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MRI Quick Reference

Ordering Guide

Ordering Guide

Below is a list of exams and how they should be ordered and scheduled. If you have any questions about the list, please contact the MRI department at 864-560-7805 or Pelham Medical Center MRI 864-849-9278. To schedule a procedure, call Regional Scheduling 864-560-7777.

MRI HEAD/BRAIN

With & without contrast
CPT 70553

Without contrast
CPT 70551

*With contrast
CPT 70552

Orbits, pituitary, IAC, MS, facial nerves, cancer, stroke, CVA, TIA, headaches

Pregnant patients, dialysis patients, patients with history of MR contrast allergies, patients with GFR less than 30

ONLY performed in a brain lab protocol where prior MRI head was performed at SRHS or a nearby imaging facility or if a patient were to return for additional scans where W/O was already performed

 

MRI CERVICAL SPINE

With & without
contrast

CPT 72156

Without contrast
CPT 72141

*With contrast
CPT 72142

MS, cancer, syrinx, or infection

Pain, HNP, bulging disc, compression FX, pregnant patients, dialysis patients, patients with history of MR contrast allergies, patients with GFR less than 30

ONLY performed if a patient were to return for additional scans where a W/O was already performed

 

MRI THORACIC SPINE

With & without
contrast

CPT 72157

Without contrast
CPT 72146

*With contrast
CPT 72147

MS, cancer, syrinx, or infection

Pain, HNP, bulging disc, compression FX, pregnant patients, dialysis patients, patients with history of MR contrast allergies, patients with GFR less than 30

ONLY performed if a patient were to return for additional scans where a W/O was already performed

 

MRI LUMBAR SPINE

With & without
contrast

CPT 72158

Without contrast
CPT 72148

*With contrast
CPT 72149

Cancer, infection or back surgery

Pain, HNP, bulging disc, Compression FX, pregnant patients, dialysis patients, patients with history of MR contrast allergies, patients with GFR less than 30

ONLY performed if a patient were to return for additional scans where a W/O was already performed

 

MRI CHEST

With & without
contrast

CPT 71552

Without contrast
CPT 71550

*With contrast
CPT 71551

Mass or infection

Pain, pregnant patients, dialysis patients, patients with history of MR contrast allergies, patients with GFR less than 30

ONLY performed if a patient were to return for additional scans where a W/O was already performed

 

MRI CARDIAC

With & without
contrast

CPT 75561

Without contrast
CPT 75557

Function and viability (most cardiac exams are preformed w & w/o contrast)

Function, pregnant patient, dialysis patients, patients with history of MR contrast allergies, patients with GFR less than 30

 

MRI ABDOMEN (MRCP, LIVER, KIDNEYS, PANCREAS, ADRENALS)

With & without
contrast

CPT 74183

Without contrast
CPT 74181

*With contrast
CPT 74182

All abdomens

Pregnant patients, dialysis patients, patients with history of MR contrast allergies, patients with GFR less than 30

ONLY performed if a patient were to return for additional scans where a W/O was already performed

 

MRI PELVIS

With & without
contrast

CPT 72197

Without contrast
CPT 72195

*With contrast
CPT 72196

Female, prostate, rectum, ulcers, open wounds, mass, osteomyelitis, infection

Boney structures, pain, pregnant patients, dialysis patients, patients with history of MR contrast allergies, patients with GFR less than 30

ONLY performed if a patient were to return for addition scans where a W/O was already performed abdomen/pelvis are routinely done with IV and oral contrast.

 

MRI UPPER EXTREMITY JOINT (SHOULDER, ELBOW, WRIST)

Ninety percent of all orthopedic work is performed without contrast. Arthograms are always performed with contrast. Order does not have to specify contrast, just arthrogram.

With & without
contrast

CPT 73223

Without contrast
CPT 73221

*With contrast
CPT 73222

Osteomyelitis, mass, ulcer, or infection

Pregnant patients, dialysis patients, patients with history of MR contrast allergies, patients with GFR less than 30

ONLY performed if a patient were to have an arthrogram of the joint or were to return for additional scans where a W/O was already performed

 

MRI UPPER EXTREMITY NON-JOINT (HUMERUS, FOREARM, HAND)

Ninety percent of all orthopedic work is performed without contrast.

With & without
contrast

CPT 73220

Without contrast
CPT 73218

*With contrast
CPT 73219

Osteomyelitis, mass, ulcer, or infection

Pregnant patients, dialysis patients, patients with history of MR contrast allergies, patients with GFR less than 30

ONLY performed if a patient were to return for additional scans where a W/O was already performed

 

MRI LOWER EXTREMITY JOINT (HIP, KNEE, ANKLE)

Ninety percent of all orthopedic work is performed without contrast. Arthograms are always performed with contrast. Order does not have to specify contrast, just arthrogram.

With & without
contrast

CPT 73723

Without contrast
CPT 73721

*With contrast
CPT 73722

Osteomyelitis, mass, ulcer, or infection

Signature knee, pregnant patients, dialysis patients, patients with history of MR contrast allergies, patients with GFR less than 30

ONLY performed if a patient were to have an arthrogram of the joint or were to return for additional scans where a W/O was already performed

 

MRI LOWER EXTREMITY NON-JOINT (FEMUR, LOWER LEG, FOOT)

Ninety percent of all orthopedic work is performed without contrast.

With & without
contrast

CPT 73720

Without contrast
CPT 73718

*With contrast
CPT 73719

Osteomyelitis, mass, ulcer or infection

Pregnant patients, dialysis patients, patients with history of MR contrast allergies, and with GFR less than 30

ONLY performed if a patient were to return for additional scans where a W/O was already performed

 

MRI BREAST

Unilateral CPT 77058-(mastectomy patients only)

Bilateral CPT 77059

Breast Biopsy CPT 19085

With & without
contrast

CPT Unilateral 77058
CPT Bilateral 77059

Without contrast
CPT Unilateral 77058
CPT Bilateral 77059

*With contrast
CPT Unilateral 77058
CPT Bilateral 77059

Almost all breasts are performed with and without contrast.

Breast implant screening/rupture with no history of breast cancer, mentor study patients, pregnant patients, dialysis patients, patients with history of MR contrast allergies, patients a with GFR less than 30

ONLY performed if a patient were to return for additional scans where a W/O was already performed

 

MRA/MRV

With & without
contrast

Without contrast

With contrast

Upper Extremity-CPT 73225
Lower Extremity-CPT 73725
Chest- CPT 71555
Pelvis-CPT 72198
Abdomen- CPT 74185 Abdomen with runoff -
CPT 74185, 73725 x 2

Head-CPT 70544
COW-CPT 70544

Carotids-CPT 70548

 

* With Contrast- Ordering an exam “with contrast” means that the MRI will be performed “with and without contrast” the order will need to state with and without contrast. MRIs have to be performed without contrast first before a contrast injection is administered.

* With Contrast will ONLY be performed in the following situations:

  • MRA Carotids
  • MRI Arthrograms
  • When a patient is to return for additional images with contrast requested by the radiologist after an MRI without contrast procedure was performed (usually 2 weeks)

** If patient has a history of cancer then the MRI needs to be ordered with and without contrast. (Exceptions would be when ordering orthopedic imaging; MRI upper and lower extremity, MRI upper and lower extremity joint, these will be done without contrast the majority of the time unless you are looking for an indication listed on the guided chart).