Head & Neck Brain Alzheimer's Dz Stroke/CVA No MRI Brain w/o 70551 Mental Status Change Confusion Dementia Memory Loss Suspected MS Tumor/mass/Cancer Seizures Cranial Nerve Lesions H Infection/ Abscess TIA Trauma Dizziness Headaches Cerebral Palsy Epilepsy Syrinx Vasculitis Vascular Lesions (AVM) Neurofibromatosis Visual Change IAC protocol Vestibular Schwannoma Vertigo Hearing Loss, IAC Mass Bell's palsy Pituitary Protocol Pituitary Lesion Elevated Prolactin MRA Brain Aneurysm, family hx TIA No MRA Brain w/o 70544 Anuerysm Stroke/CVA MRA Neck Bruit Abnormal doppler or MRA Neck w/ & w/o 70549 Stroke / CVA Dissection TIA Syncope MRA Arch and Great Stroke / CVA TIA MRA Neck w/ & w/o 70549 Vessels Bruit/ Stenosis Dissection MRV Brain Venous Thrombosis No MRV w/o 70544 Orbits (includes whole Trauma No MRI Orbits/Face/Neck/ w/o 70540 brain - plus thin cuts Vision Loss Diplopia MRI Orbits/ Face/ Neck thru the orbits) Graves Disease w/ & w/o 70543 Neck Exopthalmos / Proptosis Vascular Lesions Pseudotumor Optic Neuritis Infection MRI Orbits / Face/Neck Pain Vocal Cord Paralysis w/ & w/o MRI Brain w/ & w/o 70553 70543
Area of Concern Chest Body Part Tumor / Mass / Cancer / Mets Description by CPT Code* CPT Code Brachial Plexus Brachial Plexus Injury MRI Chest / Mediastinum 71552 Nerve Avulsion w/& w/o MRA Aorta Abdominal Aortic Dissection MRA Aorta w/ & w/o contrast 74185 MRA Chest Excluding cardiac myocardium MRA Chest w/ & w/o contrast 71555 Breast Breast MRI Breast Bilateral w/wo contrast 77059 Newly diagnosised cancer Evaluate response to chemo Abdomen and Pelvis Mediastinum Abdomen: General Abdomen: Liver MRCP: Billary Pancreas Personal History of BC BRCA 1 or 2 Gene High risk screnning Implant Integrity/Rupture Tumor / Mass / Cancer / Mets Abdominal Pain Post embolization Hemangioma Hepatoma Billary Obstruction Stones Pancreatitis Pancreas Mass Cholangiocarcinoma Dense breasts Palpable lump w/abnormal US or mammographic findings Hepatitis Cirrhosis Increased LFT's Jaundice Abdomenal enzymes Increased LFT's Painless jaundice Ampulla evaluation No MRI Abdomen w/o (MRCP) MRA Abdomen PSC (primary sclerosing) cholangitis) Renal artery stenosis Mesenteric Arterial MRA Abdomen w/ & w/o contrast 74185 Hypertension Ischemia MRI Chest / Mediastinum w/& w/o MRI Abdomen w/ & w/o MRI Abdomen w/ & w/o 71552 74183 74181 74183
Abdomen and Pelvis MRA Pelvis Femoral Arteries (proximal) MRA Pelvis w/ & w/o contrast 72198 Continued Pelvis: General Abscess MRI Pelvis w/ & w/o 72197 Pain Decubitus Ulcer Pelvis: Uterus Fibroid Pre/Post Fibroid Embolization Adenomyosis Infertility Pelvis: Ovaries Ovarian Mass Endometrioma Bony Pelvis/ Pelvis/Hip Fracture Trauma Pain Muscle/Tendon Tear No MRI - Pelvis w/o contrast 72195 Septic Arthritis MRI - Pelvis w/ & w/o contrast 72197 Musculoskeletal Extremity: Non Joint Fracture Muscle / Tendon / Ligament No MRI - Non Joint w/o Forearm Stress Fracture Tear Upper Extremity 73218 Humerus Lower Extremity 73718 Lower Leg/Calf MRI - Non Joint w/ & w/o Abscess Myositis Femur/Thigh Ulcer Morton's Neuroma Upper Extremity 73220 Hand Tumor/Mass/Mets Lower Extremity 73720 Foot (ankle/hind foot, Cellulitis Soft tissue Tumor/Mass midfoot, forefoot) Faclitis Mets Extremity: Joint Arthritis Meninscal Tear No MRI - Non Joint w/o Upper Avascular Necrosis (AVN) Muscle Tear Upper Extremity 73221 Shoulder Stress Fracture Ligament Tear Lower Extremity 73721 Wrist Internal Derangement Cartilage Tear Elbow Pain Ostochondritis Dissecans Labral Tear (OCD) Lower Abscess Inflammatory Arthritis MRI - Joint w/ & w/o contrast Hip - includes pelvis Ulcer Upper Extremity 73223
Musculoskeletal Knee Cellulitis Septic Arthritis Lower Extremity 73723 continued Ankle (includes distal, tibia & tibia & fibula thru base of metatarsals) Fascitis Myositis Tumor/Mass/Meets MRA Upper Extremity Subclavian Tenderness MRA Upper Extremity w/ & w/o 73225 Redness, swelling MRA Lower Extremity (Run off) Peripheral vascular disease MRA Lower Exremity w/ & w/o 73725 Spinal Column Spine: Cervical Arm/Shoulder Pain Disc Herniation No 72141 Numbness Radiculopathy Neck Pain Degenerative Disease MRI Cervical Spine w/o Syrinx Myelopathy 72156 Discitis Spine: Thoracic Back pain Trauma Degenerative disc disease Compression Fracture - Spine: Lumbar Disc Herniation (no hx of malignancy) Radiculopathy Discitis Post-op Fusion Myelopathy Syrinx Compression Fracture - (w/hx of malignancy) Demyelinating Disease Back, Leg pain Sciatica No MRI Lumbar Spine w/o 72148 Degenerative Disease Disc Herniation Spondylolisthesis Spinal Stenosis Radiculopathy Compression Fracture - Trauma (no hx of malignancy) MRI Cervical Spine w/ & w/o No MRI Thoracic Spine w/o 72146 MRI Thoracic Spine w/ & w/o 72157 Discitis Post-Op-Hx of Back Surgery 72158 MRI Lumbar Spine w/ & w/o
Area of Concern Musculoskeletal Arthrography MR Body Part Sacrum Sacral Insufficiency Fracture No MRI Sacrum wo 72196 Wrist Arthrogram SacralIliitis MRI Sacrum w/ & w/o 72197 TFCC tear Scaphoid nonunion Intercarpal Ligaments Soft tissue ganglia MR Upper Ext joint w/ 73222 Injection - Wrist 25246 Rad exam - wrist 73115 Elbow Arthrogram MR Upper Ext joint w/ 73222 Loose body Internal derangement Injection - Elbow 24220 Rad exam - Elbow 73085 Shoulder Arthrogram MR Upper Ext joint w/ 73222 Labral tear RCT Injection - Shoulder 23350 Synovitis Adhesive capsulitis Rad exam - Shoulder 73040 Hip Arthrogram Labral tear MR Lower Ext joint w/ 73722 Injection - Hip 27093 Rad exam - Hip 73525 Knee Arthrogram MR Lower Ext joint w/ 73722 Recurrent meniscal tearq Loose bodies Injection - Knee 27370 post op Chondromalacia Rad exam - Knee 73580 Ankle Arthrogram Loose body OCD MR Lower Ext joint w/ 73722 Injection - Ankle 27648 Rad exam - Ankle 73615 This is for reference only. These are the protocol standards for Desert Medical Imaging. Information subject to change. ** Radiologist Injects Directly into Joint. Screening BUN and Creatinine labs are not required.