Head Brain Alzheimer s Mental Status Change Confusion Dementia Memory Loss Dizziness Headaches MRI Brain w/o 70551 Tumor / Mass / Cancer Cranial Nerve Lesions HIV Infection Suspected MS Neurofibromatosis Hearing Loss, IAC Mass Pituitary Lesion Acoustic Neuroma Syrinx Visual Change Vascular Lesions (AVM) Elevated Prolactin Vertigo Bell s palsy MRI Brain 70553 Orbits MRI Orbits / Face / Neck w/o 70540 Graves Disease Exophthalmos / Proptosis Vascular Lesions (Hemangioma) Pseudotumor MRI Orbits / Face / Neck 70543 Neck Infection Vocal Cord Paralysis MRI Orbits /Face / Neck 70543 Chest Mediastinum MRI Chest / Mediastinum 71552 Brachial Plexus Brachial Plexus Injury Nerve Avulsion MRI Chest/Mediastinum w/o 71552 Breast Breast Newly diagnosed cancer Personal history of BC BRCA 1 or 2 gene High-risk screening Implant integrity/rupture Evaluate response to chemo Dense breast Palpable lump w/abnormal US or mammographic findings MRI Breast Bilateral 77059
Abdomen and Pelvis Abdomen: General MRI Abdomen Abdomen: Liver Post embolization Hemangioma Hepatoma Hepatitis Cirrhosis Increased LFTs MRI Abdomen MRCP: Biliary Biliary obstruction Stones Jaundice Abnormal enzymes MRI Abdomen w/o (MRCP) 3D Reconstruction 74181 76377 Renal Renal Mass (cyst or solid) Hematuria Transitional cell carcinoma of kidney Abnormal finding MRI Abdomen Adrenal Adrenal Mass or Lesion Pheochromocytoma Hypertension MRI Abdomen w/o 74181 Pancreas Pancreatitis Pancreas Mass Cholangiocarcinoma PSC (primary sclerosing cholangitis) Increased LFTs less Jaundice Ampulla evaluation MRI Abdomen Tissue: General Decubitis Ulcer MRI Pelvis Tissue: Uterus Fibroid Adenomyosis Pre/Post Fibroid Embolization Infertility MRI Pelvis Bicomuate Uterus Septate Uterus MRI Pelvis Tissue: Ovaries Ovarian Mass Endometrioma MRI Pelvis Prostate Cancer Staging Treatment Planning MRI Pelvis www.inspirahealthnetwork.org/radiology
Musculoskeletal Extremity Fracture Muscle / Tendon Tear MRI n Joint w/o 73218 Stress Fracture 73718 n-joint Upper: Forearm, Humerus, Hand/ Finger/Thumb Lower: Leg/Calf, Toes, Femur/Thigh/ Hamstring, Foot (Midfoot, Forefoot) Ulcer Tumor / Mass / Mets Cellulitis Fasciitis Myositis Morton s Neuroma Soft Tissue Tumor/ Mass / Mets MRI n Joint 73220 73720 Extremity Joint Upper: Wrist Elbow Shoulder Lower: Ankle Knee Hip Arthritis Avascular Necrosis (AVN) Stress Fracture Internal Derangement Ulcer Cellulitis Fasciitis Myositis Meniscal Tear Muscle Tear Ligament Tear Cartilage Tear Osteochondritis Dissecans (OCD) Bony Cyst Inflammatory Arthritis Septic Arthritis Tumor / Mass / Mets MRI Joint w/o MRI Joint 73221 73721 73223 73723 Bony Pelvis Fracture Muscle / Tendon Tear MRI Pelvis w/o 72195 Tumor / Mass/ Cancer / Mets Septic Arthritis MRI Pelvis Athletic Pubalgia (Sports Hernia) Athletic Injury Groin MRI Pelvis w/o 72195 Spine, Cervical Arm / Shoulder / Neck Numbness, Disc Herniation Degenerative Disease Radiculopathy MRI Cervical Spine w/o 72141 Syrinx, Discitis, Myelopathy MRI Cervical 72156
Musculoskeletal Continued Spine: Thoracic Back, Degenerative Disc Disease Radiculopathy, Disc Herniation Compression Fracture no hx MRI Thoracic Spine w/o 72146 Discitis Post-op Fusion Syrinx Myelopathy Compression Fracture w/ hx MRI Thoracic 72157 Spine: Lumbar Back / Leg, Degenerative Disease Disc Herniation Radiculopathy Sciatica Spondylolithesis Spinal Stenosis Compression Fracture no hx MRI Lumbar Spine w/o 72148 Discitis Post-Op-Hx of Back Surgery MRI Lumbar 72158 Musculoskeletal MR Arthrography Wrist Arthrogram TFCC Tear Intercarpal Ligaments Soft Tissue Ganglia w/ Injection Wrist Rad Exam Wrist 25246 73115 Elbow Arthrogram Loose Body Collateral Ligament Tear Internal Derangement w/injection Elbow Rad Exam Elbow 24220 73085 Shoulder Arthrogram Synovitis RCT Adhesive Capsulitis w/injection Shoulder Rad Exam Shoulder 23350 73040 Hip Arthrogram w/injection Wrist Rad Exam Wrist 27093 73525 Knee Arthrogram Recurrent Meniscal Tear Post Op Loose Bodies Chondromalacia w/injection Hip Rad Exam Hip 27370 73580 Ankle Arthrogram Loose Body ODC w/injection Knee Rad Exam Knee 27648 73615
MRA Brain (COW) Aneurysm, Family Hx Aneurysm MRA Brain w/o 70544 MRV Brain Venous Thrombosis MRV w/o 70544 Neck Bruit Abnormal Doppler or Dizziness Dizziness MRA Neck MRA Neck w/o 70549 Arch and Great Vessels Bruit MRA Neck 70549 Abdominal Aorta Abdominal Aortic Dissection Aneurysm MRA Aorta 74185 Chest Aneurysm Thoracic Aortic Dissection Excluding Cardiac Myocardium MRA Chest 71555 Abdomen Renal Artery Stenosis Hypertension Mesenteric Arterial Ischemia MRA Abdomen 74185 Pelvis Femoral Arteries MRA Pelvis 72198 Subclavian Redness, Swelling Tenderness MRA 73225 Peripheral Vascular Disease MRA 73725 www.inspirahealthnetwork.org/radiology