CT EXAM CPT CODE REFERENCE Use this reference to quickly determine the correct exam for your patients based on the 0000000876 00000 n 0.2 mL/kg in adults, children and infants. Radiographics. endobj endobj Our radiologists work closely with OHSU MRI technologists in the art of creating optimal images using current technology. For active surveillance, postablation surveillance, or postpartial nephrectomy surveillance, precontrast and nephrographic phases should be obtained. American Hospital Association ("AHA"), Appropriate Use Criteria (AUC) in Coding, Reimbursement, and Clinical Practice. Nephrographic and excretory phases also are included, with the field of view expanded from diaphragm to iliac crest. An important component of adrenal MRI protocol is chemical shift imaging (CSI). CT is the most commonly used modality for the detection and characterization of renal masses as well as presurgical planning and post-therapy surveillance. @\N 0000013275 00000 n $_ @'a7H\?/ mWI . (Liver Mass Protocol) Characterize masses previously seen on CT or US-hepatoma screening-metastasis follow-up/ post cryo or RF ablation-assessment of spleen-pancreatic masses with question of liver mets *This scan MAY include MRCP: if so the patient needs to fast 4 hours before scan. JN Contrast injection risk and benefits must be explained to the patient before the scan (, CT in a 68-year-old woman with a clear cell RCC. For others, it may consist of a corticomedullary phase (40-60 second delay) and/or an excretory phase (5-10 minute delay). Check for errors and try again. The recommended dose of gadolinium DTPA injection is 0.1 mmol/kg, i.e. > For the assessment of benign renal lesions (e.g. INTRODUCTION. 0000009557 00000 n (, CT in a 64-year-old man with a renal mass illustrating the utility of excretory phase in delineating involvement of the collecting system. Do not start scan until the patient has stopped breathing. `|G]&s Hematuria (CT Urogram, CT IVP) CT Hematuria Protocol CT/IVP w & wo 74178 MRI Abdomen and Pelvis w . endobj The specifics will vary depending on CT hardware and software, radiologists' and referrers' preference, institutional protocols, patient factors (e.g. q)q_=)kK'? These include renal cysts, benign renal tumors, and renal cell carcinomas (RCCs) that have variable biological aggressiveness. Excretory phase is obtained at 7 minutes to 10minutes after IV contrast injection. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 14 0 R 15 0 R] /MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Position the patient over the spine coil and place the body coil over the abdomen (xiphoid process down to anterior superior iliac spine) Chest w/o contrast (with 3D reconstructions), CTA Chest w/ contrast (with 3D reconstructions), EVT Abdomen Pelvis w/o contrast w/3D (with 3D reconstructions), Abdomen and Pelvis enterography w/ contrast, CTA Abdomen Pelvis (with 3D reconstructions), CTA EVT Chest Abdomen Pelvis w/o contrast w/3D (C) (with 3D reconstructions), CTA Chest Abdomen Pelvis (with 3D reconstructions), EVT Chest Abdomen Pelvis w/o contrast w/3D (C) (with 3D reconstructions), Urogram CT Abdomen and Pelvis w/ and w/o contrast w/3D reconstruction (with 3D reconstructions), Abdominal Aorta and Bilateral Iliofemoral Runoff (with 3D reconstructions), Internal Auditory Canal Cochlear Implant w/o contrast, CTA Head w/ and w/o contrast (with 3D reconstructions), CTA Head Neck w/ and w/o contrast (3D reconstructions), Arthrogram Shoulder (Arthrogram only; no IV contrast), Arthrogram Elbow (Arthrogram only; no IV contrast), Arthrogram Wrist (Arthrogram only; no IV contrast), Arthrogram Hip (Arthrogram only; no IV contrast), Arthrogram Knee (Arthrogram only; no IV contrast), Arthrogram Ankle (Arthrogram only; no IV contrast), Woodard to Lead Mallinckrodt Institute of Radiology, Sauk Named Interventional Radiology Chief, Miller-Thomas Receives Distinguished Service Teaching Award. Check the positioning block in the other two planes. Instruct the patient to hold their breath for the breath hold scans (its better to coach the patient two to three times before starting the scan) A three plane TrueFISP localiser must be taken initially to localise and plan the sequences. Note: Instruct patient to arrive 45 minutes prior to exam for registration and prep. Contrast injection risk and benefits must be explained to the patient before the scan, T2 tse breath hold (TRUFI or HASTE)coronal, Use T1 VIBE fat sat axial and coronal after the administration of IV, CLICK THE SEQUENCES BELOW TO CHECK THE SCANS. Patients with hives or rash must be pre-medicated for an IV contrast CT scan (not oral contrast). 0000031716 00000 n >, Any electrically, magnetically or mechanically activated implant (e.g. Description by CPT Code* CPT Code Sacrum Sacral Insufficiency Fracture No MRI Sacrum wo 72196 SacralIliitis Tumor/Mass/Cancer/Mets Yes MRI Sacrum w/ & w/o 72197 Wrist Arthrogram TFCC tear Scaphoid nonunion Yes ** MR Upper Ext joint w/ Contrast Injection - Wrist 73222 25246 Intercarpal Ligaments Soft tissue ganglia Yes ** Rad exam - wrist 73115 Scanner preference: 1.5T. More CPT Codes: MRI | Nuclear Medicine | PET/CT | PET/MR | Ultrasound, Prep: NPO 2 hours for all studies w/ contrastArrival time: 30 minutes prior to exam for registration and prep, Dissection (if in conjunction with Abdomen and Pelvis CT w/contrast please see Chest w/ and w/o contrast and Abdomen Pelvis w/contrast (CPT Code 74177, IMG 698). CLINICAL GUIDELINES EXAM DESCRIPTION CT/CTA CPT CODES EXAM DESCRIPTION MRI/MRA CPT CODES Abdominal mass CT Abdomen & Pelvis w 74177 MRI Abdomen w & wo 74183 . H= {,# $9N2)vELLc# qTxPec%={nv.lU'V{sMR7v';c9c%F. 0000025763 00000 n It outlines all sequences and protocols currently applied in our MRI section. hb```b``)a`e``ld`@ 4">kvv6*g^.i#wVz7_[/P=6w,t9ijtOT ~+IbInz/?^zPY\ w m:8G1j NOx/4n O i8sp?X&{`Ec{qr%R2Tto]^8_gYQ*.Ivp+kZ1/z`y@"6}Y&$4Ps0kRu$!IQK1q{%zu4Pm?= ha^Vv&T(`(kqi!RXa&_$/6,YpCA=gbxhWfD7=X9nB[0\c?. Note: This article is intended to outline some general principles of protocol design. I can't find anything on the federal register stating p Read a CPT Assistant article by subscribing to. 9 ). Call 855-SAFE-RAD to schedule a radiology exam. Give 2L O2 if it will help with breath-holdsUNLESS PATIENT HAS COPD OR ANOTHER REASON NOT TO GIVE O2. 0000018234 00000 n Charge as: Abdomen W/WO The excretory phase may be helpful for distinguishing urothelial cancers from RCCs and parapelvic or peripelvic cysts from hydronephrosis and for diagnosing calyceal diverticula. endobj endstream endobj 45 0 obj <> endobj 46 0 obj <> endobj 47 0 obj <>stream 6qMo4#w4Q E Monitor that patient is breath-holding. Furthermore, imaging plays a key role in the presurgical planning of renal tumors and in surveillance after surgery or systemic therapy for advanced RCCs. 0000007606 00000 n 66 0 obj <>/Filter/FlateDecode/ID[]/Index[44 37]/Info 43 0 R/Length 103/Prev 145237/Root 45 0 R/Size 81/Type/XRef/W[1 2 1]>>stream Such information can be helpful in guiding patient management. During this phase, there is intense enhancement of the renal cortex, allowing differentiation between the cortex and the medulla. 2004;24(2):e20. endstream endobj 102 0 obj <>stream Angiomyolipomas (AMLs) can be diagnosed confidently once intralesional macroscopic fat has been identified in the absence of other worrisome findings, such as intralesional calcification. Indeterminate renal mass, renal adenocarcinoma, metastasis, monitoring of known renal mass. It is most often comprised of a non-contrast, nephrogenic phase and excretory phase. a,qN*)[6%Tz\ mv9xBFk$K/c1?gz3?t{A#!=)01ST`ipFY{\1>c$&34pR ?@Q6/g_1%H5zY^wm@2>^K~oY!QEm.f2Gw;rty^W=D *l !%/"2vGVc>|~{OmL tR7tH]VVB 50A'1|e8 , Suggested IV contrast type by the SAR DFP is low-osmolar or iso-osmolar contrast material, at a dose of 35 g to 52.5g iodine equivalent (ie, for contrast material that contains 350mg of iodine/mL, the corresponding dose is 100150mL), or weight-based dosing. 0000005493 00000 n MRI renal mass protocol v1.0 Society of Abdominal Radiology Disease Focused Panel on Renal Cell Carcinoma Zhen Jane Wang, MD, Project Leader Matthew S. Davenport, MD, Co-Chair Stuart G. Silverman, MD, Co-Chair Hersh Chandarana, MD Ankur Doshi, MD Gary M. Israel, MD John R. Leyendecker, MD Ivan Pedrosa, MD, PhD Steve Raman, MD Erick M. Remer, MD For prepartial nephrectomy or preablation planning of renal masses that have been previously completely characterized, the primary goal is to delineate the tumor and vascular anatomy. > /1 G,G5?I7 Offer earplugs or headphones, possibly with music for extra comfort Thirty patients undergoing four-phase renal CT scans for assessment of renal lesions (>10 mm) were included in the study. x]_s8OU&_6.IV=qcD ( @8nt7n\vysKw/seK?Dr)/bs9:_}? Measurement of HU change after contrast administration using the earlier corticomedullary phase in a papillary RCC may result in erroneous categorization of the lesion as a nonenhancing cyst (see Fig. IV contrast generally is needed for the characterization, staging, surveillance, and post-treatment follow-up of renal tumors. The excretory phase allows better depiction of the relationship between the mass and the renal collecting system. (, CT in a 57-year-old woman with a renal AML. At the time the article was last revised Raymond Chieng had These are fast single shot localisers with under 25s acqusition time which are excellent for localising abdominal structures. Phase oversampling and, in the case of 3D blocks, slice oversample, must be used to avoid wrap around artefacts. Note: NPO 4 hours. y;?5Zr|e~fhlw`m@b]z"tKp+#14^w]^wwt22*Z#OlA?rv1HDXM\m w`,3UE~^X_~1E1(S8lyLV7qL6D"98%eM-r!zU ), T1 In-opposed phase breath hold axial 4mm. 11 The vast majority of asymptomatic adrenal masses are benign, and patients . The patient had MRI w/o contrast for the HIP right side and MRI w/o contrast of the Knee right side. [QUOTE="bnmoody, post: 392628, member: 265484"] > Use T1 VIBE fat sat axial and coronal after the administration of IV gadolinium DTPA injection(copy the planning outlined above). 97 29 1 0 obj > carcinoma) MRI Abdomen with or without contrast 74183 Hematuria (blood in urine) Renal mass (cyst or solid) Transitional cell carcinoma of kidney Abnormal findings on other imaging studies Yes Body . Current Procedural Terminology CPT 2022 MAGNETIC RESONANCE IMAGING - MRI COMPUTED TOMOGRAPHY - CT MAGNETIC RESONANCE ANGIOGRAHY - MRA MAGNETIC RESONANCE VENOGRAPHY - MRV . CT Abdomen with contrast (CPT 74160) or without and with contrast (CPT 74170) with suspicion of a solid organ lesion (liver, kidney, pancreas, spleen). (, Presurgical planning CT in a 65-year-old man with a left renal tumor. . Diagnostic Radiology (Diagnostic Imaging) Procedures, Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities, Copyright 2023. , For example, prior studies have shown that clear celltype RCCs demonstrate peak enhancement during the corticomedullary phase. Prednisone: 50 mg PO (three doses total) to be taken 13 hours, 7 hours and 1 hour prior to appointment. Consider not using SENSE and allowing wrap into the peripheral image, but not into the kidneys. 0 'f2J}0y:[]m jB|+7)Hed6'BghE~1-&&y-:+qX$*4p:5Zt5_l^t}Zp@[?e[lI{'? ak+k)g3_%"-st*:@1LyrkzAK RbRY QpeWD4-g5EE9:K_tJ,s#ZxiBUo&9z(3>,m 10 ). I agree with what t Radiologist is performing MRI RT foot and ankle - the report talks about both areas. M}]JS+9uG7^E@h z/EZZ?_Fefmz-@vfpri)6KdK3:DHT8L2F1: This phase is useful in confirming anatomic variants, such as column of Bertin, which can mimic a tumor but which has the same corticomedullary differentiation as normal kidney parenchyma ( Fig. BODY PART REASON FOR EXAM PROCEDURE NOTES CPT CODE HEAD AND NECK Sella/Pituitary Pituitary dysfunction Adenoma, Sellar or suprasellar mass MRI HEAD W AND W/O CONTRAST (UMC order appears as MRI BRAIN W AND W/O CONTRAST) 70553 Inner Ear (IAC) CPA tumor > The precontrast and nephrographic phase images are used to evaluate for changes of tumor size or enhancement characteristics in cases of active surveillance or detecting enhancing tumor in post-treatment settings ( Fig. For clinical responsibility, terminology, tips and additional info start codify free trial. Contrast material is excreted into the renal collection system, ureters, and bladder in this phase, allowing better visualization of these structures. Kang S, Huang W, Pandharipande P, Chandarana H. Solid Renal Masses: What the Numbers Tell Us. However, this article will cover the optional,corticomedullary phase too. Multiplanar reformats in the coronal and sagittal planes of each postcontrast scan series also can be done with 3-mm reconstruction section thickness without overlap. CT images are acquired in the axial plane, with suggested 3-mm reconstruction section thickness. HCC Renal Mass or Cyst Transitional Cell Carcinoma of Kidney Increased Liver . no financial relationships to ineligible companies to disclose. 6Mvw\Th_?\)&sEpka>yB" }T]),i7x7/:j]`)\AJ]%#-I> `-e$=nr&=>naj@r"0cTHaZegZ[lIi;Beh&/h]$Swt\' !uQ!FzRe?EjI-.'iJ~z]wN&:7W^Usn?pEl?dlMQ ?[?: ?L5tZD'UT]gUDoor 125 0 obj <>stream Within the next several years providers will be required to observe appropriate use criteria AUC as a condition of payment when reporting certain services for Medicare beneficiaries. It is most often comprised of a non-contrast, nephrogenic phase and excretory phase. Plan the axial slices on the coronal plane; angle the position block parallel to the right and left renal pelvis. stream 4 ) compared with postcontrast CT or MR imaging. x]_sLHkG38NL&CsT[N4V" bISM-bw:=V7]nN~=\,O-o;|rqE&,Lr!O?$O|HD\|B_r~"gjf{x^'fv_'%|ONKE.5p%ujTd"gGVd Coil: Torso Coil. >, Position the patient in supine position with head pointing towards the magnet (head first supine) endstream endobj 103 0 obj <>stream 4u|29q9E15x=mB^y_o: Ehh5W O J2p71H q The specifics will vary depending on MRI hardware and software, radiologist's and referrer's preference, institutional protocols . > Tumor/Mass/Cancer/Mets Note: MRI is more sensitive Yes ortho CT Extremity without contrast Upper Extremity Lower Extremity 73200 . UB@&^v0c&]IG'#4-;j84j8BB"a6z2L0f#MG5ZP6l#AlX*k%rm9 R8XAe+S7"kTPPOA^vd@b/[wO;R}cH3@4B nMEz|pHj-ZBuQZr)AC6>*dZ3Yd'~AqClWIA{7^l!T >, A satisfactory written consent form must be taken from the patient before entering the scanner room 2 0 obj Renal masses usually are discovered incidentally on either a noncontrast-enhanced or a single-phase postcontrast CT obtained for unrelated indications. GU PROTOCOLS: CT cystogram: BCT G01: 3 phase: nc.90sec.6min, Primary eval or post-op bladder canc: CT Cystogram (Trauma) - Filled only: 1 phase (filled) Evaluate for bladder injury, or follow-up of bladder injury (low-dose) Renal Mass 3 phase: BCT G02: 3 phase: nc.90sec.6min: Evaluate renal mass: Renal Donor 3 phase: BCT G04: 3 phase: nc.art . Those that are homogeneous with HU greater than 70 are hemorrhagic or proteinaceous cysts ( Fig. CPT ETO CYC DXR: Craniospinal (25.5 Gy) + Local (25.5 Gy) An appropriate angle must be given in the sagittal plane (perpendicular to the long axis of kidney). oncocytoma and angiomyolipoma) Nephrographic phase is the most sensitive for detecting renal lesions. Renal mass (cyst or solid) Transitional cell carcinoma of kidney Abnormal findings mri aBdomen: Adrenal MRI Abdomen with and without contrast 74183 Adrenal mass or lesion Hypertension Pheochromocytoma Determined by Radiologist Body mrcP: Biliary MRI Abdomen with and without contrast 74183 Abdominal pain Jaundice Ask the patient to remove all metal object including keys, coins, wallet, any cards with magnetic strips, jewellery, hearing aid and hairpins The field of view, whether restricted to the kidneys themselves or expanded to include from the diaphragm to the iliac crest, also depends on the clinical questions. > On the other hand, the presence of intralesional calcification, regardless of the presence of fat, should prompt suspicion for malignancy, such as RCC. AJR Am J Roentgenol. Check the positioning block in the other two planes. Crosswalk to an anesthesia code and its base units, and calculate payments in a snap! Axial (, CT in a 75-year-old woman with a left renal lesion demonstrating higher lesion conspicuity in the nephrographic phase compared with the corticomedullary phase. Given the indolent nature of papillary RCCs in general, these may be appropriate for active surveillance rather than surgical resection, especially in patients who are poor surgical candidates. Computed tomography (CT) and MR imaging are mainstays for renal mass characterization, presurgical planning of renal tumors, and surveillance after surgery or systemic therapy for advanced renal cell carcinomas. HUIn@aHY 8?"[_ fs)95=m>SMZ}5}K?OKb m#r+Y rQ`Iv ^3J&)-aGUbL+B3MRg\xh%PZ 7mJ2S\J>-F]dazBzaa9B-mh9c\9`RB Adrenal glands protocol is an MRI protocol comprising a group of MRI sequences put together to further assess indeterminate adrenal lesions, in particular, lipid-poor adenomas.. Our podiatrist states that she can report reading for MRI, if patient is bringing in the MRI disc with images and she read it [COLOR="#EE82EE"][/COLOR] Ok, so this seems silly, however, sometimes when reviewing information, there is not always a cut and dry answer to questions. Check the positioning block in the other two planes. bYBqbQ-)(?x%r0810 Instruct the patient to hold their breath during image acquisition. Contrast-enhanced ultrasound is discussed in detail in a separate chapter. Lung Nodules (may be done w/contrast if ordering MD desires), Pneumonia (may be done w/contrast if ordering MD desires), Pleural effusion (may be done w/contrast if ordering MD desires), Airway imaging (includes TBM), Tracheal stenosis, Tracheal malacia (Tracheal Tree), Redo sternotomy for patients who cannot have contrast, Aortic or mitral valve for patients who cannot have contrast, Lung Cancer (may be done w/o Contrast if ordering MD desires), Chest Pain (may be done w/o contrast if ordering MD desires), Liver Mass Characterization/Surgical Planning, Post treatment HCC (not for metastatic surveillance), Renal Mass Characterization/Surgical Planning (if in conjunction with Pelvis CT w/contrast CPT Code 74178, IMG 783), Pancreatic mass characterization/surgical planning (if in conjunction with Pelvis CT w/contrast CPT Code 74178, IMG 783), Liver chemo embolization or RFA (if in conjunction with Pelvis CT w/ contrast CPT Code 74178, IMG 783), Abdomen and pelvis patients who cannot have contrast, Pre- and post-endoluminal grafting for patients who cannot have contrast, Diverticulitis/appendicitis/abscess/acute pancreatitis, Any other indication that is not already listed, Pre liver transplant/portal vein embolization, Gated TAVI (if in conjunction with Heart CT w/contrast (Morphology), CPT code 75572, IMG 7603), Malignancy staging/malignancy follow-up angiography, Failed colonoscopy (if with IV contrast, CPT Code 74262, IMG 2251), Patients that cannot be sedated or cannot stop blood thinners for conventional colonoscopy (if with IV contrast, CPT Code 74262, IMG 2251), Hematuria (if w/o 3D reconstructions, CPT Code 74178, IMG 2252), CT AIF/bypass evaluation/cold leg/leg ischemia, Coronary artery disease/Bypass graft evaluation, Neck mass/malignancy staging/malignancy follow (if contrast is not desired, w/o contrast CPT Code 70490, IMG 191), Acute or chronic sinusitis/nasal cavity polyps, Trauma/black eye/facial contusion/jaw injury, Facial weakness/neoplasm/malignancy/cellulitis/abscess, Intracranial aneurysm/stenosis/dissection, Subarachnoid hemorrhage (SAH)/Arteriovenous malformation (AVM), Extracranial aneurysm/stenosis/dissection, Problem cases unresolved by non-invasive imaging, Cervical myelopathy or radiculopathy in which fine bone detail is desired, Thoracic myelopathy or radiculopathy in which fine bone detail is desired, Lumbar radiculopathy in which fine bone detail is desired presurgical planning and mapping, Infection (if concern for septic joint should be aspirated prior to CT), Rotator cuff or labral injury, unable to get MRI, Triangular fibrocartilage (TFC) complex injury. The Society of Abdominal Radiology (SAR) Disease-Focused Panel (DFP) on RCC is a multi-institutional working group aimed at addressing the unmet needs in the clinical care, research, and education in RCCs. Minimize SENSE if there is mottling in the center of the image. Patients with vomiting or dizziness with IV contrast or shellfish allergy do not require premedication. To plug inpatient facility revenue drains, subscribe to DRG Coder today. Metal shrapnel or bullet, > > For the assessment of malignant renal lesions (e.g. Securely tighten the body coil using straps to prevent respiratory artefacts Similarly, precontrast CT also improves visualization of calcification ( Fig. For example, a tumor with enhancement features that suggest a papillary RCC can be confirmed with percutaneous biopsy. endstream endobj startxref Renal masses increasingly are found incidentally during work-up for nonrenal indications, largely due to the frequent use of medical imaging. Patient with renal insufficiency or hemodialysis; Rib mass/fracture (bony chest) Patient pregnant; MRA/MRV Chest w/ and w/o contrast . Notes: Indeterminate adrenal lesions are typically discovered incidentally on contrast enhanced Planning must be done in the breath hold T1 vibe coronal because the diaphragm will push down the upper abdominal organs during inhalation and change the position of the kidneys from the initial localizer scans. Phase oversampling and, in the case of 3D blocks, slice oversample, must be used to avoid wrap around artefacts. oD}tw.. > 0000011681 00000 n <> renal cell carcinomas and transitional cell 2 AD). > For the assessment of xanthogranulomatous pyelonephritis <> C`:+y(B^\}iO`,;6yg9&Mlc. }\nLz& F6R@8X@kfRc& g-|>7+a#9Y"iaRLDep +JCVb7lBhad(0:8SX3]3svx{4^Q6.V. startxref Recommended additional reformats: coronal and sagittal of each postcontrast scan series; 3-mm reconstruction section thickness without overlap. 0000002227 00000 n CPT Code 73721, Diagnostic Radiology (Diagnostic Imaging) Procedures, Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities - . (In our department we instruct the patients to breathe in and out twice before the breathe in and hold instruction. 0000001521 00000 n 7 ). MRI EXAM CPT CODE REFERENCE Use this reference to quickly determine the correct exam for your patients based on the indications described herein and the . Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Protocol Optimization for Renal Mass Detection and Characterization, Added Value of Magnetic Resonance Imaging for the Evaluation of Mediastinal Lesions, Clinical Review of Computed Tomography and MR Perfusion Imaging in Neuro-Oncology, Radiologic Clinics of North America Volume 58 Issue 5, May be helpful to differentiate urothelial cancer from RCC and parapelvic or peripelvic cysts from hydronephrosis and to diagnose calyceal diverticula, Prepartial nephrectomy or preablation planning for renal masses that have been previously completely characterized, Better depict the arteries and their relationship to the renal mass. The MR sensitivity for adenomas measuring 10-20 HU is nearly 100%, while that for lipid-poor adenomas measuring greater than 30 HU is significantly lower (13 . If RENAL FAILURE (Creatinine over 1.8)-ORDER EXAM WITHOUT CONTRAST. For these masses, no further imaging is indicated. What CPT would you use 73718 or 73721 - I know I cannot code for both. 2. %PDF-1.7 The renal vasculature also enhances intensely in this phase, which can provide additional information for surgical planning if needed ( Fig. of localised blastemal-type Wilms tumour patients treated according to intensified treatment in the SIOP WT 2001 protocol, a report of the SIOP Renal Tumour Study Group (SIOP-RTSG). Papillary RCCs typically have low-level progressive enhancement that peaks in the nephrographic phase. Instruct the patient to keep still In order to optimally visualize the small foci of fat, thin sections (eg, 1.25mm) may be required. codes. RENAL MASS W/WO RENAL ARTERY STENOSIS W/WO SCROTUM WO or W/WO - Updated 1 . CPT Code 74170. (IMG 2390) - fMRI (Functional MRI w/ Tractography) CPT Codes 70551 & 76377 . Pregnancy (risk vs benefit ratio to be assessed) The corticomedullary and excretory phases together with the precontrast-phase and nephrographic-phase images may be helpful to subtype renal masses. <> 80 0 obj <>stream View matching HCPCS Level II codes and their definitions. 0000009361 00000 n 3 ). IV contrast material type, volume, and injection rate: type, low-osmolar or iso-osmolar contrast material; volume, 35-g to 52.5-g iodine equivalent (ie, for contrast material that contains 350mg of iodine/mL, the corresponding dose is 100150mL); and weight-based dosing injection rate, 25mL/s. Power inject 2mL/sec. 2 0 obj This modality enables the radiologist to detect intra-tumor fat resulting in a loss of signal intensity. %PDF-1.3 % Do not interleave images. > Hematuria, > Computed tomography (CT) and MR imaging with intravenous (IV) contrast are the mainstays of renal mass evaluation. hb```f``e`e`cd@ A(G x{LonCI%[p]W-m=J;::*$. <<9D26B84D59B5D04CBD15A8A60877983D>]/Prev 685671>> non-contrast scan is best to determine the HU of homogenous renal mass or masses containing macroscopic fat 1, corticomedullary phase is best to delineate subcategories of renal cell carcinomas further, nephrogenic phase is best for optimal enhancement of the renal parenchyma, including the renal medulla, and will demonstrate enhancing components of a mass, excretory phase will demonstrate enhancement of calyces, renal pelvis and ureters. Adding a U prior to the IV makes the exam ultralow dose, o BCT 02UIV abd pelv w/IV contrast, ultralow dose. Trigger when contrast reaches SMA. Slices must be sufficient to cover both kidneys anterior to posterior. NB: This article is intended to outline some general principles of protocol . MRA carotid with contrast. Acquisition: axial, 3-mm reconstruction section thickness with or without 50% overlap. View any code changes for 2023 as well as historical information on code creation and revision. Free-breathing sequence, so please position slices accordingly. Some masses can be confidently characterized on these images without requiring a subsequent dedicated multiphase renal protocol CT or MR image. It has been reported that up to 66% more small renal masses are detected in the nephrographic phase compared with the corticomedullary phase.

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