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RADIOLOGY ORDERING & PHYSICIAN SERVICES TOOLKIT

PREPARED IN 2014

Goals of this Toolkit

1. TO HELP REFERRING PHYSICIANS ORDER THE RIGHT TEST AT THE RIGHT TIME

2. TO MINIMIZE TIME CONSUMING RE-ORDERS AND RE-PRECERTING

3. TO IMPROVE PATIENT CARE

4. TO PROVIDE VALUABLE RESOURCES TO PATIENTS

5. TO PREPARE FOR ICD10 CHANGES & DOCUMENTATION CHALLENGES

6. TO PROVIDE ELECTRONIC FORMS AND DOCUMENTS TO REFERRING PHYSICIANS

7. TO REDUCE DENIALS TO THE HOSPITAL AND RADIOLOGISTS

CONTACT RADIOLOGY WITH ANY QUESTIONS Contact Name Responsibility Phone Number Email

Michael Langenberg University Radiology Administrator

(865) 803-2973 [email protected]

Allen Gilbert University Radiology I/T (865) 661-9060 [email protected]

Denise Ruggles University Radiology Admin Support


Shannon Buck Radiology Department Manager

(XRay, MRI, Ultrasound)


Brett Hines Radiology Department Manager

(CT, Nuclear Medicine, PET CT)


Donna Johnson Radiology Support Manager TBD TBD

TBD IR Nurse Manager (865) 305-9067 TBD

Cristina Whitehead IR / NIR Clinic Coordinator (865) 558-0225 [email protected]

Let us know how we can help you!

mailto:[email protected]






Table of Contents

1. Section 1 - Radiology Ordering Quick Tips

2. Section 2 – Common Radiology Protocols

3. Section 3 - “The Radiology Man” Diagram

4. Section 6 – Radiology Departmental Order Form

5. Section 7 - Comprehensive Imaging Ordering Guide

6. Section 8 – CT Abdomen Pelvis Ordering Guide

7. Section 9 – CT Chest Ordering Guide

8. Section 10 - MRI Brain Ordering Guide

9. Section 4 – Patient Preparation Instructions

10. Section 5 – Patient Maps

Radiology Ordering Quick Tips Physicians please provide all or as much of the following when ordering

Imaging Studies Information “MUST HAVE” DESCRIPTION

1. LOCATION Provide as much as possible the specific anatomical sites requiring imaging

(left right, upper, outer, etc), Laterality, Quadrant of Organ, Location of the

Bone, Individual Vessel Occluded, Graft vs Native

2. SEVERITY Indicate on the order whether it is Acute or Chronic, Traumatic or Non-

Traumatic, Open or Closed, With or Without Hemorrhage, With or without

perforation

3. CONTEXT / SIGNSSYMPTOMS

Provide ALL SIGNS AND SYMPTOMS patient is experiencing relevant to this

imaging exam, Relevant prior procedures and previous treatments,

underlying conditions, history of…, what is the intent of imaging study…

imaging ordered for what condition?

4. STORY Provide as much information to let radiology know what was the patient

doing? Where did event happen? What was patient’s status at the time?

*Information obtained from Coding Strategies, Inc. “Embrace ICD10” presentation on February 14, 2014

Radiology Protocols

Please Note – All CPT Codes Must be Precerted even if Ordered as a “Protocol”

COMMON IMAGING PROTOCOLS

PROTOCOL – CT Studies CPT Code to Precert

CPT Description

Renal Protocol 74178 CT Abdomen/Pelvis with and without Contrast

CT Stone Study/Urinary Tract 74176 CT Abdomen/Pelvis without Contrast

Urogram 74178 &

76376

CT Abdomen/Pelvis with and without Contrast

3D Reformatted CT Images

Liver (Hepatic) Protocol 74170 CT Abdomen with and without Contrast

CT Enterography 74177 CT Abdomen/Pelvis with Contrast

Pancreatic Protocol 74170 CT Abdomen with and without Contrast

Pulmonary Embolism (PE) Protocol 71275 CTA Chest

Parathyroid Protocol 70492 CT Neck Soft Tissue with and without Contrast

CT Dissection Study 71275 &

74175

CTA Chest and CTA Abdomen

MRI PROTOCOLS

PROTOCOL – MRI Studies CPT Description

Carotid Protocol 70549 MRA Neck with and without Contrast

Liver (Hepatic) Protocol 74183 MRI Abdomen with and without Contrast

Stroke Protocol 70553 &

70544 &

70549

MRI Brain with and Without Contrast

MRA Head without Contrast

MRA Neck with and without Contrast

CPT Code to Precert

University Radiology

Call 865-305-8080 to schedule and appointment.

CT ChestChest w/o Contrast 71250Chest w Contrast 71260Chest w/wo Contrast 71270Chest CTA/ PE Study 71275Cardiac CTA w Calcium Scoring 75574 Cardiac CTA w/o Calcium Scoring 75574 Calcium Scoring 75571

CT SpineCervical Spine w/o Contrast 72125Thoracic Spine w/o Contrast 72128Lumbar Spine w/o Contrast 72131

CT Abdomen OnlyAbdomen w/o Contrast 74150 Abdomen w Contrast 74160 Abdomen w/wo Contrast 74170

CT Pelvis OnlyPelvis w/o Contrast 72192 Pelvis w Contrast 72193 Pelvis w/wo Contrast 72194

CPT Code Guidelines for MRI and CT

CT AngiographyCoronary Calcium Score 75571Cardiac CTA without Calcium Score 75574 Cardiac CTA w Calcium Score 75574 Head w/wo Contrast 70496Neck w/wo Contrast 70498Abdomen 74175Lower Extremities w/wo Contrast 73706 CTA Runoff 75635Pelvis w/wo Contrast 72191

MRI Head and NeckTMJ 70336Brain wo Contrast 70551Brain w/wo Contrast 70553Neck Soft Tissue wo Contrast 70540Neck Soft Tissue w/wo Contrast 70543

MRI ChestChest wo Contrast 71550Chest w/wo Contrast 71552

MRI Spine Cervical wo Contrast 72141Thoracic Spine wo Contrast 72146Lumbar Spine wo Contrast 72148C Spine w/wo Contrast 72156T Spine w/wo Contrast 72157L Spine w/wo Contrast 72158

MRI Abdomen Abdomen wo Contrast 74181Abdomen w/wo Contrast 74183Abdomen w MRCP 74183

MRI PelvisPelvis wo Contrast 72195Pelvis w/wo Contrast 72197

MRI AngiographyMRA Head wo Contrast 70544MRA Head w Contrast 70545MRA Neck wo Contrast 70547MRA Neck w Contrast 70548MRA Chest w or wo Contrast 71555MRA Renal Artery w or wo Contrast 74185MRA Runoff w or wo Contrast 73725

MRI Lower Extremity Other than Joint wo Contrast 73718Other than Joint with Contrast 73719Other than Join w/wo Contrast 73720Joint wo Contrast 73721Joint with Contrast 73722Joint w/wo Contrast 73723

MRI Upper ExtremityOther than Joint wo Contrast 73218Other than Joint with Contrast 73219Other than Join w/wo Contrast 73220Joint wo Contrast 73221Joint w/wo Contrast 73223

MRI BreastBreast Unilateral with and/or without Contrast 77058Breast Bilateral with and/or without Contrast 77059

MRI Orbits, Pituitary,Cranial Nerve, IAC’s Orbits, Pituitary, Cranial Nerve IAC’s w/wo Contrast 70543

MRI ArthogramShoulder 23350, 73222Elbow 24220, 73222Wrist 25246, 73222Hip 27093, 73722Knee 27370, 73722Ankle 27648, 73722

CT Head and NeckBrain wo Contrast 70450Brain w Contrast 70460Brain w/wo Contrast 70470Sinus Complete 70486Maxillofacial wo Contrast 70486Maxillofacial w Contrast 70487Maxillofacial w/wo Contrast 70488Orbits wo Contrast 70480

CT Abdomen and Pelvis Abdomen/Pelvis w/o Contrast 74176 (Stone Study)Abdomen/Pelvis w Contrast 74177Abdomen/Pelvis w/wo Contrast 74178

CT ExtremitiesUpper Ext wo Contrast 73200Upper Ext w Contrast 73201Upper Ext w/wo Contrast 73202Lower Ext wo Contrast 73700Lower Ext w Contrast 73701Lower Ext w/wo Contrast 73702

CT Urogram CT Urogram 74178

Orbits w Contrast 70481Orbits w/wo Contrast 70482Temporal Bones wo Contrast 70480Temporal Bones w Contrast 70481Temporal Bones w/wo Contrast 70482Neck Soft Tissue wo Contrast 70490Neck Soft Tissue w Contrast 70491Neck Soft Tissue w/wo Contrast 70492

DOB:

Precert# / Authorization#:

CT ProCedures (Available at Turkey Creek, Precert required)CT Head and Neck

Head wo Contrast 70450

Head w/wo Contrast 70470

Sinus Complete 70486

Maxillofacial wo Contrast 70486

Maxillofacial with Contrast 70487

Orbits wo Contrast 70480

Orbits with Contrast 70481

Temporal Bones wo Contrast 70480

Temporal Bones with Contrast 70481

Neck Soft Tissue wo Contrast 70490

Neck Soft Tissue with Contrast 70491

Neck Soft Tissue w/wo Contrast 70492

CT Chest

CT spine

Chest wo Contrast 71250

Chest w Contrast 71260

Cervical Spine wo Contrast 72125

Thoracic Spine wo Contrast 72128

Lumbar Spine wo Contrast 72131

CT AbdomenAbdomen wo Contrast 74150

Abdomen with Contrast 74160

Abdomen w/wo Contrast 74170

CT PelvisPelvis wo Contrast 72192

Pelvis with Contrast 72193

Pelvis w/wo Contrast 72194

CT AngiographyCTA Head 70496

CTA Neck 70498

CTA Chest 71275

CTA Abdomen 74175

CTA Pelvis 72191

CTA Abdomen and Pelvis 74174

CTA Runoff 75635 (abdominal aorta and bilateral iliofemoral lower extremity runoff)

CTA Upper Extremitites 73206

CTA Lower Extremities 73706

MrI Head and Neck

TMJ 70336

Brain wo Contrast 70551

Brain w/wo Contrast 70553

Stroke Brain Only wo Contrast 70551

Stroke Protocol w/wo Contrast 70553,

70544, 70549

Multiple Sclerosis w/wo Contrast 70553

Neck Soft Tissue wo Contrast 70540

Neck Soft Tissue w/wo Contrast 70543

Orbits, Pituitary, Cranial Nerve IAC’s w/wo Contrast 70543

MrI Chest

MrI spine

Chest wo Contrast 71550 Chest w/wo Contrast 71552

Cervical wo Contrast 72141

Cervical w/wo Contrast 72156

Thoracic wo Contrast 72146

Thoracic w/wo Contrast 72157

Lumbar wo Contrast 72148

Lumbar w/wo Contrast 72158

MrI AbdomenAbdomen wo Contrast 74181

Abdomen w/wo Contrast 74183

Abdomen w MRCP (wo Contrast) 74181

MrI Pelvis Pelvis wo Contrast 72195

Pelvis w/wo Contrast 72197MrI Angiography

MRA Head wo Contrast 70544

MRA Neck wo Contrast 70547

MRA Neck w/wo Contrast 70549 MRA Chest w or wo Contrast 71555 MRA Pelvis w or wo Contrast 72198 MRA Abdomen w or wo Contrast 74185 MRA Renal Artery w or wo Contrast 74185

MRA Lower Ext w or wo Contrast 73725

MrI Lower extremity

MrI upper extremity

Left RightOther than Joint wo Contrast 73218*

Other than Joint w/wo Contrast 73220*

Joint wo Contrast 73221*

Joint w/wo Contrast 73223*

MrI ProCedures (Precert required)

Name:

Date of Service:

Ordering Physician:

Reason for Exam:

Signs and Symptoms:

Phone:

Fax:

DX Code(s):

CT extremities

Upper Ext wo Contrast 73200Upper Ext with Contrast 73201Upper Ext w/wo Contrast 73202Lower Ext wo Contrast 73700Lower Ext with Contrast 73701Lower Ext w/wo Contrast 73702

MrI BreastBreast Unilateral w and/or wo Contrast 77058

Breast Bilateral w and/or wo Contrast 77059

MrI Arthogram

Left RightShoulder 23350, 73222

Elbow 24220, 73222

Wrist 25246, 73222

Hip 27093, 73722

Knee 27370, 73722

Ankle 27648, 73722

Virtual ColonographyDiagnostic CT Colonography wo Contrast 74261

Diagnostic CT Colonography w Contrast (IV) 74262

Screening CT Colonography 74263

oTHer rAdIoLogy requesTs

MR #:

MrI CardiacMorphology and Function w/wo Contrast 75561

Velocity Flow Mapping wo Contrast 75557, 75565

Report is Stat /Call Back #: _______________

radiology procedure not listed, special protocol requests, specific area of interest, Additional patient instructions

Joint:

Left RightOther than Joint wo Contrast 73718*

Other than Joint w/wo Contrast 73720*

Joint wo Contrast 73721*

Joint w/wo Contrast 73723*

Joint:

Radiology Order Form - 932604 (Dev 2/10)

UniveRsity OF tennessee MeDical centeR1924 alcOa Hwy : knOxville, tn 37920scHeDUling: 865-305-8080Fax: 865-305-6131

RaDiOlOgy ORDeR FORM

CT Abdomen and PelvisAbdomen Pelvis wo Contrast 74176

Abdomen Pelvis with Contrast 74177

Abdomen Pelvis w/wo Contrast 74178

*Recommend w/wo Extremity for 1) Infection 2) Tumor of Soft Tissue

radiology Protocoled studiesRenal Protocol 74178

Kidney Stone Study/Urinary Tract 74176

Urogram 74178,76376

Dual Phase Liver (Hepatic) 74170

CT Enterography 74177

Pancreatic 74170

Parathyroid 70492

PE Study 71275

Dissection Study 71275, 74175

Cardiac CTCalcium Score 75571

Coronary CT Angiography 75574

CT of Heart for Structure & Morphology 75572

CT of Heart for Structure & Morphology with Known Congenital Heart Disease 75573

Left Right

CT Myelogram

Cervical Spine with Contrast 72126

Thoracic Spine with Contrast 72129

Lumbar Spine with Contrast 72132

*Also Precert 62284 and 77003 for injection

3d reformats3D Reformats 76377

CPT only © American Medical Association. ©2012 Order Form may not be reprinted or reproduced without authorization by the author.

Ordering MD Signature:___________________________

X-ray Head and Neck

X-ray Chest

X-ray spine

Chest; 2 Views 71020

Ribs; Unilateral, 2 Views 71100

Ribs; Bilateral; 3 Views 71110

Sternum; 2 Views 71120

Sternoclavicular Joints 71130

Cervical Spine 2/3 Views 72040

Cervical Spine Complete 72052

Thoracic Spine 2 Views 72070

Lumbar Spine 2/3 Views 72100

Lumbar Spine 4 Views 72110

Lumbar Complete w/ Bending 72114

X-ray AbdomenAbdomen; Single View 74000

Abdomen; Supine & Erect 74020

Acute Abdomen Series Complete 74022

X-ray upper extremity Left RightClavical 73000

Shoulder 73030

AC Joints 73050

Humerus; 2 Views 73060

Elbow; 3 Views 73080

Forearm; 2 Views 73090

Wrist; Complete 73110

Hand; 3 Views 73130

Fingers; Minimum 2 Views 73140

X-rAy ProCedures (Available at Turkey Creek)X-ray Lower extremity

Left RightHip; 2 Views 73510

Hips; Bilateral, w / AP Pelvis 73520

Hips / Pelvis; Infant 73540

Femur; 2 Views 73550

Knee; 3 Views 73562

Bilateral Standing Knees 73565

Tibia/Fibula; 2 Views 73590

Lower Ext. Infant; 2 Views 73592

Ankle; 3 Views 73610

Calcaneus; 2 Views 73650

Toes; Minimum 2 Views 73660

Foot; 3 Views 73630

other X-ray requests

Nuc Med CardiovascularCardiac Shunt Imaging 78428

Cardiac 1st Pass, Single 78481

Cardiac 1st Pass, Multiple 78483

Vascular Flow Imaging 78445

DVT Imaging; Peptide (AcuTect) 78456

Heart MPS; SPECT; Single Study 78451

Heart MPS; SPECT; Multiple Study 78452

Heart MPS; PET; Single Study 78491

Heart MPS; PET; Multiple Study 78492

MUGA; Single Study 78472

MUGA; Multiple Study 78473

Nuc Med respiratory

Nuc Med gastrointestinalNuCLeAr MedICINe ProCedures (Available at Turkey Creek, Precert required)

Nuc Med Musculoskeletal

Liver-Spleen SPECT 78205

Hepatobiliary, including GBEF 78227

GE Reflux 78262

Gastric Emptying 78264

GI Bleeding Scan 78278

Meckel’s 78290

Shunt Patency 78291

Perfusion Lung Scan 78580

Ventilation/Perfusion Lung Scan 78582

Quantitative Ventilation/Perfusion 78598

Limited Area Bone Scan 78300

Multiple Area Bone Scan 78305

Whole Body Bone Scan 78306

Three Phase Bone Scan 78315

Bone SPECT 78320

Parathyroid Exam 78070123I Thyroid Uptake Scan 78012,13,14 Thyroid CA; Neck/Chest 78015 Thyroid CA; WB 78018Thyroid CA; Uptake 78020131I Thyroid Therapy 79005131I Thyroid Therapy w Imaging 79005 & 78018131I Mets Survey 78018Sentinel Node wo Imaging 38792

Sentinel Node w Imaging 78195

Nuc Med endocrine

uLTrAsouNd ProCedures

Abdominal Complete 76700

Organ Follow-up Gall Bladder Liver Spleen Pancreas Kidney Billiary Aorta IVC

other Nuc Med requests

other ultrasound requests BoNe deNsITyDEXA Scan 77080

Neonatal ultrasoundNeonatal Head 76506

Neonatal Spine 76800

Neonatal Hip Dynamic 76885

Neonatal Hip Static 76886

Female ultrasoundPelvic Complete 76856

with Transvaginal 76830

with Transvaginal if indicated 76830

Transvaginal 76830

Breast 76645

1st Trimester, Transabdominal 76801

Male ultrasoundScrotal 76870

Prostate 76872

ultrasound

Abdominal Limited 76705

Abdominal Limited 76705B-scan/real time, Single or First Gestation 76805

OB Limited 76815

Follow-up, Transabdominal, Per Fetus 76816

OB Transvaginal 76817

ultrasound oB

DIGITAL MAMMogrAPHy

Bilateral Screening Mammogram with two view film study of each breast G0202

Unilateral Screening Mammogram with two view study of single breast G0202 -52 Right Left

screening

diagnosticDiagnostic Mammogram, Bilateral (to include mammographic imaging, ultrasound, or biopsy as deemed necessary by the radiologist. G0204

Diagnostic Mammogram, Unilateral (to include mammographic imaging, ultrasound, or biopsy as deemed necessary by the radiologist. G0206 Right Left

reason for exam/ other requests

Tumor Imaging; Limited 78800

Tumor Imaging; WB 78802

Tumor Imaging; Spect 78803

Infection Imaging; Limited 78805

Infection Imaging; WB 78806

Infection Imaging; Spect 78807

Nuc Med Tumor/ Infection/ Inflammation

Nuc Med Head & CNsBrain Limited w Flow 78601

Brain Complete w Spect 78607

Cisternogram 78630

Cerebral Shunt Evaluation 78645

CSF Leak 78650

Nuc Med genitourinaryRenal Perfusion / Function 78707Renal Perfusion / Function w Lasix 78708

Renal Perfusion / Function w ACE 78709

Renal Scan; Spect 78710

Ureteral Reflux Scan 78740

Nuc Med otherUrea Breath TST C-14; Collection 78267

Urea Breath TST C-14; Analysis 78268

ArthographyLeft RightAnkle 73615

Hip 73525

Wrist 73115

Shoulder 73040

Knee 73580

Elbow 73085

TMJ 70332Myelogram - See CT Myelogram

X-ray FlouroscopyBarium Swallow 74220

Modified Barium Swallow 74230

Single Contrast Upper GI 74241

Double Contrast Upper GI 74247

Small Bowel Series 74251

Barium Enema, Diagnostic 74280

Barium Enema, Therapeutic 74283

Defecography 74270

Cystogram 74430

Hysterosalpingogram 74740

Sinus Tract Study 76080

Pelvic Complete 76856

Pelvic Limited 76857

Retroperitoneal 76770

Retroperitoneal Limited 76775

Bladder 76857

Chest 76604

Soft Tissue Abd Mass/Hernia 76705

Thyroid, Head/Neck 76536

Extremity Non-Vascular 76880

Up Left Quad Low Left QuadUp Right Quad Low Right Quad

ultrasound Continued

Radiology Order Form - 932604 (Dev 2/10)

Name:

Date of Service:

DOB:

Precert# / Authorization#:

Ordering Physician Signature:

Ordering Physician: Phone:

Fax:

diagnosis (required):

MR #:

Mandible; Complete 70110

Facial Bones; Complete 70150

Nasal Bones; Complete 70160

Orbits; Complete 70200

Sinus; Less than 3 Views 70210

Sinus; Complete 70220

Skull; Less than 4 Views 70250

Skull; Complete 70260

Neck; Soft Tissue 70360

CPT only © American Medical Association. ©2012 Order Form may not be reprinted or reproduced without authorization by the author.

RADIOLOGY ORDER FORM

University Radiology MRI & MRA Ordering Guide

To Order an MRI study call 305-8080 If you are unsure what MRI to order call 305-8656

For more Information visit www.utrad.com

Please use this guide to determine the correct MRI or MRA exam to Order and Precert

Body Part Reason for Exam or Exam Indications Procedure to Order & Precert CPT Code(s) to Precert

MRI Brain

Alzheimers Mental Status Change Confusion Dementia

Memory Loss Stroke / CVA Suspected MS TIA

MRI Brain Without Contrast 70551

Headaches Dizziness / Vertigo Cranial Nerve Lesions HIV / AIDS

Hearing Loss IAC Mass Infection Multiple Sclerosis

Neurofibromatosis Pituitary Lesion Elevated Prolactin Seizures

Tumor/Mass/Cancer Visual Changes Vascular Lesions AVM

Bell’s Palsy Facial Weakness Acoustic Neuroma Metastases

MRI Brain With and Without Contrast 70553

MRA Brain (Arterial or Venous Circulation or Circle

of Willis)

Aneurysm or Family History of Aneurysm TIA

Stroke / CVA* (Order with MRI Brain W/Out 70551) Venous Thrombosis

MRA Brain Without Contrast 70544

MRA Brain (Venous Circulation)

AVM* (Order with MRI Brain W/WOut 70553) Sinus Thrombosis

Venous Circulatory Symptoms MRA Brain With and Without Contrast 70546

MRA Neck (Arch and Great

Vessels)

Alzheimers Mental Status Changes

Stroke/CVA TIA

Bruit

MRA Neck With and Without Contrast 70549

MRI Orbits Trauma MRI Orbits (Face/Neck) Without Contrast 70540

Grave’s Disease MRI Orbits (Face/Neck) Without and With 70543

© Association of University Radiologists, PC Page 1

http://www.utrad.com/






MRI Orbits Exopthalmos / Proptosis

Pseudotumor Tumor/Mass/Cancer/Mets

Vascular Lesions (Hemangioma)

Contrast

MRI Neck

Infection Pain

Tumor / Mass / Cancer / Mets Vocal Cord Paralysis

MRI Orbits (Face/Neck) Without and With Contrast 70543

MRI Spine - Cervical

Arm/Shoulder Pain Degenerative Disease Neck Pain Disc Herniation

Radiculopathy Numbness

MRI Cervical Spine Without Contrast 72141

Syrinx Post Op Fusion Discitis Osteomyelitis

Myelopathy Tumor/Mass/Cancer MRI Cervical Spine Without and With Contrast 72156

MRI Spine – Thoracic

Back Pain Degenerative Disease Disc Herniation Radiculopathy

Trauma Compression Fracture MRI Thoracic Spine Without Contrast 72146

Discitis Post Op Fusion Osteomyelitis Multiple Sclerosis Myelopathy Syrinx

Tumor/Mass/Cancer

MRI Thoracic Spine With and Without Contrast 72157

MRI Spine – Lumbar

Back / Leg Pain Degenerative Disease Disc Herniation Radiculopathy

Trauma Compression Fracture Sciatica Spinal Stenosis

Spondylolithesis Scoliosis

MRI Lumbar Spine Without Contrast 72148

Discitis Osteomyelitis MRI Lumbar Spine Without and With Contrast 72158








Post Op HX of Back Surgery Tumor / Mass / Cancer / Mets

MRI Abdomen (General, Liver, Renal, Adrenal,

Biliary, Pancreas)

Tumor/Mass/Cancer Abdominal Pain Post Embolization Hepatitis

Hemangioma Cirrhosis Hepatoma Renal Mass or Cyst

Transitional Cell Carcinoma of Kidney

Increased Liver Function Tests

Adrenal Mass / Lesion Hematuria Pheochromocytoma Hypertension

Jaundice Abnormal Enzymes Stones Biliary Obstruction

Pancreatitis Pancreas Mass Painless Jaundice Ampulla Evaluation

Cholangiocarcinoma PSC – Primary Sclerosing Cholangitis

MRI Abdomen With and Without Contrast 74183

MRA Abdomen Renal Artery Stenosis

Mesenteric Arterial Hypertension Ischemia

MRA Abdomen With or Without Contrast 74185

MRI Pelvis (Hip) Fracture Trauma Hip/Pelvis Pain Muscle /Tendon Tear MRI Pelvis Without Contrast 72195

MRI Pelvis (Soft Tissue, Uterus,

Ovaries)

MRI Pelvis Continued

Pain Abscess Fibroid Adenomysis

Infertility Ovarian Mass Osteomyelitis Septic Arthritis

Tumor/Mass/Cancer Pre/Post Uterine Fibroid Embolization

Endometrioma Decubitis Ulcer

MRI Pelvis With and Without Contrast 72197








MRA Pelvis (Iliac Vessels) Pelvic Venous Thrombosis MRA Pelvis With and Without Contrast 72198

MR Enterography

Crohn’s Disease Celiac Disease

Small Bowell Tumor Crohn’s Fistulous Disease

MRI Abdomen With and Without Contrast MRI Pelvis With and Without Contrast

74183 72197

MRI Extremity NON JOINT:

Forearms Humerus

Lower Leg/Calf Femur/Thigh

Fracture Stress Fracture

Muscle or Tendon Tear

MRI Non-Joint Without Contrast: Upper Extremity Lower Extremity

73218 (Upper) 73718 (Lower)

Abscess Myositis Ulcer Osteomyelitis

Tumor/Mass/Mets Morton’s Neuroma Plantar Fasciitis Soft Tissue Mass

MRI Non-Joint With and Without Contrast: Upper Extremity Lower Extremity

73220 (Upper) 73720 (Lower)

MRI Extremity JOINT:

Upper: Hand Wrist Elbow

Shoulder SC Joint

Lower: Foot Ankle Knee

Hip (Whole Pelvis)

Arthritis Meniscal Tear Avascular Necrosis Muscle Tear

Stress Fracture Ligament Tear Joint Pain Cartilage Tear

Internal Derangement Ostochondritis (OCD)

MRI Joint Without Contrast: Upper Extremity Lower Extremity

73221 (Upper) 73721 (Lower)

Abscess Osteomyelitis Ulcer Inflamed Arthritis

Cellulitis Septic Arthritis Plantar Fasciitis Tumor/Mets/Mass

Myositis Labral Tear

MRI Joint Without and With Contrast: Upper Extremity Lower Extremity

73223 (Upper) 73723 (Lower)

MRA Upper Extremity Subclavian Tenderness, Redness, Swelling MRA Upper Extremity With or Without

Contrast 73225

MRA Lower Peripheral Vascular Disease MRA Lower Extremity With or Without 73725








Extremity Contrast

MR Arthogram (Upper Extremity, Shoulder, Elbow,

Wrist)

Shoulder Instability Ligament Injury Labral Tear TFCC Tear Loose Body

MRI Upper Extremity Joint With and Without Contrast

Shoulder Injection Elbow Injection Wrist Injection

73222

23350 24220 25246

MR Arthogram (Lower Extremity, Hip, Knee, Ankle)

Labral Tear Loose Body Post Surgical Meniscus Retear

OCD Lesion (Osteochondritis Dissecans)

MRI Lower Extremity Joint With and Without Contrast

Hip Injection Knee Injection Ankle Injection

73722

27093 27370 27093

MRI Lumbosacral Plexus

Leg Pain/Sciatica Lumbar Plexopathy Radiculopathy Scaral/Coccyx Pain MRI Pelvis Without Contrast 72195

MRI Brachial Plexus Shoulder Injury Nerve Avulsion

Brachial Plexopathy

MRI Upper Extremity Non-Joint With and Without Contrast 73220

MRI Chest (Mediastinum) Tumor/Mass/Cancer/Mets MRI Chest/Mediastinum With and Without

Contrast 71552

MRA Aorta Abdominal Aortic Dissection MRA Abdomen With and Without Contrast 74185 MRA Aorta

With Peripheral Run-Off Peripheral Vascular Disease

Claudication

MRA Abdomen With and Without Contrast MRA Lower Extremity With and Without

Contrast

74185 73725

MRI Breast Newly Diagnosed Breast Cancer Family History of Breast Cancer

BRCA 1 and BRCA 2 Genes

MRI Breast Bi-Lateral With and Without Contrast 77059








Implant Integrity Issue or Rupture

Common MRI Protocols

STROKE PROTOCOL

Stroke Suspected Stroke

TIA

MRI Brain With and Without Contrast MRA Head Without Contrast

MRA Neck With and Without Contrast

Precert All: 70553 70544 70549

CAROTID PROTOCOL MRA Neck With and Without Contrast 70549

LIVER (HEPATIC) PROTOCOL MRI Abdomen With and Without Contrast 74183

MR ENTEROGRAPHY

Crohn’s Disease Celiac Disease

Small Bowell Tumor Crohn’s Fistulous Disease

MRI Abdomen With and Without Contrast MRI Pelvis With and Without Contrast

74183 72197



University Radiology CT and CTA Ordering Guide

To Order a CT or CTA study call 305-8080 If you are unsure what CT or CTA to order call 305-9639


Please use this guide to determine the correct CT or CTA exam to Order and Precert


CT Abdomen/Pelvis

Hematuria with Pain CT Stone Study / Urinary Tract Protocol CT Abdomen/Pelvis Without Contrast 74176

All Cancer Staging Abdominal Pain Crohns Ulcerative Colitis

IBD Appendicitis Diverticulitis Abscess

Hernia (ventral, umbilical, inguinal)

CT Abdomen/Pelvis With Contrast 74177

Cyst vs Mass Hemangioma Painless Hematuria Adrenal Mass

Melanoma Carcinoid Hepatoma

Pre and Post Embolization Transitional Cell Carcinoma of Kidney

CT Abdomen/Pelvis With and Without Contrast 74178

CT Abdomen Only

F/U for patients with Renal Cell Carcinoma in Renal Failure CT Abdomen Without Contrast 74150

Abdominal Pain Mass Epigastric Issues RUQ Pain

LUQ Pain Pseudocyst CT Abdomen With Contrast 74160

Pancreatitis Pancreas Mass Liver Mass Liver Protocol

Pancreatic Protocol Adrenal Protocol CT Abdomen With and Without Contrast 74170

CTA Abdomen (Renal, Aorta Pre-Op,

Post-Op Stent)

Crossing Vessels Nephrectomy Aneurysm CTA Abdomen 74175

CTA Abdomen (Run Off)

Peripheral Artery Disease (PAD) CTA Abdomen (and Run Off) 75635








CT Chest

Cough Pneumonia Tracheal Stenosis Renal Failure

F/U Nodules CT Chest Without Contrast 71250

Suspected Mediastinal / Hilar Adenopathy Staging Thoracic Primary Malignancy

Complex Pleural Effusion Thoracic Trauma Chest Wall Mass

CT Chest With Contrast 71260

CT Chest (High Resolution)

Interstitial Disease Fibrosis COPD Hemoptysis

Bronchiectasis Sarcoidosis Pleural Plaques Asbestosis

CT Chest Without and With Contrast --- HIGH RESOLUTION 71270

CTA Chest (PE Study)

Chest Pain/Dyspnea AAA/Aortic Dissection Tachypnea Hemoptysis

Shortness of Breath + D Dimer Pulmonary Hypertension

DVT

MRI Orbits (Face/Neck) Without and With Contrast 71275

CT Pelvis Only

Prostate Treatment Planning CT Pelvis Without Contrast 72192

Cancer Staging Mass in Pelvic Region Cysts in Pelvic Region Pain in Pelvic Region

Infection in Pelvic Region CT Pelvis With Contrast 72193

CT Neck

Order without contrast if elevated creatine CT Neck Without Contrast 70490

Submandibular Stone Parotid Stone Infection of Parotid Gland CT Neck Without and With Contrast 70492








Parotid Mass Mass Infection Cancer Workups CT Neck With Contrast 70491

CTA Carotid

Artheromatous Disease Bruit TIA CVA Vascular Tumor

Vascular Malformations Carotid Stenosis

CTA Carotid 75662

CT Head

Trauma Headaches CVA, Stroke Bleed, Hemorrhage Alzheimers Memory Loss Confusion Shunt Check

Hydrocephalus

CT Head Without Contrast 70450

Metastatic Staging Vertigo Dizziness Mass / Tumor

Infection Headache with other Neurological Symptoms

CT Head With Contrast 70460

Melanoma HIV

Toxoplasmosis CT Head With and Without Contrast 70470

CTA Head / Brain

TIA, CVA Vascular Malformation

Aneurysm AVM

CTA Brain 75671

CT Orbits

Trauma Fracture

Foreign Body Graves Disease

CT Orbit Without Contrast 70480








CT Orbits Pseudo Tumor Mass Exopthalmus Pain

Abscess

CT Orbit With Contrast 70481

Retinoblastoma CT Orbit Without and With Contrast 70482

CT Sinus Sinusitis

Osteomeatal Complex Functional Endoscopic Sinus Surgery

CT Sinus (Maxillofacial) Without Contrast *CT Sinus Limited will be billed with 52 Modifier

70486

CT Spine (Cervical / Thoracic)

Trauma Fracture Fusion Bony Degenerative

Changes *MR Recommended for disc herniation, mets,

infection

CT Without Contrast - Cervical Spine - Thoracic Spine

72125 72128

CT Spine (Lumbar / Sacral)

Trauma Fracture Fusion Pars Defect

*MR Recommended for disc herniation, mets,infection

CT Lumbar Spine Without Contrast 72131

CT Temporal Bone

Hearing Loss Cholesteotoma

Trauma *Sensory neuro hearing loss; order MRI With

Contrast

CT (Orbit) Inner Ears, Temporal Bones Without Contrast 70480

CT Extremities - Foot - Ankle - Calf - Knee - Thigh - Finger - Hand - Wrist - Arm

Fracture Fusion Non-Union Malunion

Femoral Anteversion Arthritis Malignment Knee

CT Without Contrast - Lower Extremity - Upper Extremity

73700 73200








CT Extremities Infection Tumor / Mass / Cancer / Mets

CT Without and With Contrast - Lower Extremity - Upper Extremity

73702 73202

CT Extremities (Leg Lengths)

Abnormality Leg Length Malrotation CT Leg Lengths 76380

CTA Extremities Peripheral Artery Disease (PAD)

Ischemia to Lower Extremity Arterial Stenosis – Lower Extremity

CT Angiography - Lower Extremity - Upper Extremity

73706 73206

CT Arthography - Hip - Knee - Ankle - Shoulder - Elbow - Wrist

Cartilage Abnormality Meniscus Abnormality Labrum Abnormality

Loose Bodies

CT With Contrast 1. Lower Extremity With Contrast OR

Upper Extremity With Contrast 2. Fluro Guided Arthogram

3. Choose One Code for body Part - Hip

- Knee - Ankle

-Shoulder -Elbow -Wrist

73701 73201 76003

27093 27370 27648 23350 24220 25246








Common CT Protocols

Renal Protocol

CT Abdomen/Pelvis Without and With Contrast

74178

CT Stone Study / Urinary Tract

Protocol

CT Abdomen/Pelvis Without Contrast

74176

Urogram

CT Abdomen/Pelvis With and Without Contrast

3D Reformatted CT Images

Precert Both Codes: 74178 76376

Liver (Hepatic)

Protocol CT Abdomen With and Without Contrast 74170

CT Enterography CT Abdomen/Pelvis With Contrast 74177 Pancreatic Protocol CT Abdomen With and Without Contrast 74170

Pulmonary Embolism

(PE) Protocol CTA Chest 71275

Parathyroid Protocol CT Neck Soft Tissue Without and With

Contrast 70492

CT Dissection Study CTA Chest CTA Abdomen

71275 74175



University Radiology Ordering Guide for

CT Abdomen and CT Pelvis

When to Order a CT Abdomen AND CT Pelvis TOGETHER CT Abdomen / Pelvis

WITHOUT IV CONTRAST CT Abdomen / Pelvis WITH IV CONTRAST

CT Abdomen / Pelvis W & WITHOUT IV CONTRAST

CPT 74176 CPT 74177 CPT 74178 Order when evaluating for: Order when evaluating for: Order when evaluating for: Hematuria / STONE STUDY Abdominal Pain (upper and lower

quadrants)

Inflammatory Bowel Disease(including Crohns, UlcerativeColitis)

Appendicitis

Abscess

Hernia (ventral, umbilical, inguinal)

CT Enterography

Cyst vs Mass (kidney)

Painless Hematuria

Transitional Cell Carcinoma ofKidney

CT Renal Mass

CT Urogram

Please Note – In 2011 the AMA COMBINED the CT Abdomen CT Pelvis CPT Codes into singular

combined CPT Codes (74176, 74177, and 74178). Although the individual studies for a single CT

Abdomen and CT Pelvis still exist, the above codes are designed to capture those cases where the

codes (pre 2011) would have been billed together.



When to Order a CT Abdomen ONLY CT Abdomen

WITHOUT IV CONTRAST CT Abdomen

WITH IV CONTRAST CT Abdomen

W & WITHOUT IV CONTRAST

CPT 74150 CPT 74160 CPT 74170 Order when evaluating for: Order when evaluating for: Order when evaluating for: Follow up for patients with Renal

Cell Carcinoma in Renal Failure(recommend MRI)

Epigastric issues / evaluation

RUQ Pain

LUQ Pain

Pseudocyst

Pancreatitis

Pancreas Mass

Liver Mass

Adrenal Protocol

CT Dual Phase Liver - HepaticProtocol

CT Pancreas (Pancreatic Protocol)

NOTE - The UHS Protocol for a CT Abdomen covers from the diaphragm dome (Xiphoid Process) to

iliac crests (Belly Button).



When to Order a CT Pelvis ONLY CT Pelvis

WITHOUT IV CONTRAST CT Pelvis

WITH IV CONTRAST CT Pelvis


CPT 72192 CPT 72193 CPT 72194 Order when evaluating for: Order when evaluating for: Order when evaluating for: Prostate Treatment Planning

(Pubic Arch Study Protocol)

Cancer Staging

Mass in pelvic region*

Cysts in pelvic region*

Pain in pelvic region*

Infection in pelvic region*

*The Pelvic Region as defined by Medicare is the “lower abdomen.” The UHS Protocol for a CT

Pelvis covers from the Iliac crest (Belly Button) through Ischial Tuberosities (Upper Thigh)


CT & CTA of the Chest

How to Order a CT Scan of the Chest CT CHEST

WITHOUT IV CONTRAST CT CHEST

WITH IV CONTRAST CT CHEST

W & WITHOUT IV CONTRAST CPT 71250 CPT 71260 CPT 71270

Order when evaluating for: Order when evaluating for: Order when evaluating for: • Lung Nodule(s)• Lung Cancer Screening• Chest Metastasis (known extra-

thoracic malignancy)• Chronic Dyspnea – Suspect Lung

Origin (negative Chest Xray)• Interstitial Lung Disease,

Bronchiectasis (HRCT Protocol)• Cough• Pneumonia• Tracheal Stenosis/Malacia

• Suspected Mediastinal / HilarAdenopathy

• Staging Thoracic PrimaryMalignancy

• Complex Pleural Effusion• Thoracic Trauma (high energy

blunt trauma)

•

*Make sure to include in the order ALL signs and symptoms patient is experiencing.**Consider CTA Chest as an additional Study as well


CT & CTA of the Chest

How to Order a CTA Scan of the Chest CTA CHEST

WITHOUT IV CONTRAST CTA CHEST

WITH IV CONTRAST CTA CHEST

W & WITHOUT IV CONTRAST CPT 71275

Order when evaluating for: Order when evaluating for: Order when evaluating for: • • Shortness of Breath, Chest Pain

• Hemoptysis• Pulmonary HTN

PE PROTOCOL *WHEN ORDERING A PE PROTOCOLA CTA CHEST W CONTRAST IS PERFORMED

• Chest Pain – Aortic Dissection**

**Also order with a CTA Abdomen – CPT Code 74175

•


MRI of the Brain

How to Order an MRI of the Brain* MRI BRAIN

WITHOUT IV CONTRAST MRI BRAIN

WITH IV CONTRAST MRI BRAIN


CPT 70551 CPT 70552 CPT 70553 Order when evaluating for: Order when evaluating for: Order when evaluating for: Acqueductal Stenosis

Altered Mental Status

Confusion

Dementia / Alzheimer’s

Memory Loss

Psychiatric Disorder

Trauma

Only done when an MRI of theBrain was performed WITHOUT IVContrast previously

Headaches

Abscess

Aneurysm**

AVM / Vascular Lesions

Dizziness

Encephalitis

IAC (Hearing Loss, Vertigo)

Indeterminate intracranial lesion

Meningitis

Metastasis/Neoplasm

Multiple Sclerosis

Non traumatic brain hemorrhage

Seizures

Stroke (suspected stroke, TIA)

Tumor

Vascular Malformation**

*Make sure to include in the order ALL signs and symptoms patient is experiencing.**Consider MRA as an additional Study as well

PATIENT PREPARATION INSTRUCTIONS

CT SCAN

You should wear comfortable, loose-fitting clothing to your exam. You may be given a gown to wear during the procedure.

Metal objects, including jewelry, eyeglasses, dentures and hairpins, may affect the CT images and should be left at home or removed prior to your exam. You should inform the technologist if you have a pacemaker.

You may be asked not to eat or drink anything for a few hours beforehand, especially if a contrast material will be used in your exam. If you have a known allergy to contrast material, or "dye," your doctor may prescribe medications to reduce the risk of an allergic reaction.

Women should always inform their physician and the CT technologist if there is any possibility that they may be pregnant.

Please contact the Radiology Department at 865-305-9060 if you have additional questions.

MRI

You may be asked to wear a gown during the exam or you may be allowed to wear your own clothing if it is loose-fitting and has no metal fasteners.

Guidelines about eating and drinking before an MRI exam vary with the specific exam and also with the facility. Unless you are told otherwise, you may follow your regular daily routine and take food and medications as usual.

Some MRI examinations may require the patient to receive an injection of contrast material into the bloodstream. The contrast material most commonly used for an MRI exam contains a metal called gadolinium.

• pins, hairpins, metal zippers and similar metallic items, which can distort MRI images• removable dental work• pens, pocket knives and eyeglasses• body piercings


PATIENT PREPARATION INSTRUCTIONS

NUC MED

You may be asked to wear a gown during the exam or you may be allowed to wear your own clothing.

Women should always inform their physician or technologist if there is any possibility that they are pregnant or if they are breastfeeding.

Jewelry and other metallic accessories should be left at home if possible, or removed prior to the exam because they may interfere with the procedure.

In some instances, certain medications or procedures may interfere with the examination ordered.


US

You should wear comfortable, loose-fitting clothing for your ultrasound exam. You may need to remove all clothing and jewelry in the area to be examined.

You may be asked to wear a gown during the procedure.

Preparations depend on the type of ultrasound you are having.

• For a study of the liver, gallbladder, spleen, and pancreas, you may be asked to eat a fat-free meal on the evening before the test and then to avoid eating for eight to 12 hoursbefore the test.

• For ultrasound of the kidneys, you may be asked to drink four to six glasses of liquidabout an hour before the test to fill your bladder. You may be asked to avoid eating foreight to 12 hours before the test to avoid gas buildup in the intestines.

• For ultrasound of the aorta, you may need to avoid eating for eight to 12 hours before thetest.


From West Knoxville Travel on I -40 East

Take Exit 386B and merge onto US-129/Alcoa Hwy toward Airport/Smokey Mts 1.9 miles

Take the Cherokee Trail/UT Medical Center Exit 0.4 miles

Please contact the Radiology Department at (865) 305-9060 for additional assistance.

UT Medical Center 1924 Alcoa Hwy, Knoxville, Tennessee 37920, (865) 305-9000

FOR SERVICES IN THE MAIN RADIOLOGY DEPARTMENT

Entrance to the Medical Center from Alcoa Highway

From West Knoxville

Travel on I -40 East

Take Exit 386B and merge onto US-129/Alcoa Hwy toward Airport/Smokey Mts

1.9 miles Take the Cherokee Trail/UT Medical Center Exit

0.4 miles




FOR MRI SCANS

From West Knoxville

Travel on I -40 East




FOR SERVICES IN THE BREAST CENTER

Please contact the University Breast Center at (865) 305-9069 for additional assistance.


From North I-75

2.9 miles

1.0 miles

2.3 miles

Travel on I-75 South

Continue on I-275 S

Keep left at the fork, follow sign for I-40W/I-75S Nashville/Chattanooga

and merge onto I-40West

Take exit 386B to merge onto US-129/Alcoa Hwy

Take the exit toward Cherokee Trail/UT Medical Center 0.4 miles





From North I-75


Continue on I-275 S 2.9 miles


and merge onto I-40West1.0 miles

Take exit 386B to merge onto US-129/Alcoa Hwy 2.3 miles




FOR MRI SCANS


From North I-75


Continue on I-275 S 2.9 miles


and merge onto I-40West1.0 miles

Take exit 386B to merge onto US-129/Alcoa Hwy 2.3 miles






From East Knoxville

Travel on I -40 West







From East Knoxville







FOR MRI SCANS

From East Knoxville








From South or West Travel on I-75N and merge onto I-40E/I-75N 4.5 miles

Take exit 373 Campbell Station Rd

Turn Right onto Campbell Station Rd 0.2 miles

Turn Left onto Parkside Dr.

Parkside Medical Plaza turn Right 0.7 miles

UT Outpatient Diagnostic Center 11440Parkside Dr. Suite 204 Knoxville, TN 37934

FOR SERVICES AT UT OUTPATIENT DIAGNOSTIC CENTER at TURKEY CREEK

Please contact UT Outpatient Diagnostic Center Turkey Creek at 865-777-6700 for additional assistance.

The Office is located on the 2nd floor of Parkside Medical Plaza

From North or East Travel on I-40W/I-75S 13.6 miles

Take exit 373 Campbell Station Rd

Turn Left onto Campbell Station Rd 0.2 miles

Turn Left onto Parkside Dr.

Parkside Medical Plaza turn Right 0.7 miles

The Office is located on the 2nd floor of Parkside Medical Plaza

Please contact UT Outpatient Diagnostic Center Turkey Creek at 865-777-6700 for additional assistance.

UT Outpatient Diagnostic Center 11440 Parkside Dr. Suite 204 Knoxville, TN 37934

FOR SERVICES AT UT OUTPATIENT DIAGNOSTIC CENTER at TURKEY CREEK

Interventional & NEUROINTERVENTIONAL Radiology Clinic

CONTACT NUMBER

865-558-0225For Patient Consult and Follow-Up

Interventional & NEUROINTERVENTIONALRadiology Clinic

VASCULAR INTERVENTIONAL RADIOLOGISTS - LAURA K. FINDEISS, MD - JAMES H. McELMURRAY, MD - JOHN J. SNIDOW, MD

NEUROINTERVENTIONAL RADIOLOGISTS - ANDREW S. FERRELL, MD - PETER KVAMME, MD

NURSE PRACTITIONER - DAVID BIDDLE, FNP

Interventional & NEUROINTERVENTIONALCLINIC Scheduling Phone Number

For Consult and Follow-Up Scheduling with IR Procedures, Please Call 865-558-0225

Monday through Friday, 8:00 AM to 4:30 PM

Oncologic Interventional ProceduresRF Ablation of Lung, Liver, and Renal neoplasms

Yttrium 90 Radioembolization of Hepatic NeoplasmsStandard Transarterial Chemoembolization of Hepatic Neoplasms

Preoperative Renal Tumor EmbolizationCryoablation for Renal Cell Carcinoma

Chest PortsImage Guided Biopsies

Women’s Care ProceduresUterine Fibroid Embolization

Pelvic Venous Congestion Syndrome Embolization

Neurointerventional Procedures Coiling of Intracranial Aneurysms

Intracranial and Facial AVM Embolization Preoperative Tumor Embolization

Clinic consultations are available for all major interventional radiology procedures

Gastroenterology Procedures TIPS

Gastrostomy / Jejunostomy Paracentesis

Vascular Interventional Procedures Angioplasty & StentingCritical Limb Ischemia

Varicose Veins / Venous InsufficiencyThrombosis Management / IVC Filters

Other Interventional Procedures Pulmonary Angiography and ThrombectomyPercutaneous Nephrostomy and Uretal Stents

Tunneled Pleural and Peritoneal Drain Placement Thrombolysis and Stent Placement

PATIENT IMAGING NOTICE PATIENT NOTIFICATION

MRI or CT PATIENT STEERAGE Your insurance company may use a program, often called an Imaging Services Steerage Program (ISSP) or Patient Choice Program, to attempt to direct you to another imaging provider to receive your MRI, CT or other imaging exam. This program is designed primarily to reduce cost to the insurance company, and secondarily to you as the patient. The overall cost to you, once all factors are considered, may not even be less. The value of the radiology services you receive at The University of Tennessee Medical Center includes, among other things:

• Quality and Training Expertise of the Radiologist who will interpret (read) the Imaging Study; at UTMC, exams are interpreted by Sub-Specialized Radiologists trained in specific specialty areas.

• Quality of the imaging equipment and related software programs and enhancements available on the equipment. Please know that not all CT or MRI scanners are equivalent. Newer more advanced imaging equipment leads to better images and more accurate diagnosis for patients.

• Quality and Training of the Technologist assisting with the study • Coordination of care between your Radiology Provider and the existing

physicians you see including coordination of your entire medical record

• Convenience of location and scheduling and the integration of care across the medical center and other providers

As a patient, you have the reasonable expectation of receiving the right imaging examination, properly and safely performed, appropriately interpreted, and the results communicated to you and /or your physician in a timely fashion. You have the right to have these imaging services provided in such a way that fosters collaborative care with your other physicians, which will serve to enhance the care provided to you. Your treating physician relationship should be fully maintained. Given the above benefits of having your study performed at UT Medical Center, you should also consider each of the following if your insurance company attempts to change your imaging services provider to a lower cost alternative.

• Insurance Companies should not be in the business of referring or directing patient care. This is the choice of the patient in consultation with their treating physicians.

• The quality of your imaging exam shall be considered, including the age, safety, and functional capabilities of imaging equipment used, the protocols and supervision of the imaging study, and the subspecialty training or expertise of the radiologists interpreting the examination

• The process of being steered to another imaging provider shall not cause a meaningful delay in diagnosis (which can and often does occur due to

logistical challenges of exchanging prior imaging studies with other providers among other things).

• Continuity of care shall be maintained and the imaging provider should be an integrated care partner with the treating physician

• The imaging provider should have access to all pertinent historical medical information on you, the patient, including all prior medical imaging studies

• Transparency/disclosure – Your insurance company should make your treating physician aware of the change in imaging provider if there is one. Failure to do so could compromise care.

Ultimately the decision of where you have your imaging exam is yours. If you have questions about your imaging exam or the ISSP, please do not hesitate to call _____.

Dear Physician, As many of you are aware, Insurance Companies in our market are aggressively attempting to “Steer” patient care to the lowest cost Radiology providers in town. These programs, often called “informed choice” or “patient choice” by some benefits management companies, may not be fully disclosing all the pertinent information accurately to your patients. Furthermore, this practice drives a wedge between providers in our community who are incentivized to offer services at a low and sometimes well below market rate just to be the recipient of these “steered” services. Patients are the ones put in the middle of this situation and they have difficulty making informed decisions when it occurs. The Department of Radiology and University Radiology are privileged to provide services to your patients. We aim to do so with highest quality and service standards in the market. We don’t want to see Third Party Payers make the decisions on where your patients receive their imaging services. This letter seeks to provide some information that should be shared with your patients to help them make informed decisions when this occurs. Your Patients Should Know:

1. Making a decision solely on cost can be detrimental to patient care and in many cases, the overall cost to the patient is not less for the patient, but only the insurance provider.

2. Quality of care should not be overlooked and includes things such as:

a. Integration of the imaging provider with the physician who ordered the service

b. The age and performance level of the imaging equipment c. Subspecialized expertise of the radiologists d. Practical access to prior patient information (including

prior imaging studies and the longitudinal imaging record) 3. Many payers redirect imaging examinations after the patient

leaves the referring physician’s office and an order has already been placed with UTMCK, without the knowledge or input of that responsible physician. This could create confusion in the continuity of care of the patient

We ask for your help in educating your patients on the value of receiving high quality imaging at The University of Tennessee Medical Center. Attached is a document that you can share with your patients if you

would like. If we can help answer any questions about the “steerage” of patients, please call 584-7376 and ask for Michael Langenberg. Sincerely, Michael W. Langenberg, CPA Executive Director of University Radiology 5401 Kingston Pike, Suite 540 Knoxville, TN 37919

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