MRI Quick Reference

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MRI Quick Reference

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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).