Physician / Office Information / CT Contrast Guide

CT Contrast Guide

Revised 02.09 Body - CT Scan Scheduling Guidelines Without signs or symptoms written on an order, a NORMAL study will NOT be covered by insurance. Key: W-With WO-Without WO&W-Without & With
CPT CODE	CHEST CT (x-ray is almost always required)	SIGNS/SYMPTOMS	IV	ORAL
71250	Nodules	Abnormal cxr, ancillary finding, f/u study	WO	No
71250	Interstitial lung disease, i.e. asbestosis, sarcoidosis,TB	Breathlessness during exercise, dry cough, f/u	WO	No
71260	Suspected pulmonary embolus	Chest pain, cough, rapid heart rate, sob, dyspnea	W	No
71260	Persistent unresolved cough of at least 2 weeks w normal x ray	Cough	W	No
71260	Unresolved pneumonia documented after antibiotics (4 weeks)	Chest pain, cough	W	No
71260	Suspected/known tumor/mass –evaluation, staging, restaging	Weight loss, abnormal tumor marker, pain, f/u	W	No
71260	Unexplained abnormalities on chest x ray	Abnormal cxr, ancillary finding, f/u study	W	No
71260	Aortic Root Dilation	SOB, fatigue, weakness, fainting	W	No
71295	Pulmonary Vein Stenosis-Pre/Post Ablation	SOB, fatigue, rapid heartbeat, fainting, A-fib	WO&W	No

CPT CODE	ABDOMEN CT (Superior to diaphragm to the level of the iliac bifurcation)	SIGNS/SYMPTOMS	IV	ORAL
74150	Adrenal mass	High blood pressure, low potassium, palpitations	WO	No
74170	Cirrhosis	Vomiting blood, jaundice, confusion, incr. LFTs	WO&W	Yes
74170	Renal Mass; abn ancillary findings	Blood in urine, LBP, unexplained weight loss	WO&W	Yes
74170	Hemangioma; ONLY if MRI cannot be performed	Abn. LFTs, F/U liver mass	WO&W	Yes

CPT Code	ABDOMEN/ PELVIS CT (Superior to diaphragm through the symphysis-pubis)	SIGNS/SYMPTOMS	IV	ORAL
74176	Suspected retroperitoneal hematoma/hemorrhage	Abdominal pain; hypotension, anemia	WO	No
74176	Suspected stone in kidneys, bladder and ureters	Abdominal pain; flank pain, hematuria	WO	No
74177	Clinical signs suggestive of diverticulitis, colitis, Crohn's, IBD	Abdominal pain, diarrhea	W	Yes
74177	Clinical signs suggestive of appendicitis	Abdominal pain, nausea, vomiting, fever	W	Yes
74177	Lymphadenopathy, assessment of lymphomas	Swollen enlarged lymph nodes	W	Yes
74177	F/U of complication/medical treatment of abdominal/pelvic (bowel obstruction)	Abdominal pain, distension, vomiting, fecal vomiting	W	Yes
74178	Pancreatitis, suspected necrosis or pseudocyst	Severe abdominal pain, nausea, vomiting	WO&W	Yes
74178	Hematuria	Blood in urine	WO&W	Yes
74178	Hydronephrosis	Raised creatinine,electrolyte imbalance	WO&W	Yes
74178	Abdominal Aortic Aneurysm (Stent-Graph Protocol)	Abdomen pain, rapid heart rate, abdominal rigidity	WO&W	No

Neuro - CT Scan Scheduling Guidelines Without signs or symptoms written on an order, a NORMAL study will NOT be covered by an insurance carrier. Key: W-With WO-Without WO&W-Without & With
CPT Code	BRAIN CT	SIGNS/SYMPTOMS	IV	ORAL
70450	Headache; new, sudden, severe	Headache	WO	No
70450	Stroke or TIA	Numbness, weakness, dizziness, trouble speaking	WO	No
70450	Visual Disturbance	As stated	WO	No
70450	Hydrocephalus i.e. shunt revision	Headache, vomiting, blurred vision	WO	No
70450	Trauma for depressed fracture	Pain at site	WO	No
70470	Primary or metastatic tumor, new or follow up ONLY if MRI is contraindicated!!!!!!!!	Blurred vision, chronic headaches, R/O mets	WO&W	No

CPT Code	ORBITS	SIGNS/SYMPTOMS	IV	ORAL
70480	Trauma	Facial/eye pain	WO	No
70481	No Trauma; specific localized facial pain	Localized orbital pain, swelling, inflamation	W	No

CPT Code	SINUS	SIGNS/SYMPTOMS	IV	ORAL
70486	Preoperative after failure of conservative treatment		WO	No
70486	Sinusitis; chronic, failed several courses of antibiotic therapy	Facial pain, congestion	WO	No
70487	Osteomyelitis	Pain in infected bone, fever, chills	W	No
70487	Sinus-nasal tumor	Nasal congestion, pain above or below eyes	W	No

CPT Code	NECK	SIGNS/SYMPTOMS	IV	ORAL
70490	R/O Calculi	Pain, dry mouth, bad taste in mouth, swelling	WO	No
70491	Lymphadenopathy	Swelling of lymph nodes	W	No
70491	Suspected or known tumor of larynx, pharynyx, parathyroid & parotids	Dysphagia, vocal changes, aspiration	W	No
70491	Vocal cord lesion, hoarseness, paralysis	Hoarseness, breathy sounding	W	No

CPT Code	EXTREMITIES	SIGNS/SYMPTOMS	IV	ORAL
Upper
73200	Position of known fracture	Pain and swelling around area, loss of function	WO	No
73200	Joint	Arthritis, pain	WO	No
73200	Arthrogram	Pain, decreasing ROM	WO	No
Lower
73700	Position of known fracture	Pain and swelling around area, loss of function	WO	No
73700	Joint	Arthritis, pain	WO	No
73700	Arthrogram	Pain, "clicking"	WO	No
73700	Leg Length Studies: Leg length Discrepancy	One leg is shorter, gait problems, pain in back/legs	WO	No
CPT Code	SPINE - Due to radiation exposure, levels must be indicated	SIGNS/SYMPTOMS	IV	ORAL
Cervical:
72125	Fractures	Pain, bruising and swelling	WO	No
72125	Scoliosis	Curving spine, shoulders/hips are uneven, LBP	WO	No
72125	Tumor: if MRI is contraindicated	Pain, weight loss, fatigue	W	No
72125	Tumor: if MRI was recently completed…eval for bone	Pain, weight loss, fatigue	WO	No
72125	Post-op Studies	Pain, f/u surgical eval	WO	No
Thoracic:
72128	Fractures	Pain, bruising and swelling	WO	No
72128	Scoliosis	Curving spine, shoulders/hips are uneven, LBP	WO	No
72129	Tumor: if MRI is contraindicated	Pain, weight loss, fatigue	W	No
72128	Tumor: if MRI was recently completed…eval for bone	Pain, weight loss, fatigue	WO	No
72128	Post-op Studies	Pain, f/u surgical eval	WO	No
Lumbar:
72131	Fractures	Pain, bruising and swelling	WO	No
72131	Scoliosis	Curving spine, shoulders/hips are uneven, LBP	WO	No
72132	Tumor: if MRI is contraindicated	Pain, weight loss, fatigue	W	No
72131	Tumor: if MRI was recently completed…eval for bone	Pain, weight loss, fatigue	WO	No
72131	Post-op Studies	Pain, f/u surgical eval	WO	No

CT Angiography (CTA) Scheduling Guidelines Without signs or symptoms written on an order, a NORMAL study will NOT be covered by an insurance carrier. Key: W-With WO-Without WO&W-Without & With
CPT Code	HEAD	SIGNS/SYMPTOMS	IV	ORAL
70496	Aneurysm	Double or loss of vision, headache, eye pain	WO&W	No

CPT Code	NECK	SIGNS/SYMPTOMS	IV	ORAL
70498	Suspected Carotid Stenosis	Weakness, numbness, Confusion, dizziness	W	No

CPT Code	CHEST	SIGNS/SYMPTOMS	IV	ORAL
71275	Evaluation of thoracic aortic aneurysm	Most have no symptoms until the aneurysm leaks	WO&W	No
71260	Suspected pulmonary embolis	Chest pain, cough, SOB, dyspnea	W	No

CPT Code	CHEST / ABDOMEN / PELVIS	SIGNS/SYMPTOMS	IV	ORAL
71275 + 74175 + 72191	Dissection	Stabbing or sharp chest pain	W&WO	No

CPT Code	ABDOMEN	SIGNS/SYMPTOMS	IV	ORAL
74175	Renal hypertension	Blood in urine, hypertension, renal insufficiency	W&WO	No

CPT Code	ABDOMEN / PELVIS	SIGNS/SYMPTOMS	IV	ORAL
74175 + 72191	Abdominal Aortic Aneurysm	Constant chest/abd & back pain; pulsatile mass	W&WO	No
74175 + 72191	Iliac Aneurysm	Lower abdominal pain, low back pain or groin pain	W&WO	No

CPT Code	ABDOMINAL AORTA with RUNOFFS	SIGNS/SYMPTOMS	IV	ORAL
75635	Lower extremity ischemia, claudication, foot ulcer	Absent pulse in foot, cramping pain, rest pain	W	No

CT Contrast Guide

Body - CT Scan Scheduling Guidelines

Without signs or symptoms written on an order, a NORMAL study will NOT be covered by insurance.

Key: W-With WO-Without WO&W-Without & With

Neuro - CT Scan Scheduling Guidelines

Without signs or symptoms written on an order, a NORMAL study will NOT be covered by an insurance carrier.

Key: W-With WO-Without WO&W-Without & With

Upper

Lower

Cervical:

Thoracic:

Lumbar:

CT Angiography (CTA) Scheduling Guidelines

Without signs or symptoms written on an order, a NORMAL study will NOT be covered by an insurance carrier.

Key: W-With WO-Without WO&W-Without & With