MISSION, VISION, AND CORE VALUES

Transcription

1 ORDERING GUIDE 00

2 MISSION, VISION, AND CORE VALUES Mission To provide compassionate care and superior medical imaging services to patients, providers, and healthcare organizations. Vision Enhance the wellness of our community through the delivery of high-quality, innovative healthcare. CoRE Values Compassion...for everyone Respect...in every interaction Excellence...in everything we do 01

3 WHY THIS GUIDE IS IMPORTANT TO YOU AND YOUR PATIENTS This 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 examination. Our goal is 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 performed. When 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. Feel free to specify a particular entity or condition you would like the Radiologist to comment upon in the report. In 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. 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) or at pr@radltd.com. Thank you, The Physicians and Staff of Radiology Ltd. 02

4 IMPORTANT CONTACT INFORMATION CENTRALIZED SCHEDULING Tel: (520) Fax: (520) STAT Hotline: (520) Toll Free: (866) Toll Free Fax: (866) NEED HELP OR HAVE QUESTIONS ABOUT WHAT TO ORDER? CLINICAL REVIEW Tel: (520) Fax: (520) SPECIALTY SCHEDULING BREAST BIOPSY Tel: (520) Fax: (520) BREAST MRI Tel: (520) Fax: (520) INTERVENTIONAL COORDINATION Tel: (520) Fax: (520) PET / CT Tel: (520) , opt. 3 Fax: (520) OTHER IMPORTANT NUMBERS AUTHORIZATION VERIFICATION Tel: (520) Fax: (520) CODING & PRICING HOTLINE Tel: (520) Online Requests: radltd.com/request-exam-pricing HIPAA HOTLINE Tel: (520) Toll Free Tel: (866) MEDICAL RECORDS Tel: (520) Fax: (520) Online Requests: radltd.com/medical-record-request PATIENT BILLING Tel: (520) Secure Online Bill Pay: radltd.com/online-bill-pay PROFESSIONAL RELATIONS Tel: (520) Fax: (520) pr@radltd.com For Supplies: Tel: (520) supplies@radltd.com RADVISION Tel: (520) Fax: (520) Toll Free Tel: (866) Website: radltd.com/for-providers After Hours Tech Support: Tel: (520) TAX ID AND NPI INFORMATION Radiology Ltd. Tax ID Radiology Ltd. - Carondelet Tax ID (for CT, Ultrasound and X-ray only; for MRI use Radiology Ltd. Tax ID listed above) Radiology Ltd. Group NPI# Radiology Ltd. - Carondelet NPI#

5 TABLE OF CONTENTS BREAST IMAGING High Risk Screening... 5 Mammo Ordering Decision Tree... 6 CPT Codes for Women s Imaging... 7 Screening & Diagnostic Mammography... 8 Additional Imaging & Procedures... 9 Breast MRI Scheduling Checklist Breast MRI CT / CTA CPT Codes for CT Scans Lung Screening Ordering General Head and Spine Musculoskeletal Specialty DEXA Bone Densitometry ULTRASOUND General Vascular MSK/Extremity X-RAY General INTERVENTIONAL Minimally Invasive Diagnostic Procedures Pain Management Vascular Services ICD-10 CODES ICD-10 Codes Notes PREFERRED PROVIDER INFORMATION Major Insurance Plans Major Network Plans MRI / MRA CPT Codes for MRI Scans Brain Spine Breast Chest, Abdomen, and Pelvis Musculoskeletal PET / CT PET/CT Scheduling Checklist General Bone Scan IMAGING CENTERS Locations Modality by Location Weekend MRI MISC. RadVision ACR Appropriateness Criteria Notes

6 BREAST IMAGING HIGH RISK SCREENING New American College of Radiology (ACR) Recommendations for High Risk Screening The ACR recommends all women, especially black women and those of Ashkenazi Jewish descent, should be evaluated for breast cancer risk no later than age 30, so that those at higher risk can be identified and can benefit from high risk screening. GROUP ONE Tyrer-Cuzick calculated lifetime risk of 20% or greater Patients with a known high risk gene and their untreated first-degree relatives Digital mammography with or without 3D mammography annually from age 30 Annual breast MRI from age GROUP TWO Women with a history of chest radiotherapy before age 30 Digital mammography with or without 3D mammography annually from age 25 or 8 years after radiotherapy, whichever is later Annual breast MRI from age GROUP THREE Personal history of breast cancer diagnosed before age 50 Personal history of breast cancer and dense breasts Digital mammography with or without 3D mammography annually from diagnosis Annual breast MRI from diagnosis GROUP FOUR For women with personal histories of breast cancer not included in the above Annual breast MRI should be considered in addition to digital mammography with or without 3D mammography, especially if other risk factors are present 05 To schedule an appointment, call (520) or fax (520)

7 Palpable lesion / focal pain <30 years old breast ultrasound only MAMMOGRAPHY ORDERING DECISION TREE 30 years old YES DIAGNOSTIC STUDY (see below) Does the patient have a problem? Nipple discharge (reproducible, single duct, bloody or serous) Order diagnostic mammogram w/breast ultrasound Negative Annual screening mammogram NO SCREENING MAMMOGRAPHY (beginning at age 40) ± 3D Tomosynthesis Extra views needed (call back) per radiologist recommendation: Diagnostic order required (see below) Diagnostic mammogram w/breast ultrasound, if clinically indicated Cyst aspiration (can be performed at time of exam w/ referring provider approval) BREAST IMAGING Order diagnostic mammogram w/ breast ultrasound NEGATIVE: Surgical consultation to consider need for ductography SUSPICIOUS: Order breast biopsy SUSPICIOUS: Order breast biopsy PROBABLY BENIGN: Order 6 month follow-up diagnostic mammogram NEGATIVE: Return to annual screening mammogram To schedule an appointment, call (520) or fax (520)

8 BREAST IMAGING CPT CODES for WOMEN S IMAGING This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. SCREENING MAMMOGRAPHY BILATERAL DIGITAL MAMMOGRAPHY, INCLUDING CAD SCREENING BREAST 3D TOMOSYNTHESIS BIOPSY CODING VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED EXPLANATION. DIAGNOSTIC MAMMOGRAPHY UNILATERAL UNILATERAL DIGITAL MAMMOGRAPHY, INCLUDING CAD UNILATERAL BREAST 3D TOMOSYNTHESIS BREAST MRI BILATERAL BREAST MRI DIAGNOSTIC MAMMOGRAPHY BILATERAL BILATERAL DIGITAL MAMMOGRAPHY, INCLUDING CAD BILATERAL BREAST 3D TOMOSYNTHESIS BONE DENSITY SCAN DEXA SCAN DEXA WITH VERTEBRAL FRACTURE ASSESSMENT DEXA BODY COMPOSITION STUDY ULTRASOUND UNILATERAL COMPLETE UNILATERAL LIMITED AXILLA ALONE UTERINE FIBROID EMBOLIZATION (UFE) CODING VARIES DEPENDING ON THE PROCEDURE. PLEASE CONTACT OUR CODING DEPARTMENT FOR A DETAILED EXPLANATION. For more information on exam codes and pricing, please contact the Radiology Ltd. Coding and Pricing Hotline at (520) *CMS determined that for several reasons related to claims processing systems, Medicare claims systems will be unable to process claims using CPT codes 77065, 77066, and for calendar year They will continue to use the existing G-codes G0206, G0204 and G0202 and anticipate adopting the 2017 codes for calendar year To schedule an appointment, call (520) or fax (520)

9 BREAST IMAGING: Screening and Diagnostic Mammography This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. TYPE OF EXAM PARAMETERS PROCEDURE CODE Screening Mammography, Bilateral, Including CAD mammo preps. Screening Mammography Tomosynthesis (3D) mammo preps. Adjunctive Imaging mammo preps. Mastectomy Annual Screening, Including CAD mammo preps. History of Breast Cancer mammo preps. Unilateral Mammography Tomosynthesis (3D) mammo preps. Bilateral Mammography Tomosynthesis (3D) mammo preps. Clinical Findings - Symptoms mammo preps. Annual after age 40 (12 months and 1 day since last screening exam) Screening mammogram (specify baseline or annual exam) D is requested after full-field digital mammography to evaluate dense breasts. Please call for further information if required: (520) Annual screening of untreated breast (12 months and 1 day since last exam) Lumpectomy 6 months post surgery 3 years post treatment Mass Pain - localized Unilateral screening mammogram Diagnostic mammogram: personal history of breast cancer - lumpectomy Diagnostic mammogram: with ultrasound (identify area of mass) Diagnostic mammogram: pain bilateral unilateral bilateral unilateral *CMS determined that for several reasons related to claims processing systems, Medicare claims systems will be unable to process claims using CPT codes 77065, 77066, and for calendar year They will continue to (identify use the existing area of G-codes pain) G0206, G0204 and G0202 and anticipate adopting the 2017 codes for calendar year Under 30 Years of Age - Order Ultrasound mammo preps. Mass, discharge - localized pain with ultrasound (localized pain) Diagnostic Breast Ultrasound with Mammogram (if needed) unilateral, complete unilateral, limited BREAST IMAGING Standard Mammo Preps: Arrive 15 mins prior to exam. No fasting required. No deodorant, lotions, powder or perfumes. Bring insurance cards along with doctors order to appointment. 08

10 BREAST IMAGING BREAST IMAGING: Additional Imaging and Procedures This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. TYPE OF EXAM PARAMETERS PROCEDURE CODE Recommendation of Additional Imaging (callback or recall exam) Short Term Follow-Up Exam mammo preps. Nipple Discharge mammo preps. Nipple Discharge breast preps. Cystic Mass / Lesion Found on Previous Breast Ultrasound breast preps. Indeterminate Lesion breast preps. Mammography (call back) ±Ultrasound Recommendation of previous exam (3-6 months) Post biopsy exam (6 months after previous mammogram) Unilateral Reproducible Single duct discharge (patient must be able to express discharge at time of ductogram) Ductogram (preferably after surgical consultation) Previous ultrasound report indicating need for aspiration Biopsy indicated on prior imaging Mammogram additional exam ±ultrasound Diagnostic mammogram: short-term follow-up Diagnostic mammogram: post biopsy Diagnostic mammogram +ultrasound: discharge (identify breast and describe discharge) Ductogram for nipple discharge Left / right cystic aspiration Left / right indeterminate lesion / mass unilateral unilateral bilateral RT LT unilateral bilateral unilateral bilateral unilateral unilateral bilateral RT LT Singular Duct Multiple Ducts x number of ducts Ultrasound Guided Singular Ultrasound Guided Multiple Same Side x number of add l cysts Stereotactic Guided Biopsy Additional Lesion Ultrasound Guided Biopsy Additional Lesion Magnetic Resonance Guided Biopsy Additional Lesion Standard Mammo Preps: No fasting required. No deodorant, lotions, powder or perfumes. Arrive 15 mins prior to exam. Bring insurance cards along with doctors order to appointment. Standard Breast Preps: No fasting required. No deodorant or talcum powder under arms or breast area. Arrive 30 mins prior to exam. Bring insurance cards along with doctors order to appointment. 09 3D mammography may be ordered as an adjunct to screening or diagnostic mammography, if the patient has dense breasts or it is deemed appropriate for other reasons.

11 BREAST IMAGING: Breast MRI Scheduling Checklist This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Please include the following with ALL Breast MRI orders: Order for Breast MRI (all are performed Bilateral, please do not indicate Rt or Lt) Clinical history / progress notes Copy of patients insurance card(s) Patient demographics If prior imaging studies were not performed at Radiology Ltd., please include any additional reports listed below: Last mammogram reports (past 5 years) Breast ultrasound reports (past 5 years) Breast MRI reports (past 5 years) Breast biopsy and breast pathology reports (past 5 years) BREAST IMAGING Please fax any additional notes to: Breast MRI Dept. at (520)

12 BREAST IMAGING BREAST IMAGING: Breast MRI This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. TYPE OF EXAM PARAMETERS PROCEDURE CODE Breast (pre-operative staging) breast MRI preps. Recent diagnosis of breast cancer Bilateral breast MRI (and chest MRI, if necessary) (71552) Breast (high risk screening) breast MRI preps. High risk breast cancer screening Bilateral breast MRI Breast (silicone implants) breast MRI preps. Suspected silicone implant leak Palpable lump Pain Bilateral breast MRI in addition to implant protocol Breast (indeterminate clinical or imaging results) breast MRI preps. Further evaluation of indeterminate clinical or imaging results (radiologist recommendation) Bilateral breast MRI Follow-up for Chemotherapy Treatment breast MRI preps. Follow-up for neo-adjuvant chemotherapy Bilateral breast MRI Please note: Breast MRI does not replace screening mammography. Standard Breast MRI Preps: Drink plenty of fluids day before exam, nothing to eat two hours prior to exam. Do not wear hairspray, deodorant, jewelry, metal or eye makeup. Arrive 30 mins before exam. Bring insurance card to appointment. 11 To schedule an appointment, call (520) or fax (520)

13 ORBIT W/O CONTRAST W/CONTRAST W/O & W/CONTRAST MAXILLOFACIAL W/O CONTRAST W/CONTRAST W/O & W/CONTRAST SOFT TISSUE NECK W/O CONTRAST W/CONTRAST W/O & W/CONTRAST UPPER EXTREMITY W/O CONTRAST W/CONTRAST W/O & W/CONTRAST CPT CODES for CT SCANS This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BRAIN W/O CONTRAST W/CONTRAST W/O & W/CONTRAST CERVICAL SPINE W/O CONTRAST W/CONTRAST W/O & W/CONTRAST CHEST W/O CONTRAST W/CONTRAST W/O & W/CONTRAST THORACIC SPINE W/O CONTRAST W/CONTRAST W/O & W/CONTRAST CT / CTA LOWER EXTREMITY W/O CONTRAST W/CONTRAST W/O & W/CONTRAST ABDOMEN PELVIS COMBINATION W/O CONTRAST W/CONTRAST W/O & W/CONTRAST LUMBAR SPINE W/O CONTRAST W/CONTRAST W/O & W/CONTRAST To schedule an appointment, call (520) or fax (520)

14 Eligibility not verified. Reasons for ineligibility reported to your office. If your patient does not meet these requirements, but needs a chest CT scan for another clinical indication, you can order a standard diagnostic chest CT. 13

15 CT / CTA: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Lung nodules (1 st exam) CT chest without and with contrast Chest CT Contrast Preps. Chest, High Resolution CT Preps. CTA Chest (PE Study) CT Contrast Preps. CTA Chest CT Contrast Preps. CTA Chest & Abdomen CT Preps. Neck CT Contrast Preps. Lung nodules (follow-up) Abnormal chest X-ray COPD Cough Esophageal CA Hemoptysis Lung CA Lymphoma Mass Pain Pneumonia Shortness of breath Tracheal stenosis Asbestosis Bronchiectasis Fibrosis Interstitial lung disease Pleural plaques Sarcoidosis Pulmonary embolism Shortness of breath Vascular evaluation Aortic dissection Thoracic aortic aneurysm Aortic dissection Thoracic aortic aneurysm Cancer workups Dysphagia Infection Infection of parotid gland Infection of submandibular gland Lymphadenopathy Mass Parotid mass Parotid stone Submandibular stone CT chest without contrast CT chest with contrast CT chest without contrast, highresolution CTA chest CTA chest CTA chest and abdomen CT neck with contrast CT / CTA Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment. Standard CT Contrast Preps: Nothing to eat two hours prior to exam. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before exam. 14

16 CT / CTA CT / CTA: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Pelvis (soft tissue) CT Oral Contrast Preps. Cancer staging Cysts Hernia Infection Mass Pain CT pelvis with contrast Pelvis (bone) CT Preps. Fracture, arthritis Bone Infection, Illiac joints Cancer / mass / mets / tumor CT pelvis without contrast CT pelvis with contrast Adrenal CT Preps. Adrenal mass CT abdomen with and without contrast Abdomen / Pelvis CT Preps. Abdomen / Pelvis CT Oral Contrast Preps. Stone (stone protocol) Abdominal pain Abscess Hernia (ie, ventral, umbilical, inguinal) Mass CT abdomen and pelvis without contrast (stone protocol) Area of concern: Above iliac crest (hip bone) CT abdomen with contrast Below iliac crest (hip bone) CT pelvis with contrast Location unknown or both areas apply CT abdomen and pelvis with contrast Abdomen / Pelvis Any cancer staging CT abdomen and CT Appendicitis pelvis with contrast Oral Contrast Preps. Crohns / ulcerative colitis Diarrhea Diverticulitis IBD Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment. Standard CT Oral Contrast Preps: At least one day prior to exam, patient needs pick up oral contrast at any one of our locations. Further instructions will be given.

17 CT / CTA: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Liver CT Oral Contrast Preps. Pancreas CT Oral Contrast Preps. Kidneys CT Oral Contrast Preps. Note: Diagnosis for renal calculi-no oral contrast needed, see below for standard CT prep. CT Urogram / CT IVP CT Preps. CTA Abdomen & Run Off CT Preps. Abdominal Aorta Mesenteric Vessels Renal Arteries Stent CT Preps. Hepatoma, Hepatitis, Cirrhosis Liver hemangioma (MR preferred) Pancreatic mass Pancreatitis Pseudocyst Any renal pathology Transitional cell carcinoma of kidney and/or bladder Hematuria Claudication Peripheral Artery Disease (PAD) Mesenteric ischemia Renal artery stenosis AAA Crossing vessels Stent obstruction / leak / malfunction CT abdomen with and without contrast (liver protocol) CT abdomen without and with contrast (pancreatic protocol 1st time) CT abdomen with contrast CT abdomen without and with contrast (kidney protocol) CT IVP or CT urogram CTA abdomen and Run off CTA abdomen CTA abdomen and pelvis CT / CTA Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment. Standard CT Oral Contrast Preps: At least one day prior to exam, patient needs pick up oral contrast at any one of our locations. Further instructions will be given. To schedule an appointment, call (520) or fax (520)

18 CT / CTA CT / CTA: Head and Spine This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Head / Brain CT preps. Head / Brain CT contrast preps. CTA Brain CT contrast preps. CTA Neck, Carotid Artery CT contrast preps. Orbit CT preps. Orbit CT contrast preps. Alzheimer s CVA Headache less than 7 days Hydrocephalus Memory loss, confusion Shunt check Stroke / bleed Trauma Headache more than 7 days HIV Infection Mass / tumor Meningioma Meningitis Metastatic staging Seizures Toxoplasmosis Vertigo / dizziness / mastoiditis Aneurysm AVM (Arteriovenous Malformation) Bruit CVA Stroke TIA Vascular tumor AVM (Arteriovenous Malformation) Bruit Carotid stenosis CVA Stroke TIA Vascular tumor Vertebrobasilar Insufficiency Foreign body Fracture Trauma Cellulitis Exophthalmos Graves disease Mass Pain Pseudotumor CT head / brain without contrast CT head / brain with contrast CTA head / brain (reconstruction) and/or (If both ordered, please authorize both codes) CTA neck CTA head, neck (please authorize with both) 70498, CT orbit without contrast CT orbit with contrast Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment. 17 Standard CT Contrast Preps: Nothing to eat two hours prior to exam. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before exam.

19 CT / CTA: Head and Spine This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Sinus / Face standard CT preps. Sinus / Face standard CT contrast preps. Spine: Cervical standard CT preps. Spine: Cervical standard CT contrast preps. Spine: Thoracic standard CT preps. Spine: Thoracic standard CT contrast preps. Spine: Lumbar / Sacral standard CT preps. Spine: Lumbar / Sacral standard CT contrast preps. Temporal Bone / IAC s standard CT preps. Pituitary standard CT contrast preps. Functional endoscopic sinus surgery Ostiomeatal complex Sinusitis CT sinus without contrast Mass or infection CT sinus with contrast MR recommended for disc herniation, mets, infection Trauma, fracture, fusion Abscess or infection MR recommended for disc herniation, mets, infection Assess bony degenerative changes Abscess or infection MR Recommended for disc herniation, mets, infection Trauma, fracture, fusion, pars defect Abscess or infection Cholesteotoma Trauma MRI unless contraindicated CT cervical spine without contrast CT cervical spine with contrast CT thoracic spine without contrast CT thoracic spine with contrast CT lumbar spine without contrast CT lumbar spine with contrast CT inner ears, temporal bones without contrast CT brain without and with contrast Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment. Standard CT Contrast Preps: Nothing to eat two hours prior to exam. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before exam. CT / CTA To schedule an appointment, call (520) or fax (520)

20 CT / CTA CT / CTA: Musculoskeletal This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Upper Extremity Arm Forearm Wrist Hand Finger CT preps. Lower Extremity Hip Thigh Knee Calf Ankle/Foot CT preps. Extremities standard CT contrast preps. Ischemia (lower extremity) Arterial Stenosis (lower extremity) standard CT contrast preps. All bone exams ordered without contrast except for tumor evaluations All bone exams ordered without contrast except when evaluating for mass or infection Tumor / mass / cancer / mets / infection Peripheral artery disease CT without contrast upper extremity (mention part) Note: MRI preferred CT without contrast lower extremity (mention part) Note: MRI preferred CT with contrast - upper CT with contrast - lower CTA upper extremity CTA lower extremity Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment. Standard CT Contrast Preps: Nothing to eat two hours prior to exam. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before exam. CT Chest Screening for Lung Cancer Early detection matters. The goal of the CT lung cancer screening program is to detect lung cancer early, when it is easier to treat. 19 To schedule an appointment, call (520) or fax (520)

21 CT / CTA: Specialty This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Colon Preps: At least three days prior to exam, patient needs pick up cleanings prep at our Camp Lowell location. Further Instructions will be given. Renal smallartery (or Mesenteric Artery) CT Preps. Small Intestine (bowel) Preps: Arrive 90 mins before exam for oral prep given in office. Nothing to eat two hours prior to arrival. Patient needs to stay near a restroom after completion of exam for the remainder of the day. This exam causes a laxative effect. Drink plenty of water. Urinary Bladder CT Preps. CT Heart CT Preps. CTA Heart Preps: Must have a responsible driver to drive home. Nothing to eat or drink four hours before exam. No caffeine the day of the exam. Arrival time provided at the time of scheduling. CT Chest Lung Cancer Screening CT Preps. Failed colonoscopy Patients taking blood thinners who are not candidates for routine colonoscopy Screening Hypertension Renal artery stenosis Crohn s disease Small bowel related issues Abscess Bleeding sources Bowel obstruction Fistula Inflammation Tumor Bladder cancer Bladder polyps Bleeding Hydronephrosis Vesicoureteral reflux Screening, hyperlipidemia Abnormal echo Chest pain, sub tachycardia Lung cancer screening CT colonography with 3D rendering (virtual colonoscopy) CTA abdomen for renal arteries Screening Diagnostic CT enterography CT cystogram (please authorize BOTH codes) CT calcium score without contrast CTA coronary artery without and with contrast CT chest, low-dose, lung cancer screening must meet criteria G0297 (medicare) CT / CTA Standard CT Preps: Nothing to eat two hours prior to exam. No oral contrast needed. Drink plenty of water. Bring insurance cards to appointment. Arrive 30 mins before scheduled appointment. To schedule an appointment, call (520) or fax (520)

22 CT / CTA CT / CTA: Specialty This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Additional Information Required for CT Lung Cancer Screening: Smokers age who have smoked 30 pack years Former smokers who quit less than 15 years ago and smoked 30 pack years also Packs/day (20 cigarettes/pack) x Years smoked = Pack Years* *Pack year calculator: For Medicare patients, the following G code should be used by provider for the shared decision-making visit: G Counseling visit to discuss need for lung cancer screening (LDCT) using low-dose CT scan (service is for eligibility determination and shared decision-making) Medicare will deny G0296 and G0297 for claims that do not contain ICD-10 Z87.891, personal history of tobacco use/ personal history of nicotine dependence 21 To schedule an appointment, call (520) or fax (520)

23 DEXA: Bone Densitometry This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. CLINICAL INDICATIONS PROCEDURE CODE 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 Osteoporosis DEXA preps. DEXA with Vertebral Fracture Assessment DEXA preps. Vertebral Fracture Assessment DEXA preps. DEXA Body Composition Study DEXA hips, spine (axial skeleton) DEXA + VFA DEXA (VFA) DEXA (BCS) DEXA DEXA preps. Standard DEXA Preps: No vitamins, calcium or mineral supplements the day of the exam. Prescribed medications are permitted. No IV or oral contrast given prior to study. Avoid clothing with metal. Arrive 30 mins prior to exam. Bring insurance cards along with doctors order to appointment. #StartAt40 Radiology Ltd. stands firmly behind its recommendation that women should receive yearly mammograms starting at age 40 in order to receive the maximum benefit from breast cancer screening. 21 To schedule an appointment, call (520) or fax (520)

24 MRI / MRA CPT CODES for MRI SCANS This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. ORBIT, FACE & NECK W/O CONTRAST W/CONTRAST W/O & W/CONTRAST TMJ BRAIN W/O CONTRAST W/CONTRAST W/O & W/CONTRAST CERVICAL SPINE W/O CONTRAST W/CONTRAST W/O & W/CONTRAST SHOULDER, ELBOW OR WRIST (UPPER EXTREMITY, JOINT) W/O CONTRAST W/CONTRAST W/O & W/CONTRAST CHEST W/O CONTRAST W/CONTRAST W/O & W/CONTRAST BREAST W/O & W/CONTRAST HUMERUS, FOREARM OR NON-JOINT (UPPER EXTREMITY, NON-JOINT) W/O CONTRAST W/CONTRAST W/O & W/CONTRAST THORACIC SPINE W/O CONTRAST W/CONTRAST W/O & W/CONTRAST HIP, KNEE OR ANKLE (LOWER EXTREMITY, JOINT) W/O CONTRAST W/CONTRAST W/O & W/CONTRAST THIGH, LOWER LEG OR FOOT (LOWER EXTREMITY, NON-JOINT) W/O CONTRAST W/CONTRAST W/O & W/CONTRAST ABDOMEN W/O CONTRAST W/CONTRAST W/O & W/CONTRAST LUMBAR SPINE W/O CONTRAST W/CONTRAST W/O & W/CONTRAST PELVIS W/O CONTRAST W/CONTRAST W/O & W/CONTRAST 23 To schedule an appointment, call (520) or fax (520)

25 BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Brain standard MRI Brain Preps. Brain MRI Brain Contrast Preps. Brain MRI Brain Contrast Preps. Brain NeuroQuant MRI Brain Contrast Preps. Brain / Orbits / Face MRI Brain Contrast Preps. Pituitary standard MRI Brain Preps. Ear (IAC) Brain MRI Brain Contrast Preps. Cranial Nerve Series standard MRI Brain Preps. MRV Brain standard MRI Brain Preps. TMJ MRI Brain Contrast Preps. MRA Arch & Great Vessels Brain Neck standard MRI Brain Preps. MRA Arch & Great Vessels Brain Neck standard MRI Brain Preps. MRI / MRA: Brain This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Alzheimer s, confusion, dementia, hydrocephalus, memory loss, mental status changes Headache Pseudotumor Seizures Tumor / mass / cancer / mets Vascular lesions All other reasons Mass / tumor Metabolic abnormality Demyelinating disease Dementia Memory loss Seizures Exophthalmos, proptosis Graves disease Elevated prolactin Hearing loss Bell s palsy Trigeminal neuralgia MRI brain without contrast MRI brain without and with contrast MRI brain without and with contrast, with spectroscopy MRI Brain without contrast to include NeuroQuant (3D volumetric analysis) MRI brain and orbits without and with contrast (if patient has not had recent MRI brain, please add MRI brain without & with contrast) (please authorize BOTH codes) MRI brain without and with contrast Att: pituitary MRI brain without and with contrast MRI brain without and with contrast Att: cranial nerves , , Venous thrombosis MRV without contrast Internal derangement Joint dysfunction Stroke / CVA TIA Vertebrobasilar insufficiency Stroke / CVA TIA Vertebrobasilar insufficiency MRI TMJ without contrast MRA brain without contrast MRA neck with contrast (please authorize BOTH codes) MRI / MRA Standard MRI Brain Preps: Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment. Standard MRI Brain Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment. 24

26 MRI / MRA BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Neck (soft tissue) standard MRI Contrast Preps. Spine: Cervical standard MRI Preps. Spine: Cervical standard MRI Contrast Preps. Spine: Thoracic standard MRI Preps. Spine: Thoracic standard MRI Contrast Preps. MRI / MRA: Spine This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Infection Pain Tumor / mass / cancer / mets Vocal cord paralysis Arm / shoulder pain and/or weakness Chiari malformation Degenerative disease Disc herniation Neck pain Post-op fusion radiculopathy Discitis Multiple sclerosis Myelopathy Osteomyelitis Syrinx Tumor / mass / cancer / mets Vascular lesions, AVM Back pain Compression fx (with hx of malig / mets) Degenerative disease Disc herniation Radiculopathy Trauma Vertebroplasty planning (with hx of no malig) AVM Compression fx (with hx of malig / mets) Discitis Multiple sclerosis Myelopathy Osteomyelitis Syrinx Tumor / mass / cancer / mets Vascular lesions Vertebroplasty planning (with hx of malig) MRI 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 without and with contrast Standard MRI Preps: Depending on the exam, may be asked to change into gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment. MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment. 25 To schedule an appointment, call (520) or fax (520)

27 BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Spine: Lumbar Preps: See pg. 32 for standard MRI Preps. Sacrum / SI joints Preps: See pg. 32 for standard MRI Preps. Spine: Lumbar Preps: See pg. 32 for standard MRI Contrast Preps. MRI / MRA: Spine This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Back pain Compression fx (with hx of no malig / mets) Degenerative disease Disc herniation Radiculopathy Sacrum / SI joints Sciatica Spondylolisthesis Stenosis Trauma Vertebroplasty planning (with hx of no malig) When including sacurm/si joints Compression fx (with hx of malig / mets) Discitis Osteomyelitis Post-op Tumor / mass / cancer / mets Vertebroplasty (with hx of malig) MRI lumbar spine without contrast MRI: Breast This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. MRI lumbar spine to Include sacrum/si joints (please authorize BOTH codes) MRI lumbar spine without and with contrast , MRI / MRA BODY PART COMMON REASON FOR EXAM PROCEDURE CODE 25 Breast (pre-operative staging) MRI Breast Preps. Breast (high risk screening) MRI Breast Preps. Breast (silicone implants) MRI Breast Preps. Breast (indeterminate clinical or imaging results) MRI Breast Preps. Follow-up for Chemotherapy Treatment MRI Breast Preps. Recent diagnosis of breast cancer Bilateral breast MRI (and chest MRI, if necessary) (71552) High risk breast cancer screening Bilateral breast MRI Suspected silicone implant leak Palpable lump Pain Further evaluation of indeterminate clinical or imaging results (radiologist recommendation) Follow-up for neo-adjuvant chemotherapy Bilateral breast MRI in addition to implant protocol Bilateral breast MRI Bilateral breast MRI Please note: Breast MRI does not replace screening mammography. Standard BREAST MRI Preps: Drink plenty of fluids day before exam, nothing to eat two hours prior to exam. Do not wear hairspray, deodorant, jewelry, metal or eye makeup. Arrive 30 mins before exam. Bring insurance card to appointment. 26

28 MRI / MRA MRI / MRA: Chest, Abdomen, and Pelvis This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Chest Mediastinum MRI Contrast Preps. Heart MRI Contrast Preps. Brachial Plexus MRI Contrast Preps. Abdomen Preps: Nothing to eat six hours prior to exam, fluid will interfere with the exam. Avoid wearing jewelry or metal. Will be asked to change into a gown or scrubs. Arrive 30 min before exam. Bring insurance card to appointment. Abdomen Preps: Nothing to eat six hours prior to exam, fluid will interfere with the exam. Avoid wearing jewelry or metal. Will be asked to change into a gown or scrubs. Arrive 30 min before exam. Bring insurance card to appointment. Tumor / mass / cancer / mets Congenital defect and heart valve issues Past MI - other cardiac issues Brachial plexus injury Nerve avulsion Tumor / mass / cancer / mets Adrenal MRCP (biliary / pancreatic ducts) Kidney eval Liver eval Pancreas eval All other reasons AAA (Abdominal Aortic Aneurysm) Abdominal aorta dissection Mesenteric ischemia Renal artery stenosis Pre liver transplant Pre kidney transplant Renal mass-evaluation / pre-op MRI chest without and with contrast MRI heart & MRI chest / mediastinum without and with contrast (specify brachial plexus) MRI abdomen without contrast (MRCP) MRI abdomen without and with contrast MRA abdomen Order 2 exams: MRA abdomen AND MRI abdomen without and with contrast (please authorize BOTH codes) Standard MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment. Radiology Ltd. Offers 3T MRI! This technology provides clinical advantages for certain exams like prostate, abdominal imaging, small joints, and research studies. This machine is centrally located at our Camp Lowell site. 27 To schedule an appointment, call (520) or fax (520)

29 MRI / MRA: Chest, Abdomen, and Pelvis This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Enterography Preps: Arrive 90 minutes before exam. Nothing to eat six hours prior to exam. Avoid wearing jewelry or metal. Will be asked to change into a gown or scrubs. Stay near a restroom after completion of exam for remainder of the day. This exam causes a laxative affect. Bring insurance card to appointment. Pelvis MRI Contrast Preps. Urogram Preps: Nothing to eat four hours prior to exam. Avoid wearing jewelry or metal. Will be asked to change into a gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment. Prostate MRI Contrast Preps. Crohn s disease Inflammatory bowel disease Adenomyosis Fracture Muscle / tendon tear Pelvic organ prolapse Pelvic floor dysfunction Outlet obstruction Incontinence Abscess Fibroid Osteomyelitis Pre / post fibroid embolization Septic arthritis Tumor / mass / cancer / mets Urethral diverticulum Hematuria - congenital abnormalities Urinary tract obstruction Benign prostatic hyperplasia (BPH) Enlarged prostate Evaluation of prostate cancer Infection (prostatitis) Prostate abscess MRI enterography without and with contrast MRI pelvis without contrast MRI dynamic pelvis MRI pelvis without and with contrast MRI urogram & MRI prostate (best on 3T scanner) MRI prostate with multiparmetric reconstructions Standard MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment. MRI / MRA 27 To schedule an appointment, call (520) or fax (520)

30 MRI / MRA MRI: Musculoskeletal This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Arm Hand Leg Foot standard MRI Preps. Arm Hand Leg Foot Preps: See below for standard MRI Contrast Preps. Shoulder Elbow Wrist Finger Hip Knee Ankle Toe standard MRI Preps. Shoulder Elbow Wrist Finger Hip Knee Ankle Toe Preps: See below for standard MRI Contrast Preps. Fracture Muscle / tendon tear Stress Fracture Abscess Arthritis (special protocol - please specify) Bone tumor / mass / cancer / mets Cellulitis Fasciitis Myositis Morton s neuroma Osteomyelitis Soft tissue tumor / mass / cancer / mets Ulcer Joint pain (specify joint) Internal derangement, labral tear, ligament tear, meniscal tear Articular cartilage injury Osteochondritis dissecans (OCD) Stress fracture / fracture Avascular necrosis (AVN) Tendinosis / tendon tear Plantar fasciitis Muscle strain Infection Tumor / mass / cancer / mets Inflammatory arthritis Myositis MRI - non joint without contrast Upper extremity Lower extremity MRI - non joint without and with contrast Upper extremity Lower extremity MRI - joint without contrast Upper extremity Lower extremity MRI lower extremity - joint without and with contrast Upper extremity Lower extremity Standard MRI Preps: Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment. Standard MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment. 29 To schedule an appointment, call (520) or fax (520)

31 MRI: Musculoskeletal (including Arthrography) This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Scapula (not included in shoulder) standard MRI Contrast Preps. MRI Arthrography Shoulder Elbow Wrist Hip Knee Ankle standard MRI Contrast Preps. Pain Mass Labral tear TFCC/tear scapholunate ligament Loose bodies OCD Post-op meniscus evaluation MRI chest without and with contrast MRI joint with contrast - order with 3 codes: 1 Upper extremity with contrast OR lower extremity with contrast 2 Fluoro guided arthrogram 3 Choose body part: Shoulder Elbow Wrist Hip Knee Ankle & & & & & & Standard MRI Contrast Preps: Nothing to eat two hours prior to exam. Avoid wearing facial or eye makeup, hairspray, jewelry, or metal. Depending on the exam, may be asked to change into a gown or scrubs. Arrive 30 mins before exam. Bring insurance card to appointment. MRI / MRA 29 Radiology Ltd. offers a better choice in open MRI called Espree X-Large MRI. The open design of the Magnetom Espree accommodates patients of all sizes and helps eliminate anxiety and claustrophobia. 30

32 PET / CT PET / CT: Scheduling Checklist This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Please include the following with ALL PET/CT orders: Order for exam requested: PET/CT Whole Body (78816) (Diagnosis: Melanoma, Myeloma, Sarcoma & Merkel Cell Carcinoma Cutaneous Lymphoma) PET/CT Skull Base to Mid-Thigh (78815) (All other diagnosis) PET/CT Bone Scan w/sodium Fluoride (78816) PET/CT Brain (78608) PET/CT Myocardium (78459) Indicate if for: q Staging q Re-staging q History of Diagnosis Clinical history / progress notes Copy of patients insurance card(s) Patient demographics If prior imaging studies were not performed at Radiology Ltd., please include any additional reports listed below: Biopsy CT MR PET Pathology Please fax any additional notes to: Interventional Scheduling Department at (520) To schedule an appointment, call (520) or fax (520)

33 BODY PART REQUESTED TEXT CODE Skull Base to Mid-Thigh PET / CT skull base to mid-thigh (all other diagnoses) Whole Body PET / CT whole body (diagnosis: Melanoma, Myeloma, Sarcoma, & Merkel Cell Carcinoma, Cutaneous Lymphoma) Brain PET / CT brain Myocardium PET / CT: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. PET / CT myocardium (cannot be done if patient is diabetic) PET / CT: Bone Scan This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change BODY PART REQUESTED TEXT CODE Breast Lung Prostate Thyroid PET / CT bone scan with sodium fluoride (Sodium fluoride PET bone scans are not covered by Medicare.) PET/CT PET/CT Imaging Our PET services are centrally located at our Camp Lowell site. To schedule a PET exam, please call (520) , opt. 3. To schedule an appointment, call (520) or fax (520)

34 ULTRASOUND ULTRASOUND: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. TYPE OF EXAM COMMON INDICATIONS PROCEDURE CODE Ultrasound of the Abdomen is imaging using sound waves to produce pictures of the structures within the abdomen (belly button up). It is used to help evaluate the liver, kidneys, gallbladder, pancreas, spleen and aorta. Preps: Eat a low fat meal the evening before, nothing to eat or drink anything after midnight. Prescribed medications are permitted. Arrive 30 mins before exam. Bring insurance card and doctor s orders. Pelvis Ultrasound is imaging using sound waves to produce pictures of structures and organs in the pelvis (belly button down). It is used to evaluate the uterus and ovaries. Radiology Ltd. s preferred protocol is to perform both the Transabdominal and Transvaginal scans as these will give the most detailed information. If only one study is perferred, our recommendation is to order a transvaginal scan. Note that Transvaginal scans are not performed on virgins. Abdominal pain (specify right or left upper quadrant or epigastric region) Abnormal LFT s Cirrhosis Hepatitis C Hepatomegaly Polycystic disease Splenomegaly Endometriosis Fibroids / enlarged uterus Groin (MSK/extremity) IUD Menstrual disorders Ovarian cysts PCOS Pelvic pain (relating specifically to uterus or ovaries; ultrasound is not the exam of choice for intestinal disorders) Abdominal ultrasound Transabdominal only Pelvic ultrasound complete (transabdominal and transvaginal - preferred) Transvaginal only Trans Abdominal Trans Vaginal Examples of single organ Pelvic limited Preps: 1.5 hours before appointment, empty bladder. Next 30 minutes, drink 32oz of water. Finish drinking one hour before appointment. A full bladder is required. If bladder is not full, may delay exam. Arrive 30 mins before exam. Bring insurance card, and doctor s orders. Child Preps: Ages 3-5: 8oz of water Ages 6-10: 16oz of water Ages 11+: 32oz of water 33 To schedule an appointment, call (520) or fax (520)

35 ULTRASOUND: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. TYPE OF EXAM COMMON INDICATIONS PROCEDURE CODE Flank / back pain Renal ultrasound Hematuria Neurogenic bladder Polycystic kidneys Renal cyst / mass Renal disease (CKD) UTI Renal Ultrasound imaging uses sound waves to produce pictures of the kidneys and ureteral jets. Preps 1 hour before appointment, drink 16oz of water. Do not empty bladder. A full bladder is required. If bladder is not full, may delay exam. Arrive 30 mins before exam. Bring insurance card and doctor s orders. Child Preps: Ages 3-5: 8oz of water Ages 6-10: 16oz of water Ages 11+: 32oz of water Bladder Ultrasound imaging uses sound waves to produce pictures of the bladder. Preps: 1 1/2 hours before appointment, empty bladder. Next 30 minutes, drink 32 oz of water. Finish drinking one hour before appointment. A full bladder is required. If bladder is not full, may delay exam. Arrive 30 mins before exam. Bring your insurance card, and doctor s orders. Bladder mass / stone Hematuria Renal with bladder ultrasound (this will assess kidneys/ bladder and postvoid residual) & Bladder ultrasound ULTRASOUND Child Preps: Ages 3-5: 8oz of water Ages 6-10: 16oz of water Ages 11+: 32oz of water Locally owned and operated, Radiology Ltd. offers eight imaging centers to patients across southern Arizona. To schedule an appointment, call (520) or fax (520)

36 ULTRASOUND ULTRASOUND: General This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Aorta (seen to iliacs) Ultrasound Preps. Thyroid or Soft Tissue Neck Ultrasound Preps. Testicles Ultrasound Preps. AAA Abdominal bruit / pulsatile mass Aortic dissection AAA screening for Medicare Must be referred from initial preventative physical exam (IPPE) Patient must have at least one of the following risks: Family hx of AAA year old male who has smoked at least 100 cigarettes Additional risk factors include coronary heart disease, hyper-tension, cerebrovascular disease Enlarged lymph node Palpable mass on neck Enlarged thyroid / fullness Goiter Hypo- / hyper-thyroid Nodules Thyroiditis Epididymitis Hydrocele Orchalgia Pain / swelling Palpable lump Torsion Varicocele Aorta duplex Not screening AAA for Medicare Medicare screening Soft tissue neck ultrasound Thyroid ultrasound Testicular ultrasound Standard Ultrasound Preps: Depending on the exam, may be asked to change into gown or scrubs. Arrive 30 mins before exam. Bring insurance card along with doctors order to appointment. Radiology Ltd. the best care, the best technology, and the best expertise, right in your own backyard. 35 To schedule an appointment, call (520) or fax (520)

37 ULTRASOUND: Vascular This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Carotid Ultrasound Preps. Venous Upper and Lower Extremity Ultrasound Preps. Abdominal Preps: Eat a low fat meal the evening before. Do not eat or drink anything after midnight. You may take your prescribed medications with a sip of water as needed. Renal Artery Preps: Nothing to eat or drink 8-12 hours before appointment. No soda or coffee. You may take your prescribed medications with a sip of water as needed. Arrive 30 before exam. Amaurosis fugax Arterial vascular disease Ataxia HTN Hyperlipidemia Stenosis Stroke TIA DVT Redness Upper and lower extremity Swelling / pain Portal HTN Portal venous thrombosis Liver transplant TIPS Abdominal bruit Renal artery stenosis Uncontrolled HTN Carotid duplex / doppler Venous duplex / doppler (specify upper or lower and bilateral, right, or left with indication for each) Abdominal duplex / doppler Renal artery duplex / doppler unilat bilat Abdominal duplex TIPS Duplex scan limited ULTRASOUND Standard Ultrasound Preps: Depending on the exam, may be asked to change into gown or scrubs. Arrive 30 mins before exam. Bring insurance card along with doctors order to appointment. Radiology Ltd. is one of the largest physician-owned group practices in southern Arizona and has been providing diagnostic imaging services for more than eighty years. To schedule an appointment, call (520) or fax (520)

38 ULTRASOUND ULTRASOUND: MSK/Extremity This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. BODY PART COMMON REASON FOR EXAM PROCEDURE CODE Neck / Head standard Ultrasound Preps. Hands /Wrists standard Ultrasound Preps. Foot standard Ultrasound Preps. Ankle standard Ultrasound Preps. Knee standard Ultrasound Preps. Elbow standard Ultrasound Preps. Groin standard Ultrasound Preps. Unlisted standard Ultrasound Preps. Lymphadenopathy Palpable abnormality Pain / swelling Palpable abnormality Ganglion cyst Foreign body Rheumatoid arthritis / arthritis Median/ulnar/radial Neuropathy Pain Plantar fasciitis Morton s neuroma Plantar plate tear Ganglion cyst Palpable abnormality Foreign body Pain / swelling Achilles tendinosis or tear Tendinosis (anterior tibialis, posterior tibialis, peroneals) Ganglion cyst Palpable abnormality Foreign body Pain / swelling Baker cyst Palpable abnormality Quadriceps / patellar Tendinosis or tear Pain / swelling Biceps / triceps tendon tear Olecranon bursitis Palpable abnormality Ulnar / median / radial Neuropathy Inguinal hernia Lymphadenopathy Palpable abnormality Palpable abnormality on the back or torso Soft tissue neck / head ultrasound Soft tissue hands / wrists ultrasound Soft tissue foot ultrasound Soft tissue ankle ultrasound Soft tissue knee ultrasound Soft tissue elbow ultrasound Ultrasound extremity Ultrasound soft tissue Chest wall Upper back Limb Lower back Standard Ultrasound Preps: Depending on the exam, may be asked to change into gown or scrubs. Arrive 30 mins before exam. Bring insurance card along with doctors order to appointment.

39 X-RAY: General X-rays are done on a walk-in basis. The X-ray CPT codes are for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. PROCEDURE DESCRIPTION Chest 1 View Chest 2 Views Chest 3 Views Chest 4 or More Views Ribs Unilateral 2 Views Ribs Unilateral 2 Views with PA CXR Ribs Bilateral 3 Views Sternum Minimum 2 Views Sternoclavicular Joints 3 Views Abdomen 1 View Abdomen 2 Views Abdomen 3 or More Views Acute Abdomen Series + PA CXR 3 Views Pelvis 1 or 2 Views Pelvis Minimum 3 Views Sacrum & Coccyx Minimum 2 Views Sacroiliac Joints 3+ Views Finger(s) Minimum 2 Views Hand 2 Views Hand Minimum 3 Views Wrist 2 Views Wrist Minimum 3 Views Forearm 2 Views Upper Extremity Infant (up to 364 days old) Minimum 2 Views Elbow 2 Views Elbow Minimum 3 Views Humerus Minimum 2 Views Shoulder 1 View CPT CODE X-RAY X-rays can be scheduled or done on a walk-in basis. 38

40 X-RAY X-RAY: General X-rays are done on a walk-in basis. The X-ray CPT codes are for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. PROCEDURE DESCRIPTION CPT CODE Shoulder Minimum 2 Views Acromioclavicular Joints Bilateral Clavicle Complete Scapula Complete Toe(s) Minimum 2 Views Foot 2 Views Foot Minimum 3 Views Calcaneus (Heel) Minimum 2 Views Ankle 2 Views Ankle Minimum 3 Views Tibia & Fibula 2 Views Lower Extremity Infant (up to 364 days old) 2+ Views Knee 1 or 2 Views Knee 3 Views Knee 4 or More Views Both Knees Standing AP Bone Age Studies Bone Length Studies Osseous Complete (Bone Survey) Mandible < 4 Views Mandible 4 Views Screening Orbit (Pre MRI) Facial Bones < 3 Views Facial Bones Minimum 3 Views Nasal Bones Minimum 3 Views Orbits Minimum 4 Views Sinuses Paranasal < 3 Views Sinuses Paranasal Minimum 3 Views X-rays can be scheduled or done on a walk-in basis.

41 X-RAY: General X-rays are done on a walk-in basis. The X-ray CPT codes are for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. PROCEDURE DESCRIPTION Skull < 4 Views Skull Minimum 4 Views Neck Soft Tissue (Not for Cervical Spine) C-Spine 2 or 3 Views C-Spine Minimum 4-5 Views C-Spine Complete 6 or More Views T-Spine 2 Views T-Spine 3 Views T-Spine 4 Views L/S Spine 2 or 3 Views L/S Spine Minimum 4 Views L/S Spine Complete with Bending Views (Minimum 6 Views) L/S Spine Bending Views (Only 2-3 Views) Thoracolumbar Junction (Minimum 2 Views) Spine, Entire Thoracic and Lumbar, Including Skull, Cervical and Sacral Spine If Performed (eg, Scoliosis Evaluation); 1 View Spine, Entire Thoracic and Lumbar, Including Skull, Cervical and Sacral Spine If Performed (eg, Scoliosis Evaluation); 2 or 3 Views Spine, Entire Thoracic and Lumbar, Including Skull, Cervical and Sacral Spine If Performed (eg, Scoliosis Evaluation); 4 or 5 Views Spine, Entire Thoracic and Lumbar, Including Skull, Cervical and Sacral Spine If Performed (eg, Scoliosis Evaluation); Min. 6 Views CPT CODE Hip, Unilateral, with Pelvis When Performed; 1 View Hip, Unilateral, with Pelvis When Performed; 2 or 3 Views Hip, Unilateral, with Pelvis When Performed; Minimum 4 Views Hips, Bilateral, with Pelvis When Performed; 2 Views Hips, Bilateral, with Pelvis When Performed; 3-4 Views Hips, Bilateral, with Pelvis When Performed; Minimum 5 Views Femur; 1 View Femur; Minimum 2 Views X-RAY X-rays can be scheduled or done on a walk-in basis. 40

42 INTERVENTIONAL Coumadin/Aspirin/Aggrenox/Pradaxa-off for 5 days, exam on 6th day. (Labs drawn day before exam if on Coumadin/Warfarin). Plavix/ Effient-off for 7 days, exam on 8th day. Xarelto/Pletal for 24 hrs (restart 24 hours after the exam). **Obtain prescribing doctor`s approval to hold meds** Fluoroscopy or Lung/Mediastinum: 32405, Liver: 47000, Renal: 50200, Abdominal/Retroperitoneal Mass: 49180, INTERVENTIONAL RADIOLOGY SERVICES This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Image-Guided Percutaneous Biopsy A needle is placed in a desired location using imaging guidance in order to obtain a small piece of tissue so that it can be examined by an outside pathologist. Certain biopsies may need to be performed at the hospital due to risk of complications. Preps: No solid food 6 hours before exam. Clear liquids are permitted up until 2 hours before exam. Must have a responsible driver to drive you home. Arrive 60 mins before exam. Screen for all anticoagulants listed, and schedule appointment based on the recommended days off of medication. Send lab request for PTT, PT/INR, CBC w/platelets to ordering provider. Ultrasound Lung/Mediastinum: 32405, Liver: 47000, Renal: 50200, Abdominal/Retroperitoneal Mass: 49180, CT, Lung/Mediastinum: 32405, Liver: 47000, Renal: 50200, Abdominal/Retroperitoneal Mass: 49180, Ultrasound Thyroid: 60100, Thoracentesis A thin needle or tube is placed into the chest to remove fluid for diagnosis and/or to reduce discomfort. Preps: Off Coumadin/Aspirin/Aggrenox/Pradaxa for 5 days (exam scheduled on 6th day). Off Plavix/Effient for 7 days (exam scheduled on 8th day). Off Pletal for 24 hours (restart the day after the exam). Off Xarelto or Eliquis(Apixaban) for 24 hours. Obtain prescribing doctor s approval to hold meds. STAT labs drawn the day before procedure if on Coumadin. If not on blood thinners w/in 30 and must be received two days prior to procedure. PTT, PT/INR, CBC w/platelets. Clear liquids are permitted up until 2 hrs before exam. Arrive 30 minutes early. Must have a responsible driver CT or Ultrasound Paracentesis A thin needle or tube is placed into the abdomen to remove fluid for diagnosis and/or reduce discomfort. Preps: Off Coumadin/Aspirin/Aggrenox/Pradaxa for 5 days (exam scheduled on 6th day). Off Plavix/Effient for 7 days (exam scheduled on 8th day). Off Pletal for 24 hours (restart the day after the exam). Off Xarelto or Eliquis(Apixaban) for 24 hours. Obtain prescribing doctor s approval to hold meds. STAT labs drawn the day before procedure if on Coumadin. If not on blood thinners w/in 30 and must be received two days prior to procedure. PTT, PT/INR, CBC w/platelets. Clear liquids are permitted up until 2 hrs before exam. Arrive 30 minutes early. Must have a responsible driver CT or Ultrasound Interventional Service Modality CPT Code(s) Minimally Invasive Diagnostic Procedures Performed By Interventional or Body Radiologist Interventional or Body Radiologist Interventional or Body Radiologist Evaluation Required No Yes Yes Labs Required Yes, call for specifics Yes, call for specifics Yes, call for specifics Sedation Required No No No Yes 4241 To schedule an interventional procedure, please call (520) or fax (520)

43 Coumadin/Aspirin/Aggrenox/Pradaxa-off for 5 days, exam on 6th day. PPT/PT/INR only needed if patient is on Coumdain and must be drawn the STAT the day before exam. Plavix/Effient-off for 7 days, exam on 8th day. Xarelto/Pletal for 24 hrs (restart 24 hours after the exam). **Obtain prescribing doctor`s approval to hold meds** CT Small Joint or Bursa (fingers, toes): 20600, Intermediate Joint or Bursa (TMJ, acromioclavicular, wrist, elbow, ankle, olecranon bursa): 20605, Major Joint or Bursa (shoulder, hip, knee, subacromial bursa): 20610, INTERVENTIONAL RADIOLOGY SERVICES This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Arthrocentesis (joint fluid aspiration, joint tap, synovial fluid aspiration) A needle is placed into a joint space and fluid is removed for diagnostic analysis or to help relieve pain and pressure on the joint. Preps: No solid food or liquids 1 hour before exam. A driver is recommended but not required. Arrive 30 mins before exam. Screen for all anticoagulants listed, and schedule appointment based on the recommended days off of medication. or Interventional or Body Radiologist No No No Fluoroscopy Small Joint or Bursa (fingers, toes): 20600, Intermediate Joint or Bursa (TMJ, acromioclavicular, wrist, elbow, ankle, olecranon bursa): 20605, Major Joint or Bursa (shoulder, hip, knee, subacromial bursa): 20610, Myelogram (thoracic, lumbar) Fluoroscopy is used to place a thin needle into the spinal canal. Dye is injected and images are obtained. In most cases additional images are then obtained using CT. Preps: No solid food or liquids 1 hour before exam. A driver is recommended but not required. Arrive 30 mins before exam. Screen for all anticoagulants listed, and schedule appointment based on the recommended days off of medication. Fluoroscopy; then CT T-Spine: 62303, L-Spine: 62304, Use for 2 or 3 levels Neuroradiologist No Only if patient is taking blood thinners No Coumadin/Aspirin/Aggrenox/Pradaxa-off for 5 days, exam on 6th day. PPT/PT/INR only needed if patient is on Coumdain and must be drawn the STAT the day before exam. Plavix/Effient-off for 7 days, exam on 8th day. Xarelto/Pletal for 24 hrs (restart 24 hours after the exam). **Obtain prescribing doctor`s approval to hold meds** CT Upper Joints Replace code with Lower Joints Replace code with Arthrogram (shoulder, elbow, wrist, hip, knee, and ankle) Fluoroscopy is used to place a thin needle into the symptomatic joint. Dye is injected and images are obtained. In most cases additional images are then obtained using MRI or CT. Preps: No solid food or liquids 1 hour before exam. A driver is recommended but not required. Arrive 30 mins before exam. Screen for all anticoagulants listed, and schedule appointment based on the recommended days off of medication. or Fluoroscopy; then MRI Upper Joints Shoulder: 73222, 23350, 73040, Elbow: 73222, 24220, 73085, Wrist: 73222, 25246, 73115, Lower Joints Hip: 73722, 27093, 73525, 77002, Knee: 73722, 27370, 73580, Ankle: 73722, 27648, 73615, Interventional, Body, or Musculoskeletal Radiologist No Only if patient is taking blood thinners No Interventional Service Modality CPT Code(s) Performed By Evaluation Required Labs Required Sedation Required Minimally Invasive Diagnostic Procedures INTERVENTIONAL To schedule an interventional procedure, please call (520) or fax (520)

44 INTERVENTIONAL Epidural Blood Patch Epidural Blood Patch (EBP) is used to treat spinal headaches that are most commonly encountered after dural puncture. The blood patch acts as a gelatinous glue which prevents cerebrospinal fluid (CSF) leakage and allows the dural hole to heal. Preps: No solid food or liquids 1 hour before exam. Must have a responsible driver. Arrive 30 mins before exam. Screen for all anticoagulants listed, and schedule appointment based on the recommended days off of medication. Fluoroscopy 62273, Neuroradiologist INTERVENTIONAL RADIOLOGY SERVICES This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Coumadin/Aspirin/Aggrenox/Pradaxa-off for 5 days, exam on 6th day. (Labs drawn day before exam if on Coumdain/Warfarin). Plavix/Effient-off for 7 days, exam on 8th day. Xarelto/Pletal for 24 hrs (restart 24 hours after the exam). Obtain prescribing doctor`s approval to hold meds. Preps: All appointments must have had a consult prior to exam. No solid food 6 hours before exam, but clear liquids are permitted up until 2 hours before exam. Must have a responsible driver to drive you home. Arrive 60 mins before exam. Screen for all anticoagulants listed, and schedule appointment based on the recommended days off of medication. Send lab request for PTT,PT/INR, CBC w/ platelets to ordering provider. Bilateral: 0201T CT Unilateral: 0200T Interventional Radiologist Sacroplasty CT is used to guide two needles into a fractured sacrum. A mixture of bone cement and contrast is then injected into the sacrum through the needles to stabilize the fracture. Coumadin/Aspirin/Aggrenox/Pradaxa-off for 5 days, exam on 6th day. (Labs drawn day before exam if on Coumdain/Warfarin). Plavix/Effient-off for 7 days, exam on 8th day. Xarelto/Pletal for 24 hrs (restart 24 hours after the exam). Obtain prescribing doctor`s approval to hold meds. Preps: All appointments must have had a consult prior to exam. No solid food 6 hours before exam, but clear liquids are permitted up until 2 hours before exam. Must have a responsible driver to drive you home. Arrive 60 mins before exam. Screen for all anticoagulants listed, and schedule appointment based on the recommended days off of medication. Send lab request for PTT,PT/INR, CBC w/ platelets to ordering provider. T-Spine: 22513, each add l level use (if biopsy is performed on separate vertebrae, use 20225) L-Spine: 22514, each add l level use (if biopsy is performed on separate vertebrae, use 20225) Kyphoplasty (thoracic, lumbar) Fluoroscopy or CT guidance is used to place a needle into a fractured vertebra. Bone cement is then injected to stabilize the fracture. CT Coumadin/Aspirin/Aggrenox/Pradaxa-off for 5 days, exam on 6th day. (Labs drawn day before exam if on Coumdain/Warfarin). Plavix/Effient-off for 7 days, exam on 8th day. Xarelto/Pletal for 24 hrs (restart 24 hours after the exam). Obtain prescribing doctor`s approval to hold meds. Fluoroscopy or Interventional Radiologist Preps: All appointments must have had a consult prior to exam. No solid food 6 hours before exam, but clear liquids are permitted up until 2 hours before exam. Must have a responsible driver to drive you home. Arrive 60 mins before exam. Screen for all anticoagulants listed, and schedule appointment based on the recommended days off of medication. Send lab request for PTT,PT/INR, CBC w/ platelets to ordering provider. T-Spine: 22510, each add l level use (if biopsy is performed on separate vertebrae, use 20225) L-Spine: 22511, each add l level use (if biopsy is performed on separate vertebrae, use 20225) Vertebroplasty (thoracic, lumbar) Fluoroscopy or CT guidance is used to place a needle into a fractured vertebra. Bone cement is then injected to stabilize the fracture. Interventional Service Modality CPT Code(s) Performed By Pain Management Evaluation Required Yes, may require a consult. Must have either MRI or CT+ Bone Scan prior to evaluation. Yes, may require a consult. Must have either MRI or CT+ Bone Scan prior to evaluation. Sometimes, contact interventional scheduling for more info. (520) Labs Required Yes, call for specifics Yes, call for specifics Only if patient is taking blood thinners Sedation Required Yes Yes No 443 To schedule an interventional procedure, please call (520) or fax (520)

45 Angiogram Angioplasty Aortagram Arteriogram Biliary Dilation w/o or w/stent Biliary Drain Biliary Tube Change Biopsy (renal / lung) Catheter Placement (renal / pelvis) Catheter Stripping Cholangiogram (T-Tube) Fistulogram (dialysis or other than dialysis) Gastric Emptying Study Intravascular Stent Placement IVC Filter Placement Kyphoplasty Loopogram Lung Biopsy (image guided percutaneous) Nephrostomy Shuntogram Stent Ureteral Catheter or Stent Uterine Fibroid Embolization (UFE) Venogram INTERVENTIONAL RADIOLOGY SERVICES This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Due to the sensitive nature of some interventional procedures, the following services are usually performed by Radiology Ltd. staff in a hospital setting: Lumbar Puncture (spinal tap, spinal puncture, thecal puncture, rachiocentesis) Local anesthesia is injected into the lumbar region of the back, and a needle is inserted into the spinal canal. Cerebrospinal fluid (CSF) can then be removed for testing. Preps: No solid food or liquids 1 hour before exam. A driver is recommended but not required. Arrive 30 mins before exam. Screen for all anticoagulants listed, and schedule appointment based on the recommended days off of medication. Fluoroscopy 62270, Neuroradiologist Yes, may require a consult. Must have either MRI or CT. Only if patient is taking blood thinners No Joint Injection (lumbar facet and sacroiliac) Steroid medication is injected into the symptomatic joint to decrease pain and swelling. Preps: No solid food or liquids 1 hour before exam. A driver is recommended but not required. Arrive 30 mins before exam. Screen for all anticoagulants listed, and schedule appointment based on the recommended days off of medication. CT or Fluoroscopy Lumbar Facet: (1st), (2nd), (3rd) Interventional or Body Sacroiliac (SI): (1st), Radiologist (2nd), (3rd) Yes Only if patient is taking blood thinners No Preps: No solid food or liquids 1 hour before exam. Must have a responsible driver. Arrive 30 mins before exam. Screen for all anticoagulants listed, and schedule appointment based on the recommended days off of medication. CT Spinal Injection (epidural, nerve root, facet, and sacroiliac) Anesthetics and/or steroid medications are injected in the spine to reduce back and/or leg pain. These can be both diagnostic and therapeutic and include epidural, nerve root, facet and sacroiliac joint injections. or Epidural: L-Spine: SI: Nerve Root/Block (per level/per side) L-Spine: 64483, Neuroradiologist Yes Fluoroscopy Epidural: L-Spine: Nerve Root/Block (per level/per side) L-Spine: 64483, Only if patient is taking blood thinners No Interventional Service Modality CPT Code(s) Performed By Evaluation Required Labs Required Sedation Required Pain Management INTERVENTIONAL To schedule an interventional procedure, please call (520) or fax (520)

46 INTERVENTIONAL Radiology Ltd. Wilmot Center for Diagnositc Imaging and Treatment 677 N. Wilmot Rd. INTERVENTIONAL RADIOLOGY SERVICES This is for reference only. This does not imply protocol standards for all radiology facilities. Information is subject to change. Radiology Ltd. La Cholla Center for Diagnostic Imaging and Treatment 5960 N. La Cholla Blvd. Radiology Ltd. offers two interventional out-patient facilities in Tucson: Preps: Nothing to eat 2 hours before exam. Must have a responsible driver to drive you home. Arrive 30 mins before exam. No labs required, and anticoagulants are ok. PICC Line Placement Fluoroscopy and ultrasound are used to guide a catheter through a vein in the arm and then into the upper chest. The catheter is used for long term IV therapy and eliminates the necessity for multiple needle punctures. Fluoroscopy & Ultrasound 36569, 77001, Interventional Technologist, RN, or M.D. Yes Only if patient is taking blood thinners Interventional Service Modality CPT Code(s) Performed By Evaluation Required Labs Required Vascular Services Sedation Required No 4645 To schedule an interventional procedure, please call (520) or fax (520)

47 ICD-10 CODES NOTES REQUESTED TEXT Please use the spaces below for notes or additional codes common in your practice. CODE REQUESTED TEXT Please use the spaces below for notes or additional codes common in your practice. CODE INTERVENTIONAL ICD-9 ICD-10 CODES To schedule an appointment, call (520) or fax (520)

48 ICD-10 CODES REQUESTED TEXT ICD-10 CODES NOTES Please use the spaces below for notes or additional codes common in your practice. CODE REQUESTED TEXT Please use the spaces below for notes or additional codes common in your practice. CODE 47 To schedule an appointment, call (520) or fax (520)

49 ICD-10 CODES NOTES REQUESTED TEXT Please use the spaces below for notes or additional codes common in your practice. CODE REQUESTED TEXT Please use the spaces below for notes or additional codes common in your practice. CODE INTERVENTIONAL ICD-9 ICD-10 CODES To schedule an appointment, call (520) or fax (520)

50 RADIOLOGY LTD. IS A PREFERRED PROVIDER FOR THE FOLLOWING INSURANCES 49 MAJOR INSURANCE PLANS AARP Medicare Complete (Formally Secure Horizons) Aetna US Healthcare (not contracted with Aetna Sr) AHCCCS (All Plans) Banner Health Plus Blue Cross/Blue Shield including BCBS Advantage Care1st HealthPlan (AHCCCS) CareMore Health Plan Cenpatico Cigna (excludes Health Springs HMO) Cochise Health System Department of Labor EverCare and Community Plan UHC* (Formally EverCare Select) GEHA Health Choice Arizona Health Choice Generations Health Net / Health Net Medicare Advantage Health Net Allwell/Ambetter Health Net Federal Services (Tricare) Humana Humana Community HMO Humana Gold Indian Health Services Mail Handlers Benet Plan (MHBP) Mayo Health Plan Arizona MDIA (Medrisk Data)* Medicare Mercy Care Healthcare Group Meritain OneCare One Call Care Diagnostic Preferred Medical Claim Solutions State Compensation Fund TriWest VA UHC West (Formally Pacicare) United Medical Resources (UMR) United Healthcare United Healthcare Community Plan* (Formally APIPA) United Healthcare Medicare Complete University Family Care (AHCCCS) University Physician Advantage * Not contracted with Carondelet for CT, Ultrasound, X-ray MAJOR NETWORK PLANS Accountable Health Plans Ancillary Care Services Arizona Foundation for Medical Care Beech Street CCN Coventry National First Health (Individual Provider Contracts) Health Management Network MultiPlan PHCS If you need further assistance with insurances, please call our Insurance Billing Representatives at (520)

51 WE HAVE 8 IMAGING CENTERS TO SERVE YOU 1 Camp Lowell Imaging Center 4640 E. Camp Lowell Dr. Tucson, AZ Tel: (520) Radiology Ltd. - Carondelet Imaging Center 6567 E. Carondelet Dr., Suite 105 Tucson, AZ Tel: (520) La Cholla Center for Diagnostic Imaging and Treatment La Cholla Center for Women s Imaging 5960 N. La Cholla Blvd. Tucson, AZ Tel: (520) Midvale Imaging Center 1598A West Commerce Ct. Tucson, AZ Tel: (520) THORNYDALE RANCHO VISTOSO TANGERINE 5 ORACLE Rancho Vistoso Diagnostic Imaging 2551 E. Vistoso Commerce Loop Oro Valley, AZ Tel: (520) Radiology Ltd. - Rincon Imaging Center E. Drexel Road Tucson, AZ Tel: (520) St. Joseph s Imaging Center 330 N. Wilmot Rd. Tucson, AZ Tel: (520) Wilmot Center for Diagnostic Imaging and Treatment ORANGE GROVE 2 RIVER Wilmot Center for Women s Imaging 677 N. Wilmot Rd. Tucson, AZ Tel: (520) ORACLE LA CANADA LA CHOLLA CAMP LOWELL 1 STONE CAMPBELL GRANT SPEEDWAY BROADWAY 5TH ST ND ST ALVERNON SWAN CRAYCROFT WILMOT KOLB HOUGHTON 29TH ST GOLF LINKS IRVINGTON IRVINGTON DREXEL VALENCIA VALENCIA

52 MODALITY BY LOCATION 51 WILMOT WOMEN S ST. JOSEPH S WILMOT RADIOLOGY LTD. - RINCON RANCHO VISTOSO RADIOLOGY LTD. - CARONDELET MIDVALE LA CHOLLA WOMEN S LA CHOLLA CAMP LOWELL MRI (High-Field) X X X X X X X X X MRI (Espree X-Large Opening) 3T MRI X CT X X X X X X X PET / CT X Interventional X X Ultrasound X X X X X X X X X X X Diagnostic Mammography X X X X Screening Mammography 3D Mammography X X Breast Biopsy X X Breast MRI X X X X Breast Interventional X X X X DEXA (Bone Densitometry) Digital X-ray X X X X X X X X X

53 WEEKEND MRI Weekend MRI Weekend MRI is available for your patient s convenience at several of our Radiology Ltd. locations! Radiology Ltd. offers 3T MRI 3T MRI technology provides clinical advantages for prostate, abdominal imaging, small joints, and research studies. The machine is centrally located at our Camp Lowell site. Radiology Ltd. offers a better choice in open MRI with the Espree X-Large Opening MRI, available at our Wilmot and La Cholla locations. To schedule your patient s appointment, call (520)

54 TECHNOLOGY Radiology Ltd. has a nearly paperless and fully electronic workflow residing on stateof-the-art infrastructure, allowing rapid and seamless communication across locations throughout the organization. We route all imaging studies to the most appropriate location, ensuring the most accurate and timely interpretations and the highest level of patient care. We focus on technological improvements that help us both practice better medicine and optimize customer service. CURRENT TECHNOLOGIES INCLUDE: (Provider Portal) Images are available to the referring community within minutes of exam completion and can be viewed anywhere, anytime. Our systems enable our referring providers to: Use different viewers to access images on any platform (one viewer is for power users; the other is a zero client viewer that can be used with any browser) Access current and historical reports Find status of patient exams View new services and products, including Clinical Decision Support and Alert Application Order patient exams Access patient reports from smartphones and tablets via our mobile app (Patient Portal) Reports and images are available to patients 2 business days after their exam is read. Our portal is a useful and interactive tool which enables our patients to: Preregister for exam and fill out safety questionnaire to expedite check-in process on the day of exam Access reports and images Access preparation instructions for exam, along with the time and location of exam Access Continuing Care Document (CCD) Communicate directly with Radiology Ltd. staff in a secure, HIPAA-compliant environment View new services and products, including billing statements and online bill payment 53

55 ACR Appropriateness Criteria The ACR Appropriateness Criteria (AC) are evidence-based guidelines to assist referring physicians and other providers in making the most appropriate imaging or treatment decision for a specific clinical condition. Employing these guidelines helps providers enhance quality of care and contribute to the most efficacious use of radiology. The list can be found here: 54