GUIDELINES FOR. Advanced. Imaging Studies

Transcription

1 GUIDELINES FOR Advanced Imaging Studies

2 Locations Herrin Hospital Memorial Hospital of Carbondale St. Joseph Memorial Hospital 201 S 14th Street Herrin, IL ext General Radiography* CT Interventional Radiology MRI NUCLEAR MEDICINE PET Ultrasound 405 W Jackson Street Carbondale, IL ext General Radiography* CT Interventional Radiology MRI NUCLEAR MEDICINE PET Ultrasound 2 S Hospital Drive Murphysboro, IL ext General Radiography* Bone Density CT MRI Ultrasound Centralized Scheduling ext FAX ext sih.net/imaging

3 BENTON Benton Professional Building 203 Bailey Lane Benton, IL ext General Radiography* Ultrasound HERRIN Herrin Logan Primary Care 405 Rushing Drive Herrin, IL ext General Radiography* Bone Density *General Radiology is walk-in, but all other diagnostic procedures must be scheduled in advance. CARBONDALE Center for Medical Arts 2601 W Main Street Carbondale, IL x25227 or General Radiography* Monday-Friday, Bone Density Monday Friday, CT Monday-Friday, Ultrasound Monday-Friday, Ultrasound WEST FRANKFORT Miners Memorial Health Center 2553 Ken Gray Boulevard West Frankfort, IL ext 4 General Radiography* Monday- Friday, Bone Density Monday-Friday, West Frankfort Logan Primary Care 502 W Saint Louis Street West Frankfort, IL ext General Radiography* Monday-Friday, sih.net/imaging 1

4 Abdomen/ Pelvis Study ContraST AAA (Acute) CT None W/O Contrast CPT Code: AAA (Non-Acute) W/O Contrast CPT Code: Adrenal Mass CT IV Only W & W/O Contrast CPT Code: Abdomen Diverticulitis, Pain, (CT) IV & W Contrast CPT Code: Colitis, Cancer Staging, Abdomen Oral & Pelvis Appendicitis CT Abd. IV Contrast W Contrast only CPT Code: & Pelvis Oral Hematuria CT IV Contrast W & W/O Contrast CPT Code: Urogram Hypervascular Liver Mass MRI IV Only W & W/O Contrast CPT Code: Abdomen Renal Mass (Confirmed) CT IV Only W & W/O CPT Code: Abdomen 2 sih.net/imaging

5 Abdomen/Pelvis Continued ContraST Study Renal Stone, Painful CT Abd No Contrast W/O Contrast CPT Code: Hematuria & Pelvis Pancreatic Mass (suspected) CT IV Contrast W & W/O Contrast CPT Code: Abdomen Pelvic Pain-Female US Pelvis non-ob CPT Code: US US TV non-ob CPT Code: MRI IV Contrast W & W/O Contrast CPT Code: CT IV Contrast W Contrast CPT Code: Pelvic Pain-Male CT Pelvis IV & W & W/O Contrast CPT Code: CT Pelvis IV W & W/O Contrast CPT Code: Prostatitis CT Pelvis IV W Contrast only CPT Code: Prostate/BPH/Cancer MRI Pelvis IV Contrast W & W/O Contrast CPT Code: Renal Arteries CTA IV Contrast W & W/O Contrast CPT Code: Abdomen Renal Donor CTA IV contrast W & W/O Contrast CPT Code: Renal Donor Testicles US first, IV Contrast Scrotum CPT Code: then MRI IV Contrast W & W/O Contrast CPT Code: sih.net/imaging 3

6 Brain & Head Study ContraST Acute Bleed CT No Contrast W/O Contrast CPT Code: Alzheimers MRI No Contrast W/O Contrast CPT Code: Aneurysm MRA No Contrast W/O Contrast CPT Code: Aneurysm CTA IV Contrast With Contrast CPT Code: Base of Skull MRI IV Contrast W & W/O Contrast CPT Code: Cranial Nerve MRI IV Contrast W & W/O Contrast CPT Code: Dementia (Under age 50) MRI No Contrast W/O Contrast CPT Code: Dementia (Over age 50) MRI IV Contrast W & W/O Contrast CPT Code: ENT Dizziness MRI IV Contrast W/O Contrast CPT Code: Headaches (Acute) CT No Contrast W/O Contrast CPT Code: Chronic headache more than MRI IV Contrast W & W/O Contrast CPT Code: day, patient over age 50 Chronic headache more than MRI No Contrast W/O Contrast CPT Code: day, patient under age 50 Hemorrhage (Non-Acute) MRI IV Contrast W & W/O Contrast CPT Code: Hydrocephalus MRI IV Contrast W & W/O Contrast CPT Code: (Normal Pressure) IAC MRI IV Contrast W & W/O Contrast CPT Code: Infection/Meningitis MRI IV Contrast W & W/O Contrast CPT Code: sih.net/imaging

7 Brain & Head Continued MRI better than CT for chronic headaches with atypical symptoms such as numbness, weakness, etc. Study ContraST Multiple Sclerosis/ MRI IV Contrast W & W/O Contrast CPT Code: Demyelinating Disease Pituitary Tumors MRI IV Contrast W & W/O Contrast CPT Code: Seizures (New Onset) MRI IV Contrast W & W/O Contrast CPT Code: Seizures or Epilepsy (Chronic) MRI No Contrast W/O Contrast CPT Code: Sella Tursica MRI IV Contrast W & W/O Contrast CPT Code: Stroke (Acute) CT First No Contrast W/O Contrast CPT Code: MRI No Contrast W/O Contrast CPT Code: Brain Attack Stroke (Non Acute > 72 hours) MRI IV Contrast W & W/O Contrast CPT Code: Syncope (Acute or Urgent) CT No Contrast W/O Contrast CPT Code: Syncope (Chronic) MRI No Contrast W/O Contrast CPT Code: Subarachnoid Bleed CT No Contrast W/O Contrast CPT Code: Trauma CT No Contrast W/O Contrast CPT Code: Tumor/Mets MRI IV Contrast W & W/O Contrast CPT Code: Venous Sinus Thrombosis MRI IV Contrast W & W/O Contrast CPT Code: (Suspected) MRV W & W/O Contrast CPT Code: sih.net/imaging 5

8 Chest Study ContraST Brachial Plexus MRI Chest IV Contrast W & W/O Contrast CPT Code: MRI Upper Ext IV Contrast W & W/O Contrast CPT Code: Calcium Scoring CT Heart No Contrast W/O Contrast CPT Code: Coronary Artery/Pulmonary CTA Heart IV Contrast With Contrast CPT Code: Vein Evaluation Interstitual Lung Disease CT No Contrast W/O Contrast CPT Code: (Fibrosis) Mass or Nodule (New) CT IV Contrast With Contrast CPT Code: Mass or Nodule (Follow up) CT No Contrast W/O Contrast CPT Code: Pulmonary Embolus CTA IV Contrast With Contrast CPT Code: Dissection CTA IV Contrast With Contrast CPT Code: sih.net/imaging

9 Musculoskeletal Study ContraST Arthrogram Elbow MRI IV Contrast With Contrast CPT Code Arthrogram Knee MRI IV Contrast With Contrast CPT Code: Arthrogram Hip MRI IV Contrast With Contrast CPT Code: Arthrogram Shoulder MRI IV Contrast With Contrast CPT Code: Arthrogram Wrist MRI IV Contrast With Contrast CPT Code: sih.net/imaging 7

10 Musculoskeletal Continued Study ContraST Lower Extremity (Muscular, MRI No Contrast Bone, Fracture, Plantar Fasciitis) Ankle, Knee, Toe, Hip Joint W/O Contrast CPT Code: Foot, Thigh No Joint W/O Contrast CPT Code: Lower Extremity (Cellulitis, MRI IV Contrast Osteomyelitis, Necrotizing Faciitis or mass) Ankle, Knee, Toe Joint W & W/O Contrast CPT Code: Foot, Thigh, Tibula, Fibula No Joint MRI W & W/O Contrast CPT Code: Lower Extremity (Aterial/Venous) CTA IV Contrast With Contrast CPT Code: Lower Extremity (Bone) CT W & W/O Contrast CPT Code: Upper Extremity (Muscular, MRI No Contrast Bone, or Fracture) Elbow, Finger, Shoulder, Wrist Joint MRI W/O Contrast CPT Code: Hand, Humerus, Forearm No Joint MRI W/O Contrast CPT Code: Upper Extremity (Cellulitis, MRI IV Contrast Osteomyelitis, Necrotizing Fasciitis or mass) Elbow, Finger, Shoulder, Wrist Joint MRI W & W/O Contrast CPT Code: Hand, Humerus, Forearm No Joint MRI W & W/O Contrast CPT Code: Upper Extremity (Arterial/Venous) CTA IV Contrast With Contrast CPT Code: Upper Extremity (Bone) CT No Contrast W/O Contrast CPT Code: sih.net/imaging

11 Neck, Sinus, Skull, Base & Orbit CT and MRI are interchangeable in the head and neck. CT has disadvantage of radiation and contrast while MRI does not show bony structures as well. On occasion, both may be necessary. Study ContraST Carotid Stenosis Carotid No Contrast CPT Code: Duplex (Screening) CTA IV Contrast W & W/O Contrast CPT Code: (Diagnosis) Cavernous Sinus MRI IV Contrast W & W/O Contrast CPT Code: sih.net/imaging 9

12 Neck, Sinus, Skull, Base & Orbit Continued Study ContraST Facial (Soft Tissue) CT IV Contrast W Contrast CPT Code: MRI W & W/O Contrast CPT Code: Facial (Trauma/Bone) CT No Contrast W/O Contrast CPT Code: Larynx CT IV Contrast W Contrast CPT Code: MRI W & W/O Contrast CPT Code: Neck (Blood Flow) CTA IV Contrast W Contrast CPT Code: Neck (Mass/Soft Tissue) CT IV Contrast W Contrast CPT Code: MRI W & W/O Contrast CPT Code: Optic (Nerve) MRI IV Contrast W & W/O Contrast CPT Code: Orbit-(Soft tissue) CT IV Contrast W & W/O Contrast CPT Code: MRI W & W/O Contrast CPT Code: Orbits-(Trauma/Bone) CT No Contrast W/O Contrast CPT Code: Salivary Gland CT IV Contrast W & W/O Contrast CPT Code: Sinusitis CT No Contrast W/O Contrast CPT Code: Squamous Cancer CT IV Contrast W & W/O Contrast CPT Code: Temporal Bone CT No Contrast W/O CPT Code: TMJ MRI No Contrast W/O Contrast CPT Code: Vocal Cord Paralysis CT IV Contrast W & W/O Contrast CPT Code: sih.net/imaging

13 Spine Study ContraST Cervical (Disc disease, pain, MRI No Contrast W/O Contrast CPT Code: radiculopathy, trauma) Cervical (Trauma/Fracture CT No Contrast W/O Contrast CPT Code: or bone) Cervical (Tumor, Infection, MS MRI IV Contrast W & W/O Contrast CPT Code: Syrinx, Transverse Myelitis) Thoracic (Disc disease, pain, MRI No Contrast W/O Contrast CPT Code: radiculopathy, trauma, pre-kyphoplasty) Thoracic (Trauma/Fracture CT No Contrast W/O Contrast CPT Code: or bone) Thoracic (Tumor, Infection, MS MRI IV Contrast W & W/O Contrast CPT Code: Syrinx, Transverse Myelitis) Lumbar (Disc HNP disease, MRI No Contrast W/O Contrast CPT Code: pain, radiculopathy, trauma, pre-kyphoplasty Lumbar (Trauma/Fracture CT No Contrast W/O Contrast CPT Code: or bone) Lumbar (Tumor, Infection, MRI IV Contrast W & W/O Contrast CPT Code: MS Syrinx, Transverse Myelitis, pre-kyphoplasty sih.net/imaging 11

14 Best Modality MRI is best for: Joint, Soft Tissue Injury or Infection Arthrogram Brachial Plexus Brain Tumor or Metastases Cervical Non Trauma IAC s Lumbar Non Trauma Multiple Sclerosis Parkinson s Pituitary/Sella/Orbits Thoracic Non Trauma Characterization of known liver masses Biliary Imaging Female Pelvis Hypervascular liver lesions PET/CT is best for: Cancer Follow-Up Cancer Staging/Restaging CT is best for: Abdominal Aortic Aneurysm Brain/Head Trauma C-Spine Trauma Calcium Scoring Facial Bones/Orbit Trauma Interstitial Lung Disease Intracranial hemorrhage Lung Nodule Abdominal & Pelvic Pain Pulmonary Embolism Renal Mass/Stone Sinus Soft Tissue Neck Carotid/Renal Artery (CTA) Pancreatic Mass Ultrasound is best for: RUQ Pain Pelvic Mass/Pain (female) Evaluation of Pregnancy Thyroid 12 sih.net/imaging

15 Considerations when ordering an MRI study: An MRI unit uses strong magnetic forces to create an image, as opposed to radiation (CT, X-Ray) or sound waves (Ultrasound). As the magnetic field is always on in an MRI scanner, great care must be taken from a safety standpoint to provide for the safety of patients being scanned. All patients go through a multistep screening process to make sure that implants, clips, stimulators, etc., that they may have are determined to be safe before entering the magnet. In general, the following are considered unsafe for scanning in a 3 T MRI: All Pacemakers and Defibrillators Star-Edwards Heart Valves Neurostimulator systems and Bone stimulators Cochlear implants Tissue expanders Aneurysm clips (Sugita clips are considered safe), all others must be researched Stents must be researched individually (some can be scanned immediately, but this varies by vendor) For 1.5 T MRI units, the following are considered unsafe: Star-Edwards Heart Valves Cochlear implants Tissue expanders Some Pacemakers and Defibrillators are 1.5 T MRI safe Some Neurostimulator systems and Bone stimulators are 1.5 T MRI safe Most stents are 1.5 T MRI safe, but must be researched The industry accepted resource/ clearinghouse for determining device safety is available at This source along with vendor websites are used to determine device safety if the patient does not have documentation at the time of screening. The above are guidelines and certainly not all inclusive. As MRI is considered a high risk study in terms of patient safety, every effort is made to determine the patient s safety status prior to undertaking any MRI study. sih.net/imaging 13

16 13 St. Louis, MO 125min from Carbondale Benton Professional 50Building Miners Memorial Health Center Logan Primary Care Mt. Vernon Herrin Hospital Logan Primary Care St. Joseph Memorial Hospital Herrin West Frankfort Murphysboro Carbondale Benton Marion Memorial Hospital of Carbondale Center for Medical Arts Cape Girardeau, MO 72min from Carbondale Paducah, KY 78min from Carbondale Imaging Services Offers: X-Ray (walk-in service) CT MRI Ultrasound Interventional Radiology Bone Density Nuclear Medicine PET/CT All services are not available in all locations. Imaging Services Centralized Scheduling The information provided in this guide is not intended to be a substitute for a licensed radiologist s recommendation. The material provided is strictly an informational guideline for the most probable imaging study ordered. Specific questions should be directed to a staff radiologist. Our radiologists may recommend an alternative study based on a patient s clinical history and diagnosis provided by the referring physician. 2014