RADIOLOGY ORDERING & PHYSICIAN SERVICES TOOLKIT PREPARED IN 2014

Transcription

1 RADIOLOGY ORDERING & PHYSICIAN SERVICES TOOLKIT PREPARED IN 2014

2 Goals of this Toolkit 1. TO HELP REFERRING PHYSICIANS ORDER THE RIGHT TEST AT THE RIGHT TIME 2. TO MINIMIZE TIME CONSUMING RE-ORDERS AND RE-PRECERTING 3. TO IMPROVE PATIENT CARE 4. TO PROVIDE VALUABLE RESOURCES TO PATIENTS 5. TO PREPARE FOR ICD10 CHANGES & DOCUMENTATION CHALLENGES 6. TO PROVIDE ELECTRONIC FORMS AND DOCUMENTS TO REFERRING PHYSICIANS 7. TO REDUCE DENIALS TO THE HOSPITAL AND RADIOLOGISTS

3 CONTACT RADIOLOGY WITH ANY QUESTIONS Contact Name Responsibility Phone Number Michael Langenberg University Radiology (865) Administrator Allen Gilbert University Radiology I/T (865) Denise Ruggles University Radiology Admin (865) Support Shannon Buck Radiology Department (865) Manager (XRay, MRI, Ultrasound) Brett Hines Radiology Department (865) Manager (CT, Nuclear Medicine, PET CT) Donna Johnson Radiology Support Manager TBD TBD TBD IR Nurse Manager (865) TBD Cristina Whitehead IR / NIR Clinic Coordinator (865) cwhitehead@utrad.com Let us know how we can help you!

4 Table of Contents 1. Section 1 - Radiology Ordering Quick Tips 2. Section 2 Common Radiology Protocols 3. Section 3 - The Radiology Man Diagram 4. Section 6 Radiology Departmental Order Form 5. Section 7 - Comprehensive Imaging Ordering Guide 6. Section 8 CT Abdomen Pelvis Ordering Guide 7. Section 9 CT Chest Ordering Guide 8. Section 10 - MRI Brain Ordering Guide 9. Section 4 Patient Preparation Instructions 10. Section 5 Patient Maps

5 Radiology Ordering Quick Tips Physicians please provide all or as much of the following when ordering Information MUST HAVE Imaging Studies DESCRIPTION 1. LOCATION Provide as much as possible the specific anatomical sites requiring imaging (left right, upper, outer, etc), Laterality, Quadrant of Organ, Location of the Bone, Individual Vessel Occluded, Graft vs Native 2. SEVERITY Indicate on the order whether it is Acute or Chronic, Traumatic or Non- Traumatic, Open or Closed, With or Without Hemorrhage, With or without perforation 3. CONTEXT / SIGNS SYMPTOMS Provide ALL SIGNS AND SYMPTOMS patient is experiencing relevant to this imaging exam, Relevant prior procedures and previous treatments, underlying conditions, history of, what is the intent of imaging study imaging ordered for what condition? 4. STORY Provide as much information to let radiology know what was the patient doing? Where did event happen? What was patient s status at the time? *Information obtained from Coding Strategies, Inc. Embrace ICD10 presentation on February 14, 2014

6 Radiology Protocols Please Note All CPT Codes Must be Precerted even if Ordered as a Protocol COMMON IMAGING PROTOCOLS PROTOCOL CT Studies CPT Code to Precert CPT Description Renal Protocol CT Abdomen/Pelvis with and without Contrast CT Stone Study/Urinary Tract CT Abdomen/Pelvis without Contrast Urogram & CT Abdomen/Pelvis with and without Contrast 3D Reformatted CT Images Liver (Hepatic) Protocol CT Abdomen with and without Contrast CT Enterography CT Abdomen/Pelvis with Contrast Pancreatic Protocol CT Abdomen with and without Contrast Pulmonary Embolism (PE) Protocol CTA Chest Parathyroid Protocol CT Neck Soft Tissue with and without Contrast CT Dissection Study & CTA Chest and CTA Abdomen

7 MRI PROTOCOLS PROTOCOL MRI Studies CPT Code to CPT Description Precert Carotid Protocol MRA Neck with and without Contrast Liver (Hepatic) Protocol MRI Abdomen with and without Contrast Stroke Protocol & & MRI Brain with and Without Contrast MRA Head without Contrast MRA Neck with and without Contrast

8 University Radiology CPT Code Guidelines for MRI and CT MRI Head and Neck MRI Orbits, Pituitary, Cranial Nerve, IAC s TMJ Brain wo Contrast Brain w/wo Contrast Neck Soft Tissue wo Contrast Neck Soft Tissue w/wo Contrast Orbits, Pituitary, Cranial Nerve IAC s w/wo Contrast MRI Chest Chest wo Contrast Chest w/wo Contrast MRI Breast Breast Unilateral with and/or without Contrast Breast Bilateral with and/or without Contrast MRI Spine Cervical wo Contrast Thoracic Spine wo Contrast Lumbar Spine wo Contrast C Spine w/wo Contrast T Spine w/wo Contrast L Spine w/wo Contrast MRI Abdomen Abdomen wo Contrast Abdomen w/wo Contrast Abdomen w MRCP CT Head and Neck Brain wo Contrast Brain w Contrast Brain w/wo Contrast Sinus Complete Maxillofacial wo Contrast Maxillofacial w Contrast Maxillofacial w/wo Contrast Orbits wo Contrast CT Chest Chest w/o Contrast Chest w Contrast Chest w/wo Contrast Chest CTA/ PE Study Cardiac CTA w Calcium Scoring Cardiac CTA w/o Calcium Scoring Calcium Scoring CT Spine Cervical Spine w/o Contrast Thoracic Spine w/o Contrast Lumbar Spine w/o Contrast CT Abdomen and Pelvis Abdomen/Pelvis w/o Contrast (Stone Study) Abdomen/Pelvis w Contrast Abdomen/Pelvis w/wo Contrast CT Abdomen Only Abdomen w/o Contrast Abdomen w Contrast Abdomen w/wo Contrast MRI Pelvis Pelvis wo Contrast Pelvis w/wo Contrast MRI Angiography MRI Arthogram Shoulder 23350, Elbow 24220, Wrist 25246, Hip 27093, Knee 27370, Ankle 27648, MRA Head wo Contrast MRA Head w Contrast MRA Neck wo Contrast MRA Neck w Contrast MRA Chest w or wo Contrast MRA Renal Artery w or wo Contrast MRA Runoff w or wo Contrast MRI Upper Extremity Other than Joint wo Contrast Other than Joint with Contrast Other than Join w/wo Contrast Joint wo Contrast Joint w/wo Contrast MRI Lower Extremity Other than Joint wo Contrast Other than Joint with Contrast Other than Join w/wo Contrast Joint wo Contrast Joint with Contrast Joint w/wo Contrast Orbits w Contrast Orbits w/wo Contrast Temporal Bones wo Contrast Temporal Bones w Contrast Temporal Bones w/wo Contrast Neck Soft Tissue wo Contrast Neck Soft Tissue w Contrast Neck Soft Tissue w/wo Contrast CT Pelvis Only Pelvis w/o Contrast Pelvis w Contrast Pelvis w/wo Contrast CT Urogram CT Urogram CT Angiography Coronary Calcium Score Cardiac CTA without Calcium Score Cardiac CTA w Calcium Score Head w/wo Contrast Neck w/wo Contrast Abdomen Lower Extremities w/wo Contrast CTA Runoff Pelvis w/wo Contrast CT Extremities Upper Ext wo Contrast Upper Ext w Contrast Upper Ext w/wo Contrast Lower Ext wo Contrast Lower Ext w Contrast Lower Ext w/wo Contrast Call to schedule and appointment.

9 UniveRsity OF tennessee MeDical center 1924 alcoa Hwy : knoxville, tn scheduling: Fax: Radiology order form Name: Date of Service: Ordering Physician: Reason for Exam: Signs and Symptoms: MR #: DOB: Precert# / Authorization#: Ordering MD Signature: Fax: DX Code(s): Phone: Report is Stat /Call Back #: MrI Head and Neck MrI Chest MrI ProCedures (Precert required) MrI Arthogram MrI upper extremity TMJ Brain wo Contrast Brain w/wo Contrast Stroke Brain Only wo Contrast Stroke Protocol w/wo Contrast 70553, 70544, Multiple Sclerosis w/wo Contrast Neck Soft Tissue wo Contrast Neck Soft Tissue w/wo Contrast Orbits, Pituitary, Cranial Nerve IAC s w/wo Contrast MRI Spine Cervical wo Contrast Cervical w/wo Contrast Thoracic wo Contrast Thoracic w/wo Contrast Lumbar wo Contrast Lumbar w/wo Contrast CT Head and Neck Head wo Contrast Head w/wo Contrast Sinus Complete Maxillofacial wo Contrast Maxillofacial with Contrast Orbits wo Contrast Orbits with Contrast Temporal Bones wo Contrast Temporal Bones with Contrast Neck Soft Tissue wo Contrast Neck Soft Tissue with Contrast Neck Soft Tissue w/wo Contrast CT Spine Cervical Spine wo Contrast Thoracic Spine wo Contrast Lumbar Spine wo Contrast CT Chest Chest wo Contrast Chest w Contrast Chest wo Contrast Chest w/wo Contrast MRI Abdomen Abdomen wo Contrast Abdomen w/wo Contrast Abdomen w MRCP (wo Contrast) MRI Pelvis Pelvis wo Contrast Pelvis w/wo Contrast MRI Cardiac Morphology and Function w/wo Contrast Velocity Flow Mapping wo Contrast 75557, MRI Breast Breast Unilateral w and/or wo Contrast Breast Bilateral w and/or wo Contrast MRI Angiography MRA Head wo Contrast MRA Neck wo Contrast MRA Neck w/wo Contrast MRA Chest w or wo Contrast MRA Pelvis w or wo Contrast MRA Abdomen w or wo Contrast MRA Renal Artery w or wo Contrast MRA Lower Ext w or wo Contrast CT Procedures (Available at Turkey Creek, Precert Required) Radiology Protocoled Studies Renal Protocol Kidney Stone Study/Urinary Tract Urogram 74178,76376 Dual Phase Liver (Hepatic) CT Enterography Pancreatic Parathyroid PE Study Dissection Study 71275, CT Myelogram *Also Precert and for injection Cervical Spine with Contrast Thoracic Spine with Contrast Lumbar Spine with Contrast Cardiac CT Calcium Score Coronary CT Angiography CT of Heart for Structure & Morphology CT of Heart for Structure & Morphology with Known Congenital Heart Disease Left Shoulder 23350, Elbow 24220, Wrist 25246, Hip 27093, Knee 27370, Ankle 27648, Right CT Abdomen Abdomen wo Contrast Abdomen with Contrast Abdomen w/wo Contrast CT Pelvis Pelvis wo Contrast Pelvis with Contrast Pelvis w/wo Contrast CT Abdomen and Pelvis Abdomen Pelvis wo Contrast Abdomen Pelvis with Contrast Abdomen Pelvis w/wo Contrast Virtual Colonography Diagnostic CT Colonography wo Contrast Diagnostic CT Colonography w Contrast (IV) Screening CT Colonography Other Radiology Requests Left Right Other than Joint wo Contrast 73218* Other than Joint w/wo Contrast 73220* Joint wo Contrast 73221* Joint w/wo Contrast 73223* MRI Lower Extremity CT Angiography CTA Head CTA Neck CTA Chest CTA Abdomen CTA Pelvis CTA Abdomen and Pelvis CTA Runoff (abdominal aorta and bilateral iliofemoral lower extremity runoff) CTA Upper Extremitites CTA Lower Extremities CT Extremities Left Right Upper Ext wo Contrast Upper Ext with Contrast Upper Ext w/wo Contrast Lower Ext wo Contrast Lower Ext with Contrast Lower Ext w/wo Contrast D Reformats 3D Reformats Radiology procedure not listed, Special protocol requests, Specific area of interest, Additional patient instructions Joint: Joint: Left Right Other than Joint wo Contrast 73718* Other than Joint w/wo Contrast 73720* Joint wo Contrast 73721* Joint w/wo Contrast 73723* *Recommend w/wo Extremity for 1) Infection 2) Tumor of Soft Tissue CPT only American Medical Association Order Form may not be reprinted or reproduced without authorization by the author. Radiology Order Form (Dev 2/10)

10 RADIOLOGY ORDER FORM Name: DOB: Date of Service: Diagnosis (Required): MR #: Precert# / Authorization#: DIGITAL MAMMogrAPHy Screening Bilateral Screening Mammogram with two view film study of each breast G0202 Ordering Physician: Ordering Physician Signature: Ultrasound Abdominal Complete Abdominal Limited Organ Follow-up Gall Bladder Liver Spleen Pancreas Kidney Billiary Aorta IVC Abdominal Limited Up Left Quad Low Left Quad Up Right Quad Low Right Quad Other Ultrasound Requests Nuc Med Cardiovascular Cardiac Shunt Imaging Cardiac 1st Pass, Single Cardiac 1st Pass, Multiple Vascular Flow Imaging DVT Imaging; Peptide (AcuTect) Heart MPS; SPECT; Single Study Heart MPS; SPECT; Multiple Study Heart MPS; PET; Single Study Heart MPS; PET; Multiple Study MUGA; Single Study MUGA; Multiple Study X-Ray Head and Neck Mandible; Complete Facial Bones; Complete Nasal Bones; Complete Orbits; Complete Sinus; Less than 3 Views Sinus; Complete Skull; Less than 4 Views Skull; Complete Neck; Soft Tissue X-Ray Chest Chest; 2 Views Ribs; Unilateral, 2 Views Ribs; Bilateral; 3 Views Sternum; 2 Views Sternoclavicular Joints Other X-Ray Requests DEXA Scan Nuclear Medicine Procedures (Available at Turkey Creek, Precert Required) Nuc Med Endocrine Nuc Med Gastrointestinal Nuc Med Tumor/ Infection/ Parathyroid Exam Liver-Spleen SPECT Inflammation 123 I Thyroid Uptake Scan 78012,13,14 Hepatobiliary, including GBEF Tumor Imaging; Limited Thyroid CA; Neck/Chest Thyroid GE Reflux Tumor Imaging; WB CA; WB Gastric Emptying Tumor Imaging; Spect Thyroid CA; Uptake GI Bleeding Scan Infection Imaging; Limited Meckel s Infection Imaging; WB Shunt Patency Infection Imaging; Spect Nuc Med Respiratory Perfusion Lung Scan Ventilation/Perfusion Lung Scan Quantitative Ventilation/Perfusion Ultrasound Procedures Ultrasound Continued Ultrasound OB B-scan/real time, Single or First Gestation OB Limited Follow-up, Transabdominal, Per Fetus OB Transvaginal I Thyroid Therapy I Thyroid Therapy w Imaging & I Mets Survey Sentinel Node wo Imaging Sentinel Node w Imaging Nuc Med Head & CNS Brain Limited w Flow Brain Complete w Spect Cisternogram Cerebral Shunt Evaluation CSF Leak X-Ray Procedures (Available at Turkey Creek) X-Ray Spine Cervical Spine 2/3 Views Cervical Spine Complete Thoracic Spine 2 Views Lumbar Spine 2/3 Views Lumbar Spine 4 Views Lumbar Complete w/ Bending X-Ray Flouroscopy Barium Swallow Modified Barium Swallow Single Contrast Upper GI Double Contrast Upper GI Small Bowel Series Barium Enema, Diagnostic Barium Enema, Therapeutic Defecography Cystogram Hysterosalpingogram Sinus Tract Study Phone: Fax: Pelvic Complete Pelvic Limited Retroperitoneal Retroperitoneal Limited Bladder Chest Soft Tissue Abd Mass/Hernia Thyroid, Head/Neck Extremity Non-Vascular Female Ultrasound Pelvic Complete with Transvaginal with Transvaginal if indicated Transvaginal Breast st Trimester, Transabdominal Male Ultrasound Scrotal Prostate Neonatal Ultrasound Neonatal Head Neonatal Spine Neonatal Hip Dynamic Neonatal Hip Static BONE DENSITY Nuc Med Musculoskeletal Nuc Med Genitourinary Limited Area Bone Scan Renal Perfusion / Function Multiple Area Bone Scan Renal Perfusion / Function w Lasix Whole Body Bone Scan Renal Perfusion / Function w ACE Three Phase Bone Scan Renal Scan; Spect Bone SPECT Ureteral Reflux Scan Nuc Med Other Other Nuc Med Requests Urea Breath TST C-14; Collection Urea Breath TST C-14; Analysis X-Ray Lower Extremity Left Right Hip; 2 Views Hips; Bilateral, w / AP Pelvis Hips / Pelvis; Infant Femur; 2 Views Knee; 3 Views Bilateral Standing Knees Tibia/Fibula; 2 Views Lower Ext. Infant; 2 Views Ankle; 3 Views Calcaneus; 2 Views Toes; Minimum 2 Views Foot; 3 Views X-Ray Abdomen Abdomen; Single View Abdomen; Supine & Erect Acute Abdomen Series Complete Myelogram - See CT Myelogram Unilateral Screening Mammogram with two view study of single breast G Right Left Diagnostic Diagnostic Mammogram, Bilateral (to include mammographic imaging, ultrasound, or biopsy as deemed necessary by the radiologist. G0204 Diagnostic Mammogram, Unilateral (to include mammographic imaging, ultrasound, or biopsy as deemed necessary by the radiologist. G0206 Right Left Reason for Exam/ Other Requests X-Ray Upper Extremity Left Right Clavical Shoulder AC Joints Humerus; 2 Views Elbow; 3 Views Forearm; 2 Views Wrist; Complete Hand; 3 Views Fingers; Minimum 2 Views Arthography Left Right Ankle Hip Wrist Shoulder Knee Elbow TMJ CPT only American Medical Association Order Form may not be reprinted or reproduced without authorization by the author. Radiology Order Form (Dev 2/10)

11 University Radiology MRI & MRA Ordering Guide To Order an MRI study call If you are unsure what MRI to order call For more Information visit Please use this guide to determine the correct MRI or MRA exam to Order and Precert CPT Code(s) to Body Part Reason for Exam or Exam Indications Procedure to Order & Precert Precert Alzheimers Mental Status Change Confusion Dementia MRI Brain Without Contrast Memory Loss Stroke / CVA Suspected MS TIA Headaches Dizziness / Vertigo Cranial Nerve Lesions HIV / AIDS Hearing Loss IAC Mass MRI Brain Infection Multiple Sclerosis Neurofibromatosis Pituitary Lesion MRI Brain With and Without Contrast Elevated Prolactin Seizures Tumor/Mass/Cancer Visual Changes Vascular Lesions AVM Bell s Palsy Facial Weakness Acoustic Neuroma Metastases MRA Brain Aneurysm or Family History of Aneurysm (Arterial or Venous TIA MRA Brain Without Contrast Circulation or Circle Stroke / CVA* (Order with MRI Brain W/Out 70551) of Willis) Venous Thrombosis AVM* (Order with MRI Brain W/WOut 70553) MRA Brain Sinus Thrombosis MRA Brain With and Without Contrast (Venous Circulation) Venous Circulatory Symptoms Alzheimers MRA Neck Mental Status Changes (Arch and Great Stroke/CVA MRA Neck With and Without Contrast Vessels) TIA Bruit MRI Orbits Trauma MRI Orbits (Face/Neck) Without Contrast Grave s Disease MRI Orbits (Face/Neck) Without and With Association of University Radiologists, PC Page 1

12 University Radiology MRI & MRA Ordering Guide To Order an MRI study call If you are unsure what MRI to order call For more Information visit Please use this guide to determine the correct MRI or MRA exam to Order and Precert Body Part Reason for Exam or Exam Indications Procedure to Order & Precert MRI Orbits Exopthalmos / Proptosis Pseudotumor Tumor/Mass/Cancer/Mets Vascular Lesions (Hemangioma) Contrast CPT Code(s) to Precert MRI Neck MRI Spine - Cervical MRI Spine Thoracic MRI Spine Lumbar Infection Pain Tumor / Mass / Cancer / Mets Vocal Cord Paralysis Arm/Shoulder Pain Degenerative Disease Neck Pain Disc Herniation Radiculopathy Numbness Syrinx Post Op Fusion Discitis Osteomyelitis Myelopathy Tumor/Mass/Cancer Back Pain Degenerative Disease Disc Herniation Radiculopathy Trauma Compression Fracture Discitis Post Op Fusion Osteomyelitis Multiple Sclerosis Myelopathy Syrinx Tumor/Mass/Cancer Back / Leg Pain Degenerative Disease Disc Herniation Radiculopathy Trauma Compression Fracture Sciatica Spinal Stenosis Spondylolithesis Scoliosis Discitis Osteomyelitis MRI Orbits (Face/Neck) Without and With Contrast MRI Cervical Spine Without Contrast MRI Cervical Spine Without and With Contrast MRI Thoracic Spine Without Contrast MRI Thoracic Spine With and Without Contrast MRI Lumbar Spine Without Contrast MRI Lumbar Spine Without and With Contrast Association of University Radiologists, PC Page 2

13 University Radiology MRI & MRA Ordering Guide To Order an MRI study call If you are unsure what MRI to order call For more Information visit Please use this guide to determine the correct MRI or MRA exam to Order and Precert Body Part Reason for Exam or Exam Indications Procedure to Order & Precert MRI Abdomen (General, Liver, Renal, Adrenal, Biliary, Pancreas) MRA Abdomen MRI Pelvis (Hip) MRI Pelvis (Soft Tissue, Uterus, Ovaries) MRI Pelvis Continued Post Op HX of Back Surgery Tumor / Mass / Cancer / Mets Tumor/Mass/Cancer Abdominal Pain Post Embolization Hepatitis Hemangioma Cirrhosis Hepatoma Renal Mass or Cyst Transitional Cell Increased Liver Carcinoma of Kidney Function Tests Adrenal Mass / Lesion Hematuria Pheochromocytoma Hypertension Jaundice Abnormal Enzymes Stones Biliary Obstruction Pancreatitis Pancreas Mass Painless Jaundice Ampulla Evaluation Cholangiocarcinoma PSC Primary Sclerosing Cholangitis Renal Artery Stenosis Mesenteric Arterial Hypertension Ischemia Fracture Trauma Hip/Pelvis Pain Muscle /Tendon Tear Pain Abscess Fibroid Adenomysis Infertility Ovarian Mass Osteomyelitis Septic Arthritis Tumor/Mass/Cancer Pre/Post Uterine Fibroid Embolization Endometrioma Decubitis Ulcer CPT Code(s) to Precert MRI Abdomen With and Without Contrast MRA Abdomen With or Without Contrast MRI Pelvis Without Contrast MRI Pelvis With and Without Contrast Association of University Radiologists, PC Page 3

14 University Radiology MRI & MRA Ordering Guide To Order an MRI study call If you are unsure what MRI to order call For more Information visit Please use this guide to determine the correct MRI or MRA exam to Order and Precert Body Part Reason for Exam or Exam Indications Procedure to Order & Precert MRA Pelvis (Iliac Vessels) MR Enterography MRI Extremity NON JOINT: Forearms Humerus Lower Leg/Calf Femur/Thigh MRI Extremity JOINT: Upper: Hand Wrist Elbow Shoulder SC Joint Lower: Foot Ankle Knee Hip (Whole Pelvis) MRA Upper Extremity CPT Code(s) to Precert Pelvic Venous Thrombosis MRA Pelvis With and Without Contrast Crohn s Disease Celiac Disease Small Bowell Tumor Crohn s Fistulous Disease Fracture Stress Fracture Muscle or Tendon Tear Abscess Myositis Ulcer Osteomyelitis Tumor/Mass/Mets Morton s Neuroma Plantar Fasciitis Soft Tissue Mass Arthritis Meniscal Tear Avascular Necrosis Muscle Tear Stress Fracture Ligament Tear Joint Pain Abscess Ulcer Cellulitis Plantar Fasciitis Myositis Internal Derangement Ostochondritis (OCD) Cartilage Tear Osteomyelitis Inflamed Arthritis Septic Arthritis Tumor/Mets/Mass Labral Tear MRI Abdomen With and Without Contrast MRI Pelvis With and Without Contrast MRI Non-Joint Without Contrast: Upper Extremity Lower Extremity MRI Non-Joint With and Without Contrast: Upper Extremity Lower Extremity MRI Joint Without Contrast: Upper Extremity Lower Extremity MRI Joint Without and With Contrast: Upper Extremity Lower Extremity (Upper) (Lower) (Upper) (Lower) (Upper) (Lower) (Upper) (Lower) Subclavian Tenderness, Redness, Swelling MRA Upper Extremity With or Without Contrast MRA Lower Peripheral Vascular Disease MRA Lower Extremity With or Without Association of University Radiologists, PC Page 4

15 University Radiology MRI & MRA Ordering Guide To Order an MRI study call If you are unsure what MRI to order call For more Information visit Please use this guide to determine the correct MRI or MRA exam to Order and Precert Body Part Reason for Exam or Exam Indications Procedure to Order & Precert Extremity MR Arthogram (Upper Extremity, Shoulder, Elbow, Wrist) MR Arthogram (Lower Extremity, Hip, Knee, Ankle) Shoulder Instability Labral Tear Loose Body Ligament Injury TFCC Tear Labral Tear Loose Body Post Surgical Meniscus Retear OCD Lesion (Osteochondritis Dissecans) Contrast MRI Upper Extremity Joint With and Without Contrast Shoulder Injection Elbow Injection Wrist Injection MRI Lower Extremity Joint With and Without Contrast Hip Injection Knee Injection Ankle Injection CPT Code(s) to Precert MRI Lumbosacral Leg Pain/Sciatica Lumbar Plexopathy Plexus Radiculopathy Scaral/Coccyx Pain MRI Pelvis Without Contrast MRI Brachial Plexus Shoulder Injury MRI Upper Extremity Non-Joint With and Nerve Avulsion Without Contrast Brachial Plexopathy MRI Chest MRI Chest/Mediastinum With and Without Tumor/Mass/Cancer/Mets (Mediastinum) Contrast MRA Aorta Abdominal Aortic Dissection MRA Abdomen With and Without Contrast MRA Aorta With Peripheral Run-Off Peripheral Vascular Disease Claudication MRA Abdomen With and Without Contrast MRA Lower Extremity With and Without Contrast MRI Breast Newly Diagnosed Breast Cancer Family History of Breast Cancer BRCA 1 and BRCA 2 Genes MRI Breast Bi-Lateral With and Without Contrast Association of University Radiologists, PC Page 5

16 University Radiology MRI & MRA Ordering Guide To Order an MRI study call If you are unsure what MRI to order call For more Information visit Please use this guide to determine the correct MRI or MRA exam to Order and Precert Body Part Reason for Exam or Exam Indications Procedure to Order & Precert Implant Integrity Issue or Rupture CPT Code(s) to Precert STROKE PROTOCOL Stroke Suspected Stroke TIA Common MRI Protocols MRI Brain With and Without Contrast MRA Head Without Contrast MRA Neck With and Without Contrast Precert All: CAROTID PROTOCOL MRA Neck With and Without Contrast LIVER (HEPATIC) PROTOCOL MRI Abdomen With and Without Contrast MR ENTEROGRAPHY Crohn s Disease Celiac Disease Small Bowell Tumor Crohn s Fistulous Disease MRI Abdomen With and Without Contrast MRI Pelvis With and Without Contrast Association of University Radiologists, PC Page 6

17 University Radiology CT and CTA Ordering Guide To Order a CT or CTA study call If you are unsure what CT or CTA to order call For more Information visit Please use this guide to determine the correct CT or CTA exam to Order and Precert Body Part Reason for Exam or Exam Indications Procedure to Order & Precert CT Abdomen/Pelvis CT Abdomen Only Hematuria with Pain CT Stone Study / Urinary Tract Protocol All Cancer Staging Abdominal Pain Crohns Ulcerative Colitis IBD Appendicitis Diverticulitis Abscess Hernia (ventral, umbilical, inguinal) Cyst vs Mass Hemangioma Painless Hematuria Adrenal Mass Melanoma Carcinoid Hepatoma Pre and Post Embolization Transitional Cell Carcinoma of Kidney F/U for patients with Renal Cell Carcinoma in Renal Failure Abdominal Pain Mass Epigastric Issues RUQ Pain LUQ Pain Pseudocyst Pancreatitis Pancreas Mass Liver Mass Liver Protocol Pancreatic Protocol Adrenal Protocol CPT Code(s) to Precert CT Abdomen/Pelvis Without Contrast CT Abdomen/Pelvis With Contrast CT Abdomen/Pelvis With and Without Contrast CT Abdomen Without Contrast CT Abdomen With Contrast CT Abdomen With and Without Contrast CTA Abdomen (Renal, Aorta Pre-Op, Post-Op Stent) Crossing Vessels Nephrectomy Aneurysm CTA Abdomen CTA Abdomen (Run Off) Peripheral Artery Disease (PAD) CTA Abdomen (and Run Off) Association of University Radiologists, PC Page 1

18 University Radiology CT and CTA Ordering Guide To Order a CT or CTA study call If you are unsure what CT or CTA to order call For more Information visit Please use this guide to determine the correct CT or CTA exam to Order and Precert Body Part Reason for Exam or Exam Indications Procedure to Order & Precert CPT Code(s) to Precert CT Chest CT Chest (High Resolution) CTA Chest (PE Study) CT Pelvis Only Cough Pneumonia Tracheal Stenosis Renal Failure F/U Nodules Suspected Mediastinal / Hilar Adenopathy Staging Thoracic Primary Malignancy Complex Pleural Effusion Thoracic Trauma Chest Wall Mass Interstitial Disease Fibrosis COPD Hemoptysis Bronchiectasis Sarcoidosis Pleural Plaques Asbestosis Chest Pain/Dyspnea AAA/Aortic Dissection Tachypnea Hemoptysis Shortness of Breath + D Dimer Pulmonary Hypertension DVT Prostate Treatment Planning Cancer Staging Mass in Pelvic Region Cysts in Pelvic Region Pain in Pelvic Region Infection in Pelvic Region CT Chest Without Contrast CT Chest With Contrast CT Chest Without and With Contrast --- HIGH RESOLUTION MRI Orbits (Face/Neck) Without and With Contrast CT Pelvis Without Contrast CT Pelvis With Contrast CT Neck Order without contrast if elevated creatine CT Neck Without Contrast Submandibular Stone Parotid Stone Infection of Parotid Gland CT Neck Without and With Contrast Association of University Radiologists, PC Page 2

19 University Radiology CT and CTA Ordering Guide To Order a CT or CTA study call If you are unsure what CT or CTA to order call For more Information visit Please use this guide to determine the correct CT or CTA exam to Order and Precert Body Part Reason for Exam or Exam Indications Procedure to Order & Precert CPT Code(s) to Precert Parotid Mass Mass Infection Cancer Workups CT Neck With Contrast CTA Carotid CT Head CTA Head / Brain CT Orbits Artheromatous Disease Bruit TIA CVA Vascular Tumor Vascular Malformations Carotid Stenosis Trauma Headaches CVA, Stroke Bleed, Hemorrhage Alzheimers Memory Loss Confusion Shunt Check Hydrocephalus Metastatic Staging Vertigo Dizziness Mass / Tumor Infection Headache with other Neurological Symptoms Melanoma HIV Toxoplasmosis TIA, CVA Vascular Malformation Aneurysm AVM Trauma Fracture Foreign Body Graves Disease CTA Carotid CT Head Without Contrast CT Head With Contrast CT Head With and Without Contrast CTA Brain CT Orbit Without Contrast Association of University Radiologists, PC Page 3

20 University Radiology CT and CTA Ordering Guide To Order a CT or CTA study call If you are unsure what CT or CTA to order call For more Information visit Please use this guide to determine the correct CT or CTA exam to Order and Precert Body Part Reason for Exam or Exam Indications Procedure to Order & Precert CPT Code(s) to Precert Pseudo Tumor Mass CT Orbits Exopthalmus Pain CT Orbit With Contrast Abscess Retinoblastoma CT Orbit Without and With Contrast CT Sinus Sinusitis CT Sinus (Maxillofacial) Without Contrast Osteomeatal Complex *CT Sinus Limited will be billed with 52 Modifier Functional Endoscopic Sinus Surgery CT Spine (Cervical / Thoracic) CT Spine (Lumbar / Sacral) CT Temporal Bone CT Extremities - Foot - Ankle - Calf - Knee - Thigh - Finger - Hand - Wrist - Arm Trauma Fracture Fusion Bony Degenerative Changes *MR Recommended for disc herniation, mets, infection Trauma Fracture Fusion Pars Defect *MR Recommended for disc herniation, mets, infection Hearing Loss Cholesteotoma Trauma *Sensory neuro hearing loss; order MRI With Contrast Fracture Non-Union Femoral Anteversion Malignment Knee Fusion Malunion Arthritis CT Without Contrast - Cervical Spine - Thoracic Spine CT Lumbar Spine Without Contrast CT (Orbit) Inner Ears, Temporal Bones Without Contrast CT Without Contrast - Lower Extremity - Upper Extremity Association of University Radiologists, PC Page

21 University Radiology CT and CTA Ordering Guide To Order a CT or CTA study call If you are unsure what CT or CTA to order call For more Information visit Please use this guide to determine the correct CT or CTA exam to Order and Precert Body Part Reason for Exam or Exam Indications Procedure to Order & Precert CT Extremities CT Extremities (Leg Lengths) CTA Extremities CT Arthography - Hip - Knee - Ankle - Shoulder - Elbow - Wrist Infection Tumor / Mass / Cancer / Mets Abnormality Leg Length Malrotation Peripheral Artery Disease (PAD) Ischemia to Lower Extremity Arterial Stenosis Lower Extremity Cartilage Abnormality Meniscus Abnormality Labrum Abnormality Loose Bodies CT Without and With Contrast - Lower Extremity - Upper Extremity CPT Code(s) to Precert CT Leg Lengths CT Angiography - Lower Extremity - Upper Extremity CT With Contrast 1. Lower Extremity With Contrast OR Upper Extremity With Contrast 2. Fluro Guided Arthogram 3. Choose One Code for body Part - Hip - Knee - Ankle -Shoulder -Elbow -Wrist Association of University Radiologists, PC Page 5

22 University Radiology CT and CTA Ordering Guide To Order a CT or CTA study call If you are unsure what CT or CTA to order call For more Information visit Please use this guide to determine the correct CT or CTA exam to Order and Precert Body Part Reason for Exam or Exam Indications Procedure to Order & Precert Common CT Protocols CPT Code(s) to Precert Renal Protocol CT Abdomen/Pelvis Without and With Contrast CT Stone Study / Urinary Tract Protocol CT Abdomen/Pelvis Without Contrast Urogram CT Abdomen/Pelvis With and Without Contrast 3D Reformatted CT Images Precert Both Codes: Liver (Hepatic) Protocol CT Abdomen With and Without Contrast CT Enterography CT Abdomen/Pelvis With Contrast Pancreatic Protocol CT Abdomen With and Without Contrast Pulmonary Embolism CTA Chest (PE) Protocol Parathyroid Protocol CT Dissection Study CT Neck Soft Tissue Without and With Contrast CTA Chest CTA Abdomen Association of University Radiologists, PC Page 6

23 University Radiology Ordering Guide for CT Abdomen and CT Pelvis When to Order a CT Abdomen AND CT Pelvis TOGETHER CT Abdomen / Pelvis WITHOUT IV CONTRAST CT Abdomen / Pelvis WITH IV CONTRAST CT Abdomen / Pelvis W & WITHOUT IV CONTRAST CPT CPT CPT Order when evaluating for: Order when evaluating for: Order when evaluating for: Hematuria / STONE STUDY Abdominal Pain (upper and lower Cyst vs Mass (kidney) quadrants) Painless Hematuria Inflammatory Bowel Disease (including Crohns, Ulcerative Transitional Cell Carcinoma of Kidney Colitis) CT Renal Mass Appendicitis CT Urogram Abscess Hernia (ventral, umbilical, inguinal) CT Enterography Please Note In 2011 the AMA COMBINED the CT Abdomen CT Pelvis CPT Codes into singular combined CPT Codes (74176, 74177, and 74178). Although the individual studies for a single CT Abdomen and CT Pelvis still exist, the above codes are designed to capture those cases where the codes (pre 2011) would have been billed together.

24 CT Abdomen WITHOUT IV CONTRAST University Radiology Ordering Guide for CT Abdomen and CT Pelvis When to Order a CT Abdomen ONLY CT Abdomen WITH IV CONTRAST CT Abdomen W & WITHOUT IV CONTRAST CPT CPT CPT Order when evaluating for: Order when evaluating for: Order when evaluating for: Follow up for patients with Renal Epigastric issues / evaluation Pancreatitis Cell Carcinoma in Renal Failure RUQ Pain Pancreas Mass (recommend MRI) LUQ Pain Liver Mass Pseudocyst Adrenal Protocol CT Dual Phase Liver - Hepatic Protocol CT Pancreas (Pancreatic Protocol) NOTE - The UHS Protocol for a CT Abdomen covers from the diaphragm dome (Xiphoid Process) to iliac crests (Belly Button).

25 CT Pelvis WITHOUT IV CONTRAST University Radiology Ordering Guide for CT Abdomen and CT Pelvis When to Order a CT Pelvis ONLY CT Pelvis WITH IV CONTRAST CT Pelvis W & WITHOUT IV CONTRAST CPT CPT CPT Order when evaluating for: Order when evaluating for: Order when evaluating for: Prostate Treatment Planning (Pubic Arch Study Protocol) Cancer Staging Mass in pelvic region* Cysts in pelvic region* Pain in pelvic region* Infection in pelvic region* *The Pelvic Region as defined by Medicare is the lower abdomen. The UHS Protocol for a CT Pelvis covers from the Iliac crest (Belly Button) through Ischial Tuberosities (Upper Thigh)

26 CT CHEST WITHOUT IV CONTRAST University Radiology Ordering Guide for CT & CTA of the Chest How to Order a CT Scan of the Chest CT CHEST WITH IV CONTRAST CT CHEST W & WITHOUT IV CONTRAST CPT CPT CPT Order when evaluating for: Order when evaluating for: Order when evaluating for: Lung Nodule(s) Suspected Mediastinal / Hilar Lung Cancer Screening Adenopathy Chest Metastasis (known extrathoracic malignancy) Malignancy Staging Thoracic Primary Chronic Dyspnea Suspect Lung Complex Pleural Effusion Origin (negative Chest Xray) Thoracic Trauma (high energy Interstitial Lung Disease, blunt trauma) Bronchiectasis (HRCT Protocol) Cough Pneumonia Tracheal Stenosis/Malacia *Make sure to include in the order ALL signs and symptoms patient is experiencing. **Consider CTA Chest as an additional Study as well

27 CTA CHEST WITHOUT IV CONTRAST University Radiology Ordering Guide for CT & CTA of the Chest How to Order a CTA Scan of the Chest CTA CHEST WITH IV CONTRAST CPT CTA CHEST W & WITHOUT IV CONTRAST Order when evaluating for: Order when evaluating for: Order when evaluating for: Shortness of Breath, Chest Pain Hemoptysis Pulmonary HTN PE PROTOCOL *WHEN ORDERING A PE PROTOCOL A CTA CHEST W CONTRAST IS PERFORMED Chest Pain Aortic Dissection** **Also order with a CTA Abdomen CPT Code 74175

28 MRI BRAIN WITHOUT IV CONTRAST University Radiology Ordering Guide for MRI of the Brain How to Order an MRI of the Brain* MRI BRAIN WITH IV CONTRAST MRI BRAIN W & WITHOUT IV CONTRAST CPT CPT CPT Order when evaluating for: Order when evaluating for: Order when evaluating for: Acqueductal Stenosis Only done when an MRI of the Headaches Altered Mental Status Brain was performed WITHOUT IV Abscess Confusion Contrast previously Aneurysm** Dementia / Alzheimer s AVM / Vascular Lesions Memory Loss Dizziness Psychiatric Disorder Encephalitis Trauma IAC (Hearing Loss, Vertigo) Indeterminate intracranial lesion Meningitis Metastasis/Neoplasm Multiple Sclerosis Non traumatic brain hemorrhage Seizures Stroke (suspected stroke, TIA) Tumor Vascular Malformation** *Make sure to include in the order ALL signs and symptoms patient is experiencing. **Consider MRA as an additional Study as well

29 PATIENT PREPARATION INSTRUCTIONS CT SCAN You should wear comfortable, loose-fitting clothing to your exam. You may be given a gown to wear during the procedure. Metal objects, including jewelry, eyeglasses, dentures and hairpins, may affect the CT images and should be left at home or removed prior to your exam. You should inform the technologist if you have a pacemaker. You may be asked not to eat or drink anything for a few hours beforehand, especially if a contrast material will be used in your exam. If you have a known allergy to contrast material, or "dye," your doctor may prescribe medications to reduce the risk of an allergic reaction. Women should always inform their physician and the CT technologist if there is any possibility that they may be pregnant. Please contact the Radiology Department at if you have additional questions. MRI You may be asked to wear a gown during the exam or you may be allowed to wear your own clothing if it is loose-fitting and has no metal fasteners. Guidelines about eating and drinking before an MRI exam vary with the specific exam and also with the facility. Unless you are told otherwise, you may follow your regular daily routine and take food and medications as usual. Some MRI examinations may require the patient to receive an injection of contrast material into the bloodstream. The contrast material most commonly used for an MRI exam contains a metal called gadolinium. pins, hairpins, metal zippers and similar metallic items, which can distort MRI images removable dental work pens, pocket knives and eyeglasses body piercings Please contact the Radiology Department at if you have additional questions.

30 PATIENT PREPARATION INSTRUCTIONS NUC MED You may be asked to wear a gown during the exam or you may be allowed to wear your own clothing. Women should always inform their physician or technologist if there is any possibility that they are pregnant or if they are breastfeeding. Jewelry and other metallic accessories should be left at home if possible, or removed prior to the exam because they may interfere with the procedure. In some instances, certain medications or procedures may interfere with the examination ordered. Please contact the Radiology Department at if you have additional questions. US You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined. You may be asked to wear a gown during the procedure. Preparations depend on the type of ultrasound you are having. For a study of the liver, gallbladder, spleen, and pancreas, you may be asked to eat a fatfree meal on the evening before the test and then to avoid eating for eight to 12 hours before the test. For ultrasound of the kidneys, you may be asked to drink four to six glasses of liquid about an hour before the test to fill your bladder. You may be asked to avoid eating for eight to 12 hours before the test to avoid gas buildup in the intestines. For ultrasound of the aorta, you may need to avoid eating for eight to 12 hours before the test. Please contact the Radiology Department at if you have additional questions.

31 FOR SERVICES IN THE MAIN RADIOLOGY DEPARTMENT From West Knoxville Travel on I -40 East Take Exit 386B and merge onto US-129/Alcoa Hwy toward Airport/Smokey Mts Take the Cherokee Trail/UT Medical Center Exit Please contact the Radiology Department at (865) for additional assistance. 1.9 miles 0.4 miles Entrance to the Medical Center from Alcoa Highway UT Medical Center 1924 Alcoa Hwy, Knoxville, Tennessee 37920, (865)

32 FOR MRI SCANS From West Knoxville Travel on I -40 East Take Exit 386B and merge onto US-129/Alcoa Hwy toward Airport/Smokey Mts Take the Cherokee Trail/UT Medical Center Exit 0.4 miles 1.9 miles Please contact the Radiology Department at (865) for additional assistance. Entrance to the Medical Center from Alcoa Highway UT Medical Center 1924 Alcoa Hwy, Knoxville, Tennessee 37920, (865)

33 FOR SERVICES IN THE BREAST CENTER From West Knoxville Travel on I -40 East Take Exit 386B and merge onto US-129/Alcoa Hwy toward Airport/Smokey Mts Take the Cherokee Trail/UT Medical Center Exit 1.9 miles 0.4 miles Please contact the University Breast Center at (865) for additional assistance. Entrance to the Medical Center from Alcoa Highway UT Medical Center 1924 Alcoa Hwy, Knoxville, Tennessee 37920, (865)

34 FOR SERVICES IN THE MAIN RADIOLOGY DEPARTMENT From North I-75 Travel on I-75 South Continue on I-275 S Keep left at the fork, follow sign for I-40W/I-75S Nashville/Chattanooga and merge onto I-40West Take exit 386B to merge onto US-129/Alcoa Hwy Take the exit toward Cherokee Trail/UT Medical Center Please contact the Radiology Department at (865) for additional assistance. 2.9 miles 1.0 miles 2.3 miles 0.4 miles Entrance to the Medical Center from Alcoa Highway UT Medical Center 1924 Alcoa Hwy, Knoxville, Tennessee 37920, (865)

35 FOR MRI SCANS From North I-75 Travel on I-75 South Continue on I-275 S Keep left at the fork, follow sign for I-40W/I-75S Nashville/Chattanooga and merge onto I-40West Take exit 386B to merge onto US-129/Alcoa Hwy Take the exit toward Cherokee Trail/UT Medical Center Please contact the Radiology Department at (865) for additional assistance. 2.9 miles 1.0 miles 2.3 miles 0.4 miles Entrance to the Medical Center from Alcoa Highway UT Medical Center 1924 Alcoa Hwy, Knoxville, Tennessee 37920, (865)

36 FOR SERVICES IN THE BREAST CENTER From North I-75 Travel on I-75 South Continue on I-275 S Keep left at the fork, follow sign for I-40W/I-75S Nashville/Chattanooga and merge onto I-40West Take exit 386B to merge onto US-129/Alcoa Hwy Take the exit toward Cherokee Trail/UT Medical Center Please contact the University Breast Center at (865) for additional assistance. 2.9 miles 1.0 miles 2.3 miles 0.4 miles Entrance to the Medical Center from Alcoa Highway UT Medical Center 1924 Alcoa Hwy, Knoxville, Tennessee 37920, (865)

37 FOR SERVICES IN THE MAIN RADIOLOGY DEPARTMENT From East Knoxville Travel on I -40 West Take Exit 386B and merge onto US-129/Alcoa Hwy toward Airport/Smokey Mts Take the Cherokee Trail/UT Medical Center Exit 1.9 miles 0.4 miles Please contact the Radiology Department at (865) for additional assistance. Entrance to the Medical Center from Alcoa Highway UT Medical Center 1924 Alcoa Hwy, Knoxville, Tennessee 37920, (865)

38 FOR MRI SCANS From East Knoxville Travel on I -40 West Take Exit 386B and merge onto US-129/Alcoa Hwy toward Airport/Smokey Mts Take the Cherokee Trail/UT Medical Center Exit 1.9 miles 0.4 miles Please contact the Radiology Department at (865) for additional assistance. Entrance to the Medical Center from Alcoa Highway UT Medical Center 1924 Alcoa Hwy, Knoxville, Tennessee 37920, (865)

39 FOR SERVICES IN THE BREAST CENTER From East Knoxville Travel on I -40 West Take Exit 386B and merge onto US-129/Alcoa Hwy toward Airport/Smokey Mts Take the Cherokee Trail/UT Medical Center Exit Please contact the University Breast Center at (865) for additional assistance. 1.9 miles 0.4 miles Entrance to the Medical Center from Alcoa Highway UT Medical Center 1924 Alcoa Hwy, Knoxville, Tennessee 37920, (865)

40 FOR SERVICES AT UT OUTPATIENT DIAGNOSTIC CENTER at TURKEY CREEK From South or West Travel on I-75N and merge onto I-40E/I-75N Take exit 373 Campbell Station Rd Turn Right onto Campbell Station Rd Turn Left onto Parkside Dr. Parkside Medical Plaza turn Right 4.5 miles 0.2 miles 0.7 miles The Office is located on the 2 nd floor of Parkside Medical Plaza Please contact UT Outpatient Diagnostic Center Turkey Creek at for additional assistance. UT Outpatient Diagnostic Center 11440Parkside Dr. Suite 204 Knoxville, TN 37934

41 FOR SERVICES AT UT OUTPATIENT DIAGNOSTIC CENTER at TURKEY CREEK From North or East Travel on I-40W/I-75S Take exit 373 Campbell Station Rd Turn Left onto Campbell Station Rd Turn Left onto Parkside Dr. Parkside Medical Plaza turn Right 13.6 miles 0.2 miles 0.7 miles The Office is located on the 2 nd floor of Parkside Medical Plaza Please contact UT Outpatient Diagnostic Center Turkey Creek at for additional assistance. UT Outpatient Diagnostic Center Parkside Dr. Suite 204 Knoxville, TN 37934

42 Interventional & NEUROINTERVENTIONAL Radiology Clinic VASCULAR INTERVENTIONAL RADIOLOGISTS - LAURA K. FINDEISS, MD - JAMES H. McELMURRAY, MD - JOHN J. SNIDOW, MD Interventional & NEUROINTERVENTIONAL Radiology Clinic CONTACT NUMBER NEUROINTERVENTIONAL RADIOLOGISTS - ANDREW S. FERRELL, MD - PETER KVAMME, MD NURSE PRACTITIONER - DAVID BIDDLE, FNP For Patient Consult and Follow-Up

43 Interventional & NEUROINTERVENTIONAL CLINIC Scheduling Phone Number For Consult and Follow-Up Scheduling with IR Procedures, Please Call Monday through Friday, 8:00 AM to 4:30 PM Clinic consultations are available for all major interventional radiology procedures Oncologic Interventional Procedures RF Ablation of Lung, Liver, and Renal neoplasms Yttrium 90 Radioembolization of Hepatic Neoplasms Standard Transarterial Chemoembolization of Hepatic Neoplasms Preoperative Renal Tumor Embolization Cryoablation for Renal Cell Carcinoma Chest Ports Image Guided Biopsies Neurointerventional Procedures Coiling of Intracranial Aneurysms Intracranial and Facial AVM Embolization Preoperative Tumor Embolization Women s Care Procedures Uterine Fibroid Embolization Pelvic Venous Congestion Syndrome Embolization Vascular Interventional Procedures Angioplasty & Stenting Critical Limb Ischemia Varicose Veins / Venous Insufficiency Thrombosis Management / IVC Filters Gastroenterology Procedures TIPS Gastrostomy / Jejunostomy Paracentesis Other Interventional Procedures Pulmonary Angiography and Thrombectomy Percutaneous Nephrostomy and Uretal Stents Tunneled Pleural and Peritoneal Drain Placement Thrombolysis and Stent Placement

44 PATIENT IMAGING NOTICE PATIENT NOTIFICATION MRI or CT PATIENT STEERAGE Your insurance company may use a program, often called an Imaging Services Steerage Program (ISSP) or Patient Choice Program, to attempt to direct you to another imaging provider to receive your MRI, CT or other imaging exam. This program is designed primarily to reduce cost to the insurance company, and secondarily to you as the patient. The overall cost to you, once all factors are considered, may not even be less. The value of the radiology services you receive at The University of Tennessee Medical Center includes, among other things: Quality and Training Expertise of the Radiologist who will interpret (read) the Imaging Study; at UTMC, exams are interpreted by Sub- Specialized Radiologists trained in specific specialty areas. Quality of the imaging equipment and related software programs and enhancements available on the equipment. Please know that not all CT or MRI scanners are equivalent. Newer more advanced imaging equipment leads to better images and more accurate diagnosis for patients. Quality and Training of the Technologist assisting with the study Coordination of care between your Radiology Provider and the existing physicians you see including coordination of your entire medical record Convenience of location and scheduling and the integration of care across the medical center and other providers As a patient, you have the reasonable expectation of receiving the right imaging examination, properly and safely performed, appropriately interpreted, and the results communicated to you and /or your physician in a timely fashion. You have the right to have these imaging services provided in such a way that fosters collaborative care with your other physicians, which will serve to enhance the care provided to you. Your treating physician relationship should be fully maintained. Given the above benefits of having your study performed at UT Medical Center, you should also consider each of the following if your insurance company attempts to change your imaging services provider to a lower cost alternative. Insurance Companies should not be in the business of referring or directing patient care. This is the choice of the patient in consultation with their treating physicians. The quality of your imaging exam shall be considered, including the age, safety, and functional capabilities of imaging equipment used, the protocols and supervision of the imaging study, and the subspecialty training or expertise of the radiologists interpreting the examination The process of being steered to another imaging provider shall not cause a meaningful delay in diagnosis (which can and often does occur due to