2018 CPT Code Reference Guide Everyone s choice for imaging

Transcription

1 2018 CPT Code Reference Guide Everyone s choice for imaging T F imaginghealthcare.com

2 HEAD/NECK & NEURO EXAM TO ORDER MRI brain - post fossa w/ & w/o contrast (IAC w/ & w/o) MRI brain (pituitary protocol) w/ & w/o contrast MRI brain (seizure protocol) w/ & w/o contrast MRI brain and orbits w/ & w/o contrast MRI brain w/ & w/o contrast MRI brain w/o contrast Bell s Palsy Hearing loss Vertigo Hormone abnormalities Pituitary Seizures - multiple early onset Loss of vision Ocular mass or tumor 70553, Optic neuritis Visual disturbance Bell s Palsy Brain tumor Dizziness Headaches (depends on Meningitis associated clinical history) Metastatic brain disease Multiple sclerosis Seizures Vertigo Ataxia CVA Dementia Headaches (depends on Traumatic brain injury associated clinical history) (chronic) Magnetic Resonance Imaging (MRI) MRI brain w/o contrast and MRA or MRV Personal or family history of aneurysm Severe headache Subarachnoid hemorrhage 70551, MRI (facial bones, orbits, neck soft tissue) w/ & w/o contrast Tumor, mass, swelling, or infection of the soft tissue neck 70543

3 EXAM TO ORDER ABDOMEN & PELVIS MRI abdomen w/ & w/o contrast MRA abdomen w/ or w/o contrast MRI abdomen w/ & w/o contrast w/ MRCP MRI abdomen and pelvis w/ & w/o contrast Abdominal pain Any complaint related to liver, spleen, pancreas or kidneys Hypertension Renal artery stenosis Gall stones Cholangitis Biliary tumor or pancreatitis Common bile duct or gallbladder concerns Pancreatic duct Crohn s disease Inflammatory bowel disease Ischemic bowel disease , Abdomen w/ & w/o Pelvis w/ & w/o Magnetic Resonance Imaging (MRI) MRI pelvis w/o contrast Coccyx fracture Pubic arthralgia Sacroiliitis Stress fracture (Pelvis) Pelvic fracture Sacral fracture Sports hernia MRI pelvis and prostate gland w/ & w/o contrast Prostate cancer screening, staging or follow up 72197

4 EXAM TO ORDER PELVIS SPINE MRI pelvis female GYN w/ & w/o contrast MRI pelvis w/ & w/o contrast MRI cervical spine w/ & w/o contrast MRI cervical spine w/o contrast Adenomyosis Cervical cancer Dermoid Family history of uterine Fibroid or ovarian malignant tumor Infection or tumor Ovarian disease Post menopausal bleeding UFE planning Uterine mass Vaginal cancer Non-gynecological tumor or infection Non-specific pelvic pain Demyelination MS Suspected tumor of cervical spinal cord Benign cervical spine Cervical neck pain Compression fracture (Cervical Spine) Degenerative disc disease Disk herniation radiculopathy Magnetic Resonance Imaging (MRI) MRI lumbar spine w/ & w/o contrast *If prior lumbar surgery (within 10 years), r/o infection, or bone mets then MRI lumbar spine w/ & w/o contrast. Low back pain longer than 6 weeks Neuro impairment Failed back syndrome Pathologic compression fracture (Lumbar Spine) 72158

5 EXAM TO ORDER SPINE ARTHROGRAM MRI lumbar spine w/o contrast MRI thoracic spine w/o contrast MRI arthrogram (knee only) MRI arthrogram (shoulder only) Compression fracture Disk herniation Radiculopathy Degenerative disk disease Low back pain Sciatica Compression fracture benign (Thoracic Spine) Degenerative disk disease Disk herniation Thoracic back pain Ankle pain with concern for unstable osteochondral lesion Hip pain with concern for labral tear Knee pain with concern for unstable osteochondral Knee pain with prior arthroscopy Elbow pain with concern for ligament or intra articular injury including unstable osteochondral lesions Shoulder pain after dislocation or concern for labral tear Shoulder pain after rotator cuff or labral repair Wrist pain with concern for ligament or intra articular injury MRI joint LOWER extremity w/ contrast Arthro injection Fluoro guidance MRI joint UPPER extremity w/ contrast Arthro injection Fluoro guidance Magnetic Resonance Imaging (MRI)

6 EXAM TO ORDER EXTREMITY UPPER MRI (joint) UPPER extremity w/o contrast MRI (non joint) UPPER extremity w/o contrast MRI (non joint) UPPER extremity w/ & w/o contrast MRI (joint) LOWER extremity w/o contrast Evaluate for bony or soft tissue pathology Internal derangement occult Joint pain Fracture to non-joint extremity Lipoma Myositis Nonspecific pain Soft tissue injury Stress response Contrast indicated for tumor or infection of extremity only Evaluate for bony or soft tissue pathology Internal derangement occult Joint pain Magnetic Resonance Imaging (MRI) EXTREMITY LOWER MRI (non joint) LOWER extremity w/o contrast MRI (non joint) LOWER extremity w/ & w/o contrast Fracture to non-joint extremity Lipoma Myositis Nonspecific pain Soft tissue injury Stress response Contrast indicated for tumor or infection of extremity only 73720

7 HEAD/NECK & NEURO EXAM TO ORDER CT head, brain w/ & w/o contrast CT head, brain w/o contrast Ataxia CVA Headaches Brain tumor Dementia (Contrast - depends on associated clinical history) Ataxia Dementia Normal pressure hydrocephalus (NPH) CVA Headaches Traumatic brain injury (acute) (Contrast - depends on associated clinical history) CT maxillofacial w/o contrast Possible fracture Trauma CT orbit w/o contrast Fracture Trauma Swelling CT sinus w/o contrast Facial pain Sinusitis CT soft tissue neck w/ contrast Lymphadenopathy Mass Swelling Computed Tomography (CT) CT soft tissue neck w/o contrast Contraindication to iodine (consider MRI) Salivary gland stone CT temporal bones w/o contrast Earache Hearing loss Cholesteatoma 70480

8 CHEST ABDOMEN EXAM TO ORDER CT angiography chest CT chest interstitial disease evaluation, high-resolution chest w/o contrast CT low dose lung screening CT chest w/ contrast CT chest w/o contrast CT abdomen w/ & w/o contrast (w/ oral contrast, unless specified) CT abdomen w/ contrast (w/ oral contrast, unless specified) CT abdomen w/o contrast (w/ oral contrast, unless specified) Pulmonary embolism Aneurysm Chest pain Dyspnea Elevated D-Dimer Ascending aorta or aortic arch dissection Interstitial lung disease Low dose lung cancer screening Minimum 30-Pack Year smoker Asymptomatic patients only Requires completion of CT Low Patient age between years Dose Screening Request Form Less than 15 years since quit smoking Preferred Abnormal chest x-ray Adenopathy Chest pain Cough Pleural effusion Lung cancer Dyspnea Pneumonia Follow up for known neoplasm Pulmonary nodule or mass Nodule follow-up when contrast is contraindicated Contraindication to iodine Adrenal mass Hepatic mass (dedicated liver study) Pancreatic mass Upper abdominal pain Renal mass Preferred Adenopathy Mass Pancreatitis Upper abdominal pain G Contraindication to iodine (consider MRI) Computed Tomography (CT)

9 ABDOMEN & PELVIS EXAM TO ORDER CT abdomen/pelvis w/ & w/o contrast* (w/ oral contrast, unless specified) CT abdomen/pelvis w/ contrast (w/ oral contrast, unless specified) CT abdomen/pelvis w/o contrast (w/ oral contrast, unless specified) CT abdomen/pelvis w/o contrast (w/o oral contrast) - renal stone study CT colonography diagnostic Abdominal pain Constipation Lymph node enlargement Preferred Abdominal distension Adenopathy Bowel obstruction or perforation Diverticulitis Mass Cancer Diverticulitis Pelvis pain Abdominal or pelvic pain Contraindication to iodine (consider MRI) Flank pain Suspected renal stones or follow-up Abdominal pain Appendicitis Cancer Constipation Lymph node enlargement Pelvic pain Failed or contraindication to traditional colonoscopy due to: - Rectal bleeding, tortuous colon, or inability to tolerate sedation CT colonography screening Colon cancer screening Family history of colon cancer CT small bowel w/ contrast (w/ oral contrast) CT urogram w/ & w/o contrast Anemia Chronic GI bleed Small bowel mass Dysuria Hematuria Bowel obstruction Crohn s disease Flank pain UTIs Computed Tomography (CT) *Performing CT Abdomen/Pelvis w/ & w/o contrast is not our recommended study, except for some dedicated oncology cases.

10 EXAM TO ORDER SPINE OTHER CT cervical spine w/o contrast CT lumbar spine w/o contrast CT extremity LOWER w/o contrast CT extremity UPPER w/o contrast Compression fracture Trauma (Cervical Spine) Neck pain Compression fracture (Lumbar Spine) Low back pain Trauma (Lumbar Spine) Fracture Swelling Fracture Swelling Pain Pain Computed Tomography (CT)

11 NECK CHEST ABDOMEN EXAM TO ORDER US neck soft tissue Palpable head, face or neck mass (describe area) US thyroid or neck US chest US abdominal complete US abdominal LTD Goiter Palpable neck mass (describe on head, face, or neck) Parotid, abnormal thyroid tests Thyroidmegaly Mediastinum Palpable mass, chest wall and upper back (describe location) Pleura Abnormal liver tests Epigastric pain Hepatitis Nausea Ascites Fatty liver Jaundice Pain Test includes the liver, pancreas, gallbladder, kidneys, aorta, and spleen. If abdominal and kidney (renal) are ordered together use abdomen and pelvic LTD (76857) to include bladder images. Inguinal hernia Quadrant pain Single organ evaluation such as liver or gallbladder Palpable mass lower abdominal and lower back (describe location) Ultrasound

12 PELVIS EXAM TO ORDER US aorta LTD US renal retroperitoneal US pelvic (female) and transvaginal *Patient or doctor may specifically request no transvaginal due to patient age (under 18 years old), pregnancy or comfort. US pelvic (female and male) (No transvaginal included) US pelvic LTD Aorta screening Abdominal aortic aneurysm (AAA) Abnormal kidney labs Calculus of kidney stones Dysuria includes bladder and Flank pain pre & post void measurements Hematuria Hydronephrosis Mass or cyst CKB UTI If clinical history suggests urinary tract pathology, then a complete evaluation of the kidneys and urinary bladder will be included in the exam. Bleeding Bloating Endometriosis Excessive or frequent Female pelvis to view menstruation uterus and ovaries Fibroids Leiomyoma Mass Lower abdominal and pelvic pain Pelvic pain Mass Irregular bleeding Bloating Fibroids Abscess Free fluid Male pelvis bladder Bladder Urinary tract problems Soft palpable mass, To evaluate bladder in pelvic wall and buttocks addition to abdominal US (describe location) , US scrotal Mass Pain Swelling and tenderness 76870, Ultrasound

13 VASCULAR OTHER EXAM TO ORDER US arterial - lower extremity only *Always includes bilateral extremity unless amputation. US carotid duplex arteries bilateral US extremity venous studies duplex scan of veins, UNILATERAL upper and lower US extremity venous study duplex scan of veins, BILATERAL upper and lower US noninvasive extremity artery bilateral US breast, unilateral, complete US breast, unilateral, limited US non-vascular extremity LTD Cellulitis Claudication Edema Extremity pain PVD or PAD (Peripheral vascular/arterial disease) Bruit Hypercholestremia Trauma Edema Swelling in extremity Pain in extremity Diplopia Hyperlipidemia Vertigo Numbness Warm limb Thrombosis Please indicate upper/lower extremity and right/left. Pain Swelling Redness Tenderness in both legs Please indicate upper/lower extremity and right/left Bilateral Unilateral Claudication Pain Palpable mass to INCLUDE side and location on breast (i.e. right breast palpable 10:00) Lumps Soft tissue masses on extremities and axilla (document specific area of concern) Ultrasound US spinal canal and contents Tethered cord (pediatric exam) 76800

14 BONE MINERAL DENSITOMETRY PREGNANCY EXAM TO ORDER DXA, Bone Density, one or more sites (hips, pelvis, spine) EXAM TO ORDER US Obstetrical < 14 weeks US Transvaginal US Obstetrical > 14 weeks US Obstetrical w/ imaging of additional fetus Evaluate bone loss Osteoporosis Osteopenia Pregnancy LESS than 14 weeks Fetal demise Please include last menstrual period or established estimated date of delivery on all exams (less than 14 weeks). *Preferred exam to include EV for early OB. Pregnancy GREATER than 14 weeks Evaluation of fetal growth Please include last menstrual period or established estimated date of delivery for OB ultrasound (more than 14 weeks or for multiple fetus). Multiple fetus US obstetrical less than 14 weeks CT, Bone Density, QCT Osteoporosis Osteopenia , , (first) (additional) Bone Mineral Densitometry Pregnancy

15 MAMMOGRAM Includes Computer Aided Detection TOMOSYNTHESIS EXAM TO ORDER Screening: Bilateral Annual All asymptomatic women; Age 40 and older Diagnostic (Women): Bilateral Annual Personal history breast cancer asymptomatic Diagnostic (Women): Unilateral Annual Personal history breast cancer asymptomatic Diagnostic (Women): Bilateral - Symptomatic Symptomatic patients; Age 30 and older Symptomatic Exam requires Breast Ultrasound Diagnostic (Men): Bilateral Palpable mass Screening: Bilateral Annual All Asymptomatic Women; Age 40 and older Diagnostic: Bilateral Symptomatic Women; Age 40 and older Diagnostic: Unilateral Symptomatic Women; Age 40 and older Complete US, Limited US, Mammography & Breast Ultrasound BREAST ULTRASOUND Complete** Limited** Complete exam of all four quadrants of the breast and retroareolar region Focused exam of the breast that is limited to one or more quadrants of the breast and retroareolar region Palpable mass woman age 29 and younger **Both code definitions include exam of the Axilla, if performed.

16 EXAM TO ORDER MAMMOGRAPHY Consider high-risk screening MRI of breasts in addition to (not as a replacement for) annual screening mammography High Risk Patients: - BRCA 1 or 2 carrier - History of chest radiation from ages Lifetime risk of breast cancer 20-25% or greater - Untested patient w/ 1st degree relative positive for BRCA 1 or Mammography

17 BONE SCANS EXAM TO ORDER Whole Body Bone Scan Neoplastic disease Limited Bone Scan Three Phase Bone Scan Occult fracture, stress reaction, arthritis, bone graft viability Osteomyelitis, avascular necrosis, Reflex Sympathetic Dystrophy (RSD) Nuclear Medicine Limited Bone Scan with SPECT Occult Fracture, stress reaction, arthritis, bone graft viability WHITE BLOOD CELL (WBC) SCANS White Blood Cell (WBC) Indium-111 (IN-111) Limited White Blood Cell (WBC) Indium-111 (IN-111) Whole Body Known or suspected infection/inflammation Known or suspected infection/inflammation PARATHYROID SCAN Parathyroid Scan Evaluate for parathyroid adenomas and patients with hyperparathyroidism and hypercalcemia

18 I-131 WHOLE BODY SCANS THYROID SCANS EXAM TO ORDER Whole Body I-131 Scan Metastatic Post thyroidectomy, diagnostic scan for thyroid Survey (with or w/o thyrogen). Thyrogen cancer metastases or residual thyroid tissue. is given at the referring provider s office Whole Body Scan Metastatic Survey (with or w/o thyrogen). Thyrogen is given at the referring provider s office Technetium 99m (Tc-99m) Thyroid Scan Only Iodine-123 (I-123) Single 24 Hour Uptake and Scan Iodine-123 (I-123) Multiple 4 & 24 Hour Uptake and Scan Post thyroidectomy, diagnostic scan for thyroid cancer metastases or residual thyroid tissue. Evaluate thyroid gland structure, location of ectopic thyroid tissue, evaluation of congenital hypothyroidism, evaluation of neck or substernal mass Suspected hyperthyroidism, thyroid masses, evaluate thyroid nodules function Suspected hyperthyroidism, thyroid masses, evaluate thyroid nodules function Nuclear Medicine THYROID THERAPY Iodine-131 (I-131) Thyroid Therapy Treatment for Graves Disease, toxic nodules, and nontoxic nodular goiter. Thyroid Cancer, treatment for residual tissue after thyroidectomy

19 LUNG SCANS HEPATOBILIARY SCANS EXAM TO ORDER Lung V/Q (Ventilation and Perfusion) Suspected pulmonary embolism Hepatobiliary Scan Hepatobiliary Scan with gallbladder ejection fraction analysis Evaluate for cystic duct obstruction and for acute cholecystitis Evaluate for gallbladder dysmotility or biliary dyskinesia Nuclear Medicine GASTRO EMPTYING Gastric Emptying Study Evaluate gastric motility and emptying CARDIAC SCANS Cardiac Blood Pool (MUGA) Scan Evaluate cardiac function LYMPHOSCIN- TIGRAPHY Lymphoscintigraphy Lymphatic Imaging 78195

20 EXAM TO ORDER LIVER SCANS LIVER HEMANGIOMA Liver Spleen Scan Without SPECT (Planar) Liver Spleen Scan With SPECT (Tomography) Liver Red Blood Cell Scan SPECT Evaluate focal liver masses such as HCC, FNH, adenoma and hemangioma when MRI is indeterminate. Evaluate focal liver masses such as HCC, FNH, adenoma and hemangioma when MRI is indeterminate. SPECT is preferred over planar study. Evaluate liver mass for possible hemangioma when MRI is indeterminate Nuclear Medicine RENAL SCANS Renal Flow and Function Evaluate renal function Renal Flow and Function Without and With Lasix Renal Flow and Function With Captopril Evaluate for renal function, renal ureter obstruction, post surgical evaluation Evaluate for hypertension. Evaluate renal function during ACE inhibitor therapy BRAIN IMAGING Brain DaTScan Evaluate for Parkinson s Disease, MSA, CBD, and PSP 78607, A9584

21 EXAM TO ORDER TUMOR IMAGING WITH FDG Skull Base to Mid-Thigh Whole Body Oncology staging, restaging, recurrence, and therapy response (Please refer to the IHS PETCT coverage guide for more information) Oncology staging, restaging, recurrence, and therapy response for melanoma or sarcoma of the long bones 78815,A , A9552 PET/CT TUMOR IMAGING WITH GA-68 Ga-68 Dotatate Scan (Skull to Mid-Thigh) Staging and restaging neuroendocrine tumors 78815, A9587 BONE SCAN WITH F-18 SODIUM FLUORIDE Whole Body Bone Scan with F-18 Naf Detection and evaluation of skeletal metastatic disease (more sensitive alternative than conventional bone scans) 78816, A9580

22 EXAM TO ORDER BRAIN IMAGING PROSTATE SCAN Brain Scan with FDG Brain Scan with Florbetapir F-18 Amyloid Imaging (Amyvid) Prostate Scan with Fluciclovine F-18 (Axumin) Evaluate Mild Cognitive Impairment and Dementia. Help differentiate Alzheimer s Disease from Fronto- Temporal Dementia (FTD) Evaluate for Alzheimer s Disease and differentiate from FTD Prostate cancer re-staging after patient has completed treatment and has a rising PSA 78608, A , A , A9588 PET/CT

23 BRAIN / HEAD wo w/wo CTA Brain/Head (w/) ORBITS wo w/ w/wo PETROUS/TEMPORAL BONE (IAC) wo SELLA (PITUITARY) w/wo SINUSES wo w/wo NECK, SOFT TISSUE wo w/ w/wo LUNG Low Dose Lung Screening G0297 CT COLONOGRAPHY Screening Diagnostic CHEST w/ wo Angio (w/) ABDOMEN wo w/wo Angio / AAA (w/) Angio Aorta Runoff (w/) BONE DENSITY SCREENING QCT HEART CACS (wo) CCTA (w/) CACS & CCTA (wo/w) PELVIS wo w/ ABDOMEN AND PELVIS w/wo Renal Stone (wo) Urogram (w/wo) Small Bowel (w/wo) CT Exams CPT Codes 3-D RECONSTRUCTION Add to Any Exam UPPER EXTREMITY wo w/wo LOWER EXTREMITY wo w/wo Angio (w/wo) SPINE Cervical wo Thoracic wo Lumbar wo COMBINATION CODES NECK, CHEST, ABDOMEN, PELVIS w/wo 70491, 71260, CHEST, ABDOMEN, PELVIS wo 71250, w/wo 71260, CHEST AND ABDOMEN w/wo 71260, ABDOMEN AND PELVIS (ANGIO) w/wo 74175, ABBREVIATION KEY *These CPT codes represent the wo = without IV contrast most commonly ordered CT exams. w/ = with IV contrast For any coding inquiry not listed please call your Marketing Team w/wo = with & without IV contrast Member at CACS = Coronary Artery Calcium Score CCTA = Coronary CT Angiogram REV 7/2017

24 SPINE, CERVICAL wo w/wo SPINE, THORACIC wo w/wo SPINE, LUMBAR wo w/wo UPPER EXTREMITY NON JOINT (HUMERUS, FOREARM, HAND) wo w/wo JOINT (SHOULDER, ELBOW, WRIST) wo w/wo MRI ARTHROGRAM Shoulder 23350, 77002, Elbow 24220, 77002, Wrist 25246, 77002, LOWER EXTREMITY NON JOINT(THIGH, CALF, FOOT) wo w/wo JOINT(HIP, KNEE, ANKLE) wo w/wo MRI ARTHROGRAM Hip 27093, 77002, Knee 27370, 77002, Ankle 27648, 77002, BRAIN wo w/wo Brain MRA (wo) ORBITS/FACE(PITUITARY, IACS) wo w/wo TMJ (wo) PETROUS/TEMPORAL BONE (IAC) wo CHEST wo w/wo Chest MRA (for Brachial Plexus) ABDOMEN wo w/wo Abdomen MRA (w/wo) ABBREVIATION KEY wo = without IV contrast w/ = with IV contrast w/wo = with & without IV contrast NECK, SOFT TISSUE wo w/wo MR Angio (w/) COMBINATION CODES Brain MRI & MRA 70553, Brain & Orbits w/wo 70553, PELVIS wo w/wo BREAST, BILATERAL w/wo *These CPT codes represent the most commonly ordered CT exams. For any coding inquiry not listed please call your Marketing Team Member at REV 7/2017 MRI Exams CPT Codes

25 Current Pre Medication Prescription: Prednisone 40mg by mouth taken 12 hours before exam and 2 hours prior to exam. IHS recommends that the referring physician order the prednisone for the patient. Coag Panel: PT, PTT, INR STAT COAG PANEL must be drawn the day prior to scheduled procedure, with results received to IHS no later than 9 a.m. on the day of the exam. Coumadin: Patient must discontinue Coumadin 5 days prior to any biopsy. Anti-coagulant medications cannot be discontinued without notification of prescribing physician. MISSING LABS may result in the rescheduling of the patient exam or changed to a non-contrast exam. *Dialysis appointment must be scheduled within 24 hours after the examination. EXAMS MRI with IV Contrast CT with IV Contrast CT Guided Biopsy Lines (picc, ports) for replacement, changes, or removals Tubes (G tubes, J tubes) for replacement, changes, or removals PATIENT INDICATIONS Age 70 and over History of kidney/renal disease (any age) Dialysis patient* Age 70 and over History of kidney/renal disease Dialysis patient* Diabetic patient Standard Patient on Coumadin Standard Patient on Coumadin Standard Patient on Coumadin CREATININE W/IN 3 MONTHS COAG PANEL W/IN 30 DAYS STAT COAG PANEL DISCONTINUE COUMADIN NO LABS Lab Requirements for IV Contrast Exams

26 Our Locations TEMECULA VALLEY Hancock Avenue, Ste 105 Murrieta, CA TRI-CITY 3601 Vista Way, Bldg A, Ste 101 Oceanside, CA ENCINITAS 477 N. El Camino Real, Ste A 102 Encinitas, CA POWAY Monte Vista Road, Ste A Poway, CA GOLDEN TRIANGLE 4150 Regents Park Row, Ste 195 La Jolla, CA HILLCREST 150 W. Washington Street San Diego, CA ALVARADO 6386 Alvarado Court, Ste 121 San Diego, CA SOUTH BAY 333 H Street, Ste 1095 Chula Vista, CA Women s Imaging Center Entrance located directly South Same building 333 H Street, Ste 1005 Chula Vista, CA CPT is a registered trademark of the American Medical Association and are subject to change. V 02.18