ORDERING GUIDELINES: MRI

Transcription

1 ORDERING GUIDELINES: MRI GENERAL INFORMATION: Pregnant Patients May undergo an MRI exam at any stage of pregnancy if the risk-benefit ratio to the patient warrants the study be performed. Present data has not conclusively documented any deleterious effects of MRI imaging exposure to the fetus. MRI contrast agents will not be routinely provided to pregnant patients. Consult with radiologist. Safety Screening - Must be done on every patient before every MRI exam to insure safety. Must be signed. Will be reviewed by MRI staff. In some cases of implants, written documentation will be needed before the patient can be cleared for an MRI exam. MRI staff will help to gather appropriate information. Clothing Policy - All patients will be changed into hospital attire to insure safety of the patient and staff. No jewelry, body piercings, hearing aides, hair clips, cell phones, or valuables will be allowed in the scan room. Lockers are provided. GFR - Current GFR is needed within 30 days prior to MRI for outpatients and non admitted ED patients, within 48 hours for all inpatients. GFR must be 35ml/min or above to receive contrast. Consult with radiologist if questions. Assessment form Must be filled out and signed by patient, health care proxy or physician. Witness signature is needed as well. Weight Limits BMC MRI 350 lbs MAC MRI 350 lbs NBIC MRI 550lbs Interpreter - If the patient does not speak English, you must notify Central Scheduling when making the appointment that an interpreter will be needed. MRI Forms - You may print out the MRI questionnaire forms (Pittsfield form) (North Adams form) to give to the patient. The patient should complete the questionnaire and bring it to his or her appointment. Contacts - Berkshire Medical Center x3815 Medical Arts MRI Dept x3080 NBIC MRI Dept

2 BRAIN (CPT 70553) BRAIN Without (CPT 70551) Hx or? mass /infection Hx Cancer/? Mets Hx or? Meningioma Hx or? Pituitary tumor Demylineation/optic neuritis? AVM Seizure (single, acute) Attn Trigeminal nerve Bell s Palsy/Skull base tumor Hx or? Stroke/Infarct Headaches Dizziness/Memory loss/vertigo Depression/Mental Status Change Trauma/Concussion Normal Pressure Hydrocephalus Need signs and symptoms NOT for Seizure Protocol Trauma Protocol BRAIN WITH CONTRAST (CPT 70552) BRAIN SEIZURE PROTOCOL (CPT 70553) Follow up if without contrast already done. Recommended by Radiologist R/O Mesial Temporal Sclerosis (MTS) Intractable/Chronic Seizures Pediatric Seizure Not for single seizure

3 INTERNAL AUDITORY CANALS (IAC S) (CPT 70553) ORBITS (CPT 70543) MRA HEAD (COW) Without (CPT 70544) MRV HEAD With (CPT 70545) CERVICAL SPINE (CPT 72156) Hearing loss/vertigo? Acoustic Neuroma/CP Angle Tumor Pulsatile Tinnitus Orbital Mass Optic Neuritis/Attn Optic Nerve Aneurysm/Stroke Pulsatile Tinnitus Venous Sinus Thrombosis Mass/Abscess/Mets Hx Cancer Hx MS Osteomyelitis Also order MRA Head & Carotids if pulsatile tinnitus

4 CERVICAL SPINE Without (CPT 72141) Stenosis? Disc Radiculopathy HNP CERVICAL SPINE With (CPT 72142) Follow up for contrast if prior MRI without already done. Recommended by Radiologist NECK (SOFT TISSUE) (CPT 70543) Soft tissue neck mass? Stone? Mets For Parotid Glands/ Thyroid/Larynx Not for Cervical spine MRA CAROTIDS With (CPT 70548) Carotid Artery Stenosis Stroke Pulsatile Tinnitus For Carotid Arteries

5 MRA CAROTIDS For Carotid Dissection (CPT 70549) MRA CAROTIDS Without (CPT 70547) Stenosis Stroke Only order if patient s GFR is below 35 ml/min BRACHIAL PLEXUS (CPT 73220)? Mets? or Hx Tumor Pain THORACIC SPINE (CPT 72157)? Mass/Mets Abscess Hx Cancer MS Osteomyelitis

6 THORACIC SPINE Without (CPT 72146) Stenosis? Disc Radiculopathy HNP THORACIC SPINE With (CPT 72147) Follow up for contrast only if prior MRI without contrast already done. Recommended by Radiologist LUMBAR SPINE (CPT 72158) LUMBAR SPINE Without (CPT 72148)? Mass/Mets Abscess Hx Cancer MS Osteomyelitis Hx back surgery Sciatica Radiculopathy Pain Stenosis HNP

7 LUMBAR SPINE With (CPT 72149) Follow up for contrast if prior MRI without already done. Recommended by Radiologist LUMBAR PLEXUS (CPT 72158) Multiple levels of nerve root involvement at the lumbar area Should always be with & without SACRAL PLEXUS (CPT 72198) Multiple levels of nerve root involvement at the sacral level Should always be with & without

8 MRI ABDOMEN EXAM GUIDELINES ABDOMEN (CPT 74183) ABDOMEN Without (CPT 74181) ABDOMEN (MCRP) Without (CPT 74181) MRI ENTEROGRAPHY (CPT & 72197) MRA/MRV AORTA Liver/Kidneys/Pancreas/Spleen? Mets/Pancreatitis/Abnormal LFT s? Hemangioma Follow up Ct Adrenals? Pheochromocytoma? Adenoma Biliary System? Stone/Obstruction Sclerosing Cholangitis MRI Small Bowel Irritable Bowel Crohn s Disease Ulcerative Colitis? Stenosis HBP Must specify organ to be imaged Patient must arrive 1 hour 15 min early Will be give oral contrast (Volumen) to drink Will be given glucagon to slow intestine Will be given metoclopramide PO to help empty stomach contents Will be given IV contrast Specify Abdominal/Thoracic or Renal MRA Specify Portal Vein/Renal Vein/ Must be NPO for 6 hours NPO 6 hours

9 (CPT C8902) Venous Structure Abnormality SMV MRI PELVIS EXAM GUIDELINES PROSTATE (CPT 72197)? Mass Elevated PSA? Mets Done with Endorectal coil inserted in rectum to obtain detailed images No biopsy done within 4 weeks Pt needs to purchase suppository to use the night before exam. PELVIS? Mass/Mets? Bony Lesion Follow up Bone Scan? Tumor/Mets of hip (CPT 72197) Surgical Planning for Rectal Ca Rectal Ca Protocol Pelvic Contents Male Pelvic Contents - Female PELVIS Without (CPT 72195) Bilateral Hips Pain? AVN Always do bilateral for? AVN

10 MRI PELVIS EXAM GUIDELINES HIPS Without Unilateral hip pain Specify Side (CPT 73721) MRI EXTREMITY EXAM GUIDELINES LOWER EXTREMITY (CPT 73720) LOWER EXTREMITY Without (CPT 73718) MRA EXTREMITY (CPT UPPER EXT C8936) (CPT LOWER EXT C8914)? Mass/Lesion? Abscess/Infection Follow up Bone Scan Pain? Tear? Injury Stenosis PVD Peripheral MRA includes from Renals to foot bilaterally Select area of interest- Femur/ Lower leg/ankle/foot/toes Specify side Select area of interest- Femur/ Lower leg/ankle/foot/toes Specify side Specify area of interest

11 MRI EXTREMITY EXAM GUIDELINES UPPER EXTREMITY (CPT 73220) UPPER EXTREMITY Without (CPT 73218) MRI ARTHROGRAM With (CPT 73222)? Mass/Lesion? Abscess/Infection Follow up Bone Scan Pain? Tear? Injury? Tear Pain Select area of interest- Humerus/ Shoulder/Elbow/Forearm/Wrist/ Hand/Fingers Select area of interest- Humerus/ Shoulder/Elbow/Forearm/Wrist/ Hand/Fingers If for Bicep Tear- Must specify proximal or distal area Booked in conjunction with Xray under Fluoroscopy Specify Joint Shoulder/Elbow/ Wrist/Hip/Knee/Ankle MRI BREAST EXAM GUIDELINES BILATERAL BREASTS (CPT C8908) Hx or? Cancer/Mets Mass/Lump Screening/Dense Breasts Family History/ High Risk Always do bilateral Must be booked 7 14 days after start of LMP (unless emergent)

12 MRI BREAST EXAM GUIDELINES BREASTS Without (CPT C8907) BREAST BIOPSY/NEEDLE LOCALIZATION (CPT 19287)? Ruptured Implant Specify which side Specify what type of implant (Saline/ Silicone) Follow up from prior imaging Booked thru WIC/CWS Specify side Patient instructions given thru Women s Imaging Center MRI CHEST EXAM GUIDELINES CARDIAC Only booked thru Cardiologist. Contact Dr Vikas Veeranna. (CPT 75561) Updated June, 2017