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Wr cpt mri 1.7 web
- 1. MRI EXAM CPTCODE REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the CPT for the order. Please review the MRI safety checklist with each patient. Notify WR Express Scheduling if your patient For their comfort, IV sedation is available for your patients upon request. has a history of renal failure. Creatinine levels can be obtained prior to contrasted studies, if needed, at WR Garner, WR Chapel Hill or WR Cary. Call if you have any questions 919-232-4700. Procedure for CPT Body Part Code Indications for Exam or Study Contrast* SPEC Pre-Authorization Brain MRI Brain without contrast 70551 Alzheimer’s Stroke/CVA No Contrast Mental status change TIA (transient ischemic attack) Confusion Trauma Neuro Dementia Dizziness/Vertigo Memory Loss Headaches Suspected MS MRI Brain with and without contrast 70553 Tumor/Mass/Cancer Pituitary lesion Yes Contrast Cranial nerve lesions Acoustic neuroma HIV/AIDS Syringomyelia (Syrinx) Infection Visual change Neuro MS (Multiple Sclerosis) Metastases Neurofibromatosis Vascular lesions (AVM) Hearing loss, IAC mass Elevated prolactin Bell’s Palsy (facial weakness) MRA Brain: MRA Brain without contrast 70544 Aneurysm, family history No Contrast Arterial Circulation TIA (transient ischemic attack) Neuro Circle of Willis (COW) Stroke/CVA (cerebrovascular accident) MRA Brain: MRA Brain without contrast 70544 Venous thrombosis No Contrast Neuro Venous Circulation MRA Brain with and without contrast 70546 AVM Sinus thrombosis As determined Neuro Venous circulatory symptoms by radiologist MRA NECK MRA Neck with and without contrast 70549 Bruit Yes Contrast Stroke CVA (cerebrovascular accident) Neuro TIA (transient ischemic attack) Abnormal doppler or dizziness MRI Orbits MRI Brain with and without contrast 70553 Trauma Pseudotumor Yes Contrast Includes brain plus Graves Disease Tumor/Mass/Cancer/Mets Neuro cuts thru the orbits Exopthalmos/proptosis Vascular lesions (Hemangioma) MRI Neck MRI Orbits/Face/Neck with and without 70543 Infection Tumor/Mass/Cancer/Mets Yes Contrast Neuro Soft Tissue contrast Pain Vocal Cord Paralysis MRI SPINE: MRI Cervical Spine without contrast 72141 Neck pain Numbness No Contrast Neuro Cervical Arm/Shoulder pain Degenerative disk disease Ortho Disk herniation (HNP) Radiculopathy MRI Cervical Spine with and without 72156 Syringomyelia (Syrinx) Myelopthy Yes Contrast Neuro contrast Discitis (disk infection) MS (Multiple Sclerosis) Ortho Osteomyelitis Tumor/Mass/Cancer/Mets MRI SPINE: MRI Thoracic Spine without contrast 72146 Back Pain Trauma No Contrast Thoracic Degenerative disk disease Compression fracture Neuro Disk herniation (HNP) (No history of malignancy) Ortho Radiculopathy MRI Thoracic Spine with and without 72157 Syringomyelia (Syrinx) Myelopthy Yes Contrast contrast Discitis (disk infection) MS (Multiple Sclerosis) Neuro Osteomyelitis Tumor/Mass/Cancer/Mets Ortho MRI SPINE: MRI Lumbar Spine without contrast 72148 Back/leg pain Sciatica/radiculopathy No Contrast Lumbar Degenerative disk disease Spondylolisthesis Disk herniation (HNP) Spinal stenosis Neuro Radiculopathy Compression fracture Ortho Trauma (No history of malignancy) Scoliosis MRI Lumbar Spine with and without 72158 Discitis (disk infection) Post-op Hx of back surgery Yes Contrast Neuro contrast Osteomyelitis Tumor/Mass/Cancer/Mets Ortho MRI Lumbosacral MRI Pelvis without contrast 72148 Leg Pain/sciatica Lumbar plexopathy No Contrast Neuro Plexus Radiculopathy Sacral/coccyx pain MRI Brachial MRI Upper Extremity Non-joint with and 73220 Shoulder injury Brachial plexopathy Determined by Neuro Plexus without contrast Nerve avulsion Radiologist MRI Chest: MRI Chest/Mediastinum with and without 71552 Tumor/Mass/Cancer/Mets Yes Contrast Body Mediastinum contrast MRA Aorta MRA Aorta with and without contrast 74185 Abdominal aortic dissection Yes Contrast Body MRA Aorta: With MRA Aorta with and without contrast MRA 74185 Peripheral vascular disease No Contrast Body peripheral runoff Lower Extremity with or without contrast 73725 Claudication MRA Chest MRI Chest with and without contrast 71555 Excluding cardiac myocardium Yes Contrast Body Thoracic aorta Breast MRI MRI Breast Bilateral with and without 77059 Newly diagnosed breast cancer Yes Contrast contrast Family history of breast cancer BRCA 1 or BRCA 2 genes (Some criteria may apply) Body Implant integrity/Rupture MRI Abdomen: MRI Abdomen with and without contrast 74183 Tumor/Mass/Cancer/Mets Yes Contrast General Abdominal pain MRI Abdomen: Post embolization Hepatitis Liver Hemangioma Cirrhosis Hepatoma Increased liver function tests Body MRI abdomen: Hematuria (blood in urine) Renal Renal mass (cyst or solid) Transitional cell carcinoma of kidney Abnormal findings MRI abdomen: MRI Abdomen with and without contrast 74183 Adrenal mass or lesion Hypertension Determined by Body Adrenal Pheochromocytoma Radiologist MRCP: Biliary MRI Abdomen with and without contrast 74183 Abdominal pain Jaundice Yes Contrast Biliary obstruction Abnormal enzymes Body Stones MRCP: Pancreas MRI Abdomen with and without contrast 74183 Pancreatitis Increased liver function tests Yes Contrast Pancreas mass Painless jaundice Cholangiocarcinoma Ampulla evaluation Body PSC (Primary Sclerosing Cholangitis) MRA Abdomen MRA Abdomen with and without contrast 74185 Renal artery stenosis Mesenteric arterial Yes Contrast Hypertension Ischemia Body MRA Pelvis: MRA Pelvis with and without contrast 72198 Pelvic venous thrombosis Yes Contrast Body Iliac vessels MRI Pelvis MRI Pelvis with and without contrast 72197 Pain Tumor/Mass/Cancer/Mets Yes Contrast Soft Tissue: General Abscess Decubitus ulcer Body MRI Pelvis MRI Pelvis with and without contrast 72197 Fibroid Pre/Post-Uterine Fibroid Embolization (UFE) Yes Contrast Soft Tissue: Adenomyosis Endometrioma Body Uterus/Ovaries Infertility Ovarian Mass MR Dual Study: Crohn’s disease Crohn’s fistulous disease Yes Contrast Enterography MRI Abdomen with and without contrast 74183 Celiac disease (Sprue) Small bowel tumor and glucagon Body MRI Pelvis with and without contrast 72197 MRI Extremity, MRI Non-Joint without contrast: Fracture No Contrast Non-Joint: Upper Extremity 73218 Stress fracture Body Forearm Lower Extremity 73718 Muscle or tendon tear Humerus Lower Leg/Calf MRI Non-Joint with and without contrast: Abscess Myositis Yes Contrast Femur/Thigh Upper Extremity 73220 Ulcer Osteomyelitis Ortho Lower Extremity 73720 Tumor/Mass/Mets Morton’s neuroma Plantar fasciitis Soft tissue tumor or mass MRI Extremity, MRI Joint without contrast: Arthritis Meninscal tear No Contrast Joint: Upper Extremity 73221 Avascular necrosis (AVN) Muscle tear Lower Extremity 73721 Stress fracture Ligament tear Upper Internal derangement Cartilage tear Ortho Hand Joint pain Ostochondritis dissecans Wrist (OCD) Elbow Shoulder MRI Joint with and without contrast: Abscess Osteomyelitis Yes Contrast SC Joint Upper Extremity 73223 Ulcer Inflammatory arthritis LOWER Lower Extremity 73723 Cellulitis Septic arthritis Foot Plantar fasciitis Tumor/Mass/Mets Ortho Ankle Myositis Labral tear Knee Hip (whole pelvis) MRI Pelvis/Hip MRI Pelvis without contrast 72195 Fracture Trauma No Contrast Hip/Pelvis Pain Muscle/Tendon tear Ortho MRI Pelvis with and without contrast 72197 Tumor/Mass/Cancer/Mets Septic arthritis Yes Contrast Ortho Osteomyelitis MRA Upper MRA Upper Extremity with and without 73225 Subclavian Tenderness Yes Contrast Ortho Extremity contrast Redness or swelling MRA Lower MRA Lower Extremity with and without 73725 Peripheral vascular disease Yes Contrast Ortho Extremity contrast MR Arthrogram MRI Upper Extremity Joint with and without 73222 Slap tear Ligament Injury Yes Contrast Upper Extremity contrast Labral tear Tunnel syndrome Shoulder Loose body Ortho Elbow TFCC tear Wrist MR Arthrogram MRI Lower Extremity Joint with and without 73722 Labral tear Yes Contrast Lower Extremity contrast FAI (Femoroacetabular impingement) Hip Loose body Ortho Knee OCD lesion (Osteochondritis Dissecans) Ankle