI preferable)Yes Contrastneurocta head (Circle of Willis)CTA Brain with and without contrast70496 Aneurysm 3rd nerve palsyFamily history of aneurysm Vascular malformationYes Contrastneuroct orBitSCT Orbits without contrast70480 Trauma Foreign BodyFracture Bony AbnormalitiesNo ContrastneuroCT Orbits with and without contrast70481 Infection PainAbscess/Cellulitis Mass/Tumor/CancerYes Contrastneuroct SinuSCT Sinus without contrast70486 Sinusitis CongestionMass Nasal PolypsPain Deviated SeptumForeign Body Sinus HeadacheNo Contrastneuroct face

2 (From orbits to mandible)CT Maxillofacial without contrast70486 Trauma FracturePain Bony AbnormalityNo ContrastneuroCT Maxillofacial with contrast70487 Tumor InfectionSwelling/Mass in Face AbscessYes Contrastneuroct temPoral BoneS/maStoidSCT Temporal Bones without contrast70480 Hearing Loss Drainage in EarTinnitus (ringing in ears) MassCholesteatomaNo ContrastneuroCT Temporal Bones with and without contrast70482 Acoustic Neuroma (When there are contraindications for MRI) Yes Contrastneuroct neckCT Soft tissue neck with contrast70491 Focal Mass DysphagiaSwollen Lymph Nodes GoiterLymphoma Esophageal CancerYes ContrastneuroCT Soft tissue neck with and without contrast70492 Salivary gland stoneAs Determined by Radiologistneurocta neck arterieSCT Angiography Neck with and without contrast 70498 Carotid stenosisStroke/CVA/TIAB ruitAbnormal carotid sonogramYes Contrastneuroct aBdomen: GeneralCT Abdomen with contrast74160 Abdominal Pain MassRUQ or LUQ pain Weight LossAbnormal U/S HerniaNeoplasm TraumaYes ContrastBodyct aBdomen & PelviS.

3 General(From lung bases to pubis)CT Abdomen with contrast74177 Mass Weight LossAbdominal Pain/Pelvic Pain HerniaRLQ or LLQ Pain TraumaAppendicitis Rectal BleedingLymphoma Constipation/ObstructionNausea/Vomiting/ Diarrhea IBD (Inflammatory Bowel Disease)Bloody Stool METSD iverticulitis Ovarian Cancer StagingDiverticulosis Prostate/Colon Cancer StagingAbnormal U/S NeoplasmAll cancer staging except Melanoma or carcinoidYes ContrastBodyCT Abdomen without contrast 1 or bothwith contrast 1 or both74178 Cancer staging for Melanoma or carcinoidYes ContrastBodyct PelviS.

4 General(From iliac crest to pubis)CT Pelvis with contrast72193 LLQ or RLQ Pain Ovarian CancerPelvic Pain Umbilical HerniaGroin Pain TraumaAbnormal Pelvic U/S Adnexal MassPelvic MassYes ContrastBodycte aBdomen & PelviS enterograPhyCT Abdomen with contrast74177 Crohn s DiseaseSuspected Small Bowel TumorsMesenteric/Intestinal BleedingSuspected GI BleedingEvaluation of Bowel PatencyYes ContrastBodyct cheSt: GeneralCT Chest with contrast71260 Abnormal CXR NeoplasmAdenopathy AbscessPneumonia Pulmonary noduleCough Enlarged Aortic ArchHemoptysis Lung LesionSarcoidosis LymphadenopathyHilar Abnormality Asbestos ExposureHx Cancer/Tumor/Mets Shortness of BreathChest Pain Abdominal Aortic AneurysmPulmonary Embolism Thoracic AneurysmAortic DissectionYes ContrastBodyhigh reSolution cheStCT Chest with and without contrast.

5 High resolution71270 Interstitial Disease COPD/EmphysemaFibrosis Asbestos ExposureBronchiectasisAs Determined by RadiologistBodyct extremitieSUpper(hand, wrist, elbow, radius/ulna, humerus, shoulder)ct extremitieSLower(foot, ankle, knee, hip, tibia/fibula, femur)Dual Study:CT Upper Extremity with contrastCT Lower Extremity with contrast7320173701 InfectionTumor/Mass/Cancer/Mets(MRI is more sensitive)Yes ContrastorthoDual Study: CT Upper Extremity without contrastCT Lower Extremity without contrast7320073700 Pain FusionArthritis MalunionFractureNo Contrastorthoct SPineTriple Study:CT cervical without contrastCT Thoracic without contrastCT Lumbar without contrast721257212872131 Pain FractureTrauma post -op/FusionDegenerative disc diseaseNo Contrastneuroct PelviS/hiPSacetaBulumCT Pelvis with contrast72193 Soft Tissue Mass InfectionTumor/Mets CellulitisAbscessYes ContrastorthoCT Pelvis without contrast(Note: MRI Pelvis may be preferred study in some circumstances.)

6 Consult the radiologist.)72192 Pain ArthritisFracture Bone LesionsCancer/MetsNo Contrastorthoct liverCT Abdomen with and without contrast(Note: MRI Abdomen may be preferred study in some circumstances. Consult the radiologist.)74170 Increased LFTs HepatomaRUQ Pain HemachromatosisAbnormal Abdominal U/S HemangiomaJaundice HepatitisHistory of liver cancer Cirrhosis Liver transplantYes ContrastBodyrenal StoneCT Abdomen & Pelvis without contrast74176 Hematuria StoneFlank plain ProstatitisLow back pain DysuriaUrinary frequency No ContrastBodytri-PhaSe renalCT Abdomen with and without contrast74170 Hematuria Renal Failure/Mass/TransplantFlank Pain HypertensionHydronephrosis History of renal cancerLow back pain

7 History of stonesAbnormal U/S Polycystic kidney diseaseYes ContrastBodyct urogram(Urinary System, kidneys to bladder)CT Abdomen without contrast 1 or bothwith contrast 1 or both74178 Abnormal Cystogram History of Renal CancerPainless Hematuria Abnormal Renal U/SBladder Mass or Tumor Suspected Renal MassYes ContrastBodyadrenalCT Abdomen with and without contrast74170 Adrenal MassYes ContrastBodycta aBdomenCTA Abdominal with and without contrast74175 Abdominal Aortic Aneurysm (AAA) TraumaRenal Artery Stenosis Abnormal U/SDissection post Stent GraftingRetroperitoneal Bleed Mesenteric IschemiaYes ContrastBodyCT 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 include creatinine levels for patients over 60 or with history of renal failure.

8 If not available, you can schedule the patient at WR Garner, WR Chapel Hill or WR Cary and we will check their levels for you.