University Radiology To Order A CT Or CTA Study Call 305 .

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University RadiologyCT and CTA Ordering GuideTo Order a CT or CTA study call 305-8080If you are unsure what CT or CTA to order call 305-9639For more Information visit www.utrad.comPlease use this guide to determine the correct CT or CTA exam to Order and PrecertBody PartCT Abdomen/PelvisReason for Exam or Exam IndicationsHematuria with PainCT Stone Study / Urinary Tract ProtocolAll Cancer StagingAbdominal PainCrohns*Ulcerative ColitisIBDAppendicitisDiverticulitisAbscessHernia (ventral, umbilical, inguinal)*Recommend CT EnterographyPainless HematuriaCT Abdomen OnlyCTA Abdomen(Renal, Aorta PreOp, Post-Op Stent)CTA Abdomen(Run Off)Urothelial NeoplasmHCCTransitional Cell Carcinoma of KidneyF/U for patients with RenalCell Carcinoma in Renal FailureLUQ PainRUQ PainEpigastric IssuesMassPseudocystPancreatitisPancreas MassLiver MassLiver ProtocolPancreatic ProtocolAdrenal ProtocolProcedure to Order & PrecertCPT Code(s) toPrecertCT Abdomen/Pelvis Without Contrast74176CT Abdomen/Pelvis With Contrast74177CT Abdomen/Pelvis With and WithoutContrast74178CT Abdomen Without Contrast74150CT Abdomen With Contrast74160CT Abdomen With and Without Contrast74170Renal TransplantRenal DonorCTA Abdomen74175Peripheral Artery Disease (PAD)CTA Abdomen (and Run Off)75635 Association of University Radiologists, PCPage 1

University RadiologyCT and CTA Ordering GuideTo Order a CT or CTA study call 305-8080If you are unsure what CT or CTA to order call 305-9639For more Information visit www.utrad.comPlease use this guide to determine the correct CT or CTA exam to Order and PrecertBody PartCT ChestCT ChestReason for Exam or Exam IndicationsCoughPneumoniaTracheal StenosisRenal FailureF/U NodulesSuspected Mediastinal / Hilar AdenopathyStaging Thoracic Primary MalignancyComplex Pleural EffusionThoracic TraumaChest Wall MassInterstitial DiseaseFibrosisAsbestosis(High Resolution)CT Chest WithoutContrastLung Cancer ScreeningProcedure to Order & PrecertCPT Code(s) toPrecertCT Chest Without Contrast71250CT Chest With Contrast71260CT Chest Without Contrast--- HIGH RESOLUTION71250CT Chest Without Contrast71250CTA Chest With Contrast71275CT Pelvis Without Contrast72192CT Pelvis With Contrast72193CT Neck Without Contrast70490(Low Dose Protocol)CTA Chest(PE Study)CT Pelvis OnlyCT NeckChest Pain/DyspneaDVTTachypneaHemoptysisShortness of Breath D DimerPulmonary HypertensionProstate Treatment PlanningPelvic FractureCancer StagingMass in Pelvic RegionCysts in Pelvic Region Pain in Pelvic RegionInfection in Pelvic RegionOrder without contrast if elevated GFR Association of University Radiologists, PCPage 2

University RadiologyCT and CTA Ordering GuideTo Order a CT or CTA study call 305-8080If you are unsure what CT or CTA to order call 305-9639For more Information visit www.utrad.comPlease use this guide to determine the correct CT or CTA exam to Order and PrecertBody PartReason for Exam or Exam IndicationsSubmandibular StoneParotid StoneInfection of Parotid GlandParotid MassInfectionCTA NeckCT Head*MRIRecommended formany of thesesame indicationsCTA Head / BrainMassCancer WorkupsArtheromatous DiseaseBruitTIACVAVascular TumorVascular MalformationsCarotid StenosisTraumaHeadachesCVA, StrokeBleed, HemorrhageAlzheimersMemory LossConfusionShunt CheckHydrocephalusMetastatic StagingVertigoDizzinessMass / TumorInfectionHeadache with other Neurological SymptomsMelanomaHIVToxoplasmosisTIA, CVAVascular MalformationAneurysmAVM Association of University Radiologists, PCProcedure to Order & PrecertCPT Code(s) toPrecertCT Neck Without and With Contrast70492CT Neck With Contrast70491CTA Neck75662CT Head Without Contrast70450CT Head With and Without Contrast70470CTA Brain75671Page 3

University RadiologyCT and CTA Ordering GuideTo Order a CT or CTA study call 305-8080If you are unsure what CT or CTA to order call 305-9639For more Information visit www.utrad.comPlease use this guide to determine the correct CT or CTA exam to Order and PrecertBody PartCT OrbitsCT OrbitsCT SinusCT Spine(Cervical / Thoracic)CT Spine(Lumbar / Sacral)CT Temporal BoneCT Extremities-FootAnkleCalfKneeReason for Exam or Exam IndicationsTraumaFractureForeign BodyGraves DiseasePseudo itisOsteomeatal ComplexFunctional Endoscopic Sinus SurgeryTraumaFractureFusionBony DegenerativeChanges*MR Recommended for disc herniation, mets,infectionTraumaFractureFusionPars Defect*MR Recommended for disc herniation, mets,infectionHearing LossCholesteotomaTrauma*Sensorineural hearing loss; order MRI WithContrastFractureFusionNon-UnionMalunionFemoral AnteversionArthritisMalignment Knee Association of University Radiologists, PCProcedure to Order & PrecertCPT Code(s) toPrecertCT Orbit Without Contrast70480CT Orbit With Contrast70481CT Orbit Without and With Contrast70482CT Sinus (Maxillofacial) Without Contrast*CT Sinus Limited will be billed with 52 Modifier70486CT Without Contrast- Cervical Spine- Thoracic Spine7212572128CT Lumbar Spine Without Contrast72131CT (Orbit) Inner Ears, Temporal BonesWithout Contrast70480CT Without Contrast- Lower Extremity- Upper Extremity7370073200Page 4

University RadiologyCT and CTA Ordering GuideTo Order a CT or CTA study call 305-8080If you are unsure what CT or CTA to order call 305-9639For more Information visit www.utrad.comPlease use this guide to determine the correct CT or CTA exam to Order and PrecertBody Part--Procedure to Order & PrecertInfectionTumor / Mass / Cancer / MetsCT Without and With Contrast- Lower Extremity- Upper Extremity7370273202CT Leg Lengths76380ThighFingerHandWristArmCT ExtremitiesCT Extremities(Leg Lengths)CTA Extremities-CPT Code(s) toPrecertReason for Exam or Exam IndicationsCT ty Leg LengthMalrotationPeripheral Artery Disease (PAD)Ischemia to Lower ExtremityArterial Stenosis – Lower ExtremityCartilage AbnormalityMeniscus AbnormalityLabrum AbnormalityLoose Bodies Association of University Radiologists, PCCT Angiography- Lower Extremity- Upper ExtremityCT With Contrast1. Lower Extremity With Contrast ORUpper Extremity With Contrast2. Fluro Guided Arthogram3. Choose One Code for body Part- Hip- Knee- 3270932737027648233502422025246Page 5

University RadiologyCT and CTA Ordering GuideTo Order a CT or CTA study call 305-8080If you are unsure what CT or CTA to order call 305-9639For more Information visit www.utrad.comPlease use this guide to determine the correct CT or CTA exam to Order and PrecertBody PartReason for Exam or Exam IndicationsProcedure to Order & PrecertCPT Code(s) toPrecertCommon CT ProtocolsRenal ProtocolCT Abdomen Without and With Contrast74170*Some Radiologists will also order with PelvisCT Stone Study /Urinary TractProtocolUrogramLiver (Hepatic)ProtocolCT EnterographyPancreatic ProtocolPulmonaryEmbolism(PE) Protocol Association of University Radiologists, PCCT Abdomen/Pelvis Without ContrastCT Abdomen/Pelvis With and WithoutContrast3D Reformatted CT Images74176Precert Both Codes:7417876376CT Abdomen With and Without Contrast74170CT Abdomen/Pelvis With ContrastCT Abdomen With and Without Contrast7417774170CTA Chest71275Page 6

University RadiologyCT and CTA Ordering GuideTo Order a CT or CTA study call 305-8080If you are unsure what CT or CTA to order call 305-9639For more Information visit www.utrad.comPlease use this guide to determine the correct CT or CTA exam to Order and PrecertBody PartReason for Exam or Exam IndicationsParathyroidProtocolCT Dissection Study Association of University Radiologists, PCProcedure to Order & PrecertCT Neck Soft Tissue Without and WithContrastCTA ChestCTA AbdomenCTA PelvisCPT Code(s) toPrecert70492712757417572191Page 7

CT Chest Asbestosis (High Resolution) Fibrosis CT Chest Without CT Chest Without Contrast --- HIGH RESOLUTION 71250 Contrast Lung Cancer Screening (Low Dose Protocol) CT Chest Without Contrast 71250 CTA Chest (PE Study) Chest Pain/Dyspnea DVT Tachypnea Hemoptysis Shortness of Bre

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