CT Scan Ordering Guide

Updated 05/18/2018 Please note, on all CT orders, the w/ or w/o contrast in the order refers to IV contrast.

BODY IMAGING

Chest CT W/O IV Contrast – CPT Code 71250

  •   Lung Nodules
  •   Pneumonia
  •   Pleural Effusion
  •   Interstitial Lung Disease (High Resolution Chest needs to be ordered)
  •   COPD

Chest CT W IV Contrast – CPT Code 71260

  •   Lung Cancer
  • Mediastinal Mass/Abnormality

Chest CT PE W IV Contrast – CPT Code 71275

  •  Pulmonary Embolism

Angiography, Chest CT W and W/O IV Contrast  – CPT Code 71275

  •   Dissection (if in conjunction with Abdomen Pelvis CT W Contrast use also CPT Code 74174)
  • Pulmonary AVM
  • Aneurysm Follow-up (Size Only)

Coronary CT W IV Contrast and W Calcium Score – CPT Code 75574 (McHenry Hospital and Huntley Hospital)

  • Coronary artery disease/Bypass graft evaluation
  • Chest Pain with cardiac etiology suspected

Abdomen CT W and W/O IV Contrast – CPT Code 74170

  •  Adrenal/Renal/Pancreatic/Liver/Splenic Mass Characterization

Abdomen and Pelvis CT W/O IV Contrast – CPT Code 74176

  •   Renal Stone/RP Bleed
  •   Abdomen and pelvis patient that cannot not have IV contrast (may give oral contrast)

Abdomen and Pelvis CT W IV Contrast (May give oral contrast) – CPT Code 74177

  •   Abdominal Pain/Abdominal Mass/Malignancy
  •   Diverticulitis/Appendicitis/Acute Pancreatitis
  •   Trauma
  •   Nausea and Vomiting/Weight Loss/Fever

Abdomen and Pelvis CT W and W/O IV Contrast – CPT Code 74178

  •   GI Bleeding
  •   Gross Hematuria (IVP,Urogram) 

Enterography CT W IV Contrast (must drink negative oral contrast) – CPT Code 7417

  • Crohn’s
  • Irritable bowel syndrome

Angiography Abdomen CT W and W/O IV Contrast – CPT Code 74174

  •   Post Endograft
  •   Hypertension, evaluate for renal artery stenosis
  •   Aneurysm follow up (Size Only)

Chest Abdomen Pelvis W Contrast IV Contrast – CPT Code 71260, 74177

  •  Malignancy Staging/Malignancy Follow-up (may give oral contrast)

Chest Abdomen Pelvis W/O IV Contrast – CPT Code 71250, 774176

  •  Patient that cannot have IV Contrast (may give oral contrast)

Angiography Abdominal Aorta CT
With Lower Extremity Run-off W and W/O IV Contrast (oral contrast will not be used) – CPT Code 75635

  •   Claudication/peripheral arterial disease
  •   Prior bypass graft of lower extremity arteries

NEURO

Head CT W/O IV Contrast – CPT Code 70450

  • Headache/Trauma/Stroke/Tia
  • Dizziness/Intracranial Bleed

Head CT W and W/O IV Contrast – CPT Code 70470

  •  Mass/Metastatic Disease

Neck CT W IV Contrast – CPT Code 70491

  •  Neck Mass/Malignancy Staging/Malignancy follow up

Sinus CT W/O IV Contrast – CPT Code 70486

  •  Acute or chronic Sinusitis/Nasal cavity polyps

Orbits CT W/O IV Contrast – CPT Code 70480

  • Trauma/black eye/visual defects

Facial Bones W/O IV Contrast – CPT Code 70487

  •  Trauma/black eye/facial contusion/jaw injury

Facial Bones W IV Contrast – CPT Code 70487 Facial

  • weakness/Neoplasm/Malignancy/Cellulitis/AbscessTemporal Bones

CT W/O IV Contrast – CPT Code 70480

  •   Ear Disorder/Deafness/Acute Mastoiditis
  •   Trauma/ear injury

Head CTA W IV Contrast – CPT Code 70496

  •   Intracranial Aneurysm/Stenosis/Dissection
  •   Subarachnoid hemorrhage (SAH)/Arteriovenous malformation (AVM)

Head and Neck CTA W IV Contrast – CPT Code 70496, 70498

  •   Intracranial/vertebral/carotid artery Aneurysm/Stenosis/Dissection
  •   Subarachnoid hemorrhage (SAH)/Arteriovenous malfunction (AVM)
  •   Penetrating neck injury
  •   Cervical Spine fracture

Spine CT W/O IV Contrast – CPT Code 72175 (C-Spine) or 72128 (T-Spine) or 72131

  • (L-Spine) Radiculopathy/Trauma/Pain

MUSCULOSKELETAL

Wrist CT W/O IV Contrast – CPT Code 73200

  •   Acute Fracture
  •   Fracture Healing (most commonly scaphoid)
  •   Intercarpal joint instability
  •   Arthrodesis evaluation
  •   Gout (McHenry Hospital only)

Elbow CT W/O IV Contrast – CPT Code 73200

  •   Fracture
  •   Fracture Healing
  •   Arthritis
  •   Gout (McHenry Hospital Only)

Shoulder CT W/O IV Contrast – CPT Code 73200

  •  Fracture
  • Healing Fracture

Foot/Calcaneus CT W/O IV Contrast – CPT Code 73700

  •   Fracture
  •   Evaluation arthrodesis
  •   Arthritis

Ankle CT W/O IV Contrast – CPT Code 73700

  • Fracture
  • Arthritis

Knee CT W/O IV Contrast – CPT Code 73700

  •   Fracture
  •   Pain
  •   Gout (McHenry Only)

Hip CT W/O IV Contrast – CPT Code 73700

  •   Hip Pain
  •   Hip Fracture

Pelvis CT W/O IV Contrast – CPT Code 72192

  •  Pelvic Fractures
    If 3D Rendering is needed with any musculoskeletal CT please also order – CPT Code 76377

PREMEDICATION FOR CONTRAST ALLERGY

  •   Patients with history of a reaction of hives or rash must be pre-medicated for an IV Contrast CT scan (not oral contrast)
  •   Patients with history of nausea or vomiting or dizziness with IV contrast, or shellfish allergy do not require premedication.
  •   Patients with history of anaphylaxis or laryngeal spasm must be discussed with the Radiologist prior to scheduling an exam
  •   Patients Kidney function EGFR must be >30 to have IV contrast or must be discussed with a Radiologist before exam is scheduled.PREMEDICATION PROTOCOL
    1. Prednisone 50MG Oral……………………………….. 13 Hours Prior to Exam Time
    2. Prednisone 50MG Oral……………………………….. 7 Hours Prior to Exam Time
    3. Prednisone 50MG Oral…………………………………..1 Hour Prior to Exam Time
    4. Benadryl 50mg Oral…………………………………….. .1 Hour Prior to Exam Time
  •  To be prescribed by the ordering physician prior to patients exam.

For questions regarding how to order any of the CT scans please call the CT Coordinator at (815) 759-4392 or (815) 344-5000 EXT 111- 6635.

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