STAMFORD HOSPITAL DEPARTMENT OF RADIOLOGY MRA ORDERING GUIDE - CHEST / ABDOMEN / PELVIS / EXTREMITIES
TO SCHEDULE AN APPOINTMENT: Call 203-276-2602 and/or Fax Requisition to 203-276-4590
BODY PART REASON FOR EXAM AAA (Abdominal Aortic Aneurysm) Abdominal Aorta Dissection Mesenteric Ischemia Renal Artery Stenosis Pre Liver Transplant Pre Kidney Transplant Renal Mass-Evaluation / Pre-Op Thoracic Aorta (other than dissection) Vascular Anomalies Subclavian Vessels Aortic Dissection PROCEDURE TO PRE-CERT Authorize 2 Exams: MRA Abdomen Without and With Contrast AND MRI Abdomen Without and With Contrast Authorize 2 Exams: MRA Abdomen Without and With Contrast AND MRI Abdomen Without and With Contrast Authorize 2 Exams: MRA Chest Without and With Contrast AND MRI Chest Without and With Contrast Authorize 4 Exams: MRA Chest Without and With Contrast AND MRI Chest Without and With Contrast AND MRA Abdomen Without and With Contrast AND MRI Abdomen Without and With Contrast Authorize 2 Exams: MRA Pelvis Without and With Contrast AND MRI Pelvis Without and With Contrast Authorize 2 Exams: MRA Pelvis Without and With Contrast AND MRI Pelvis Without and With Contrast Authorize 2 Exams: MRA Abdomen Without and With Contrast AND MRA Lower Extremity Without and With Contrast LEFT/RIGHT Please specify LEFT or RIGHT CPT CODE 74185 74183
MRA - Abdomen
74185 74183 71555
MRA - Chest
71555 74185 74183 72198 72197
AVM (Arteriovenous Malformation) MRA - Pelvis May Thurner Pelvic Congestion Claudication Cold Foot Pain
72198 72197 74185 73725
MRA - Peripheral RunOff
STAMFORD HOSPITAL DEPARTMENT OF RADIOLOGY MRI - MRA ORDERING GUIDE - NEUROLOGY (HEAD / NECK / SPINE)
TO SCHEDULE AN APPOINTMENT: Call 203-276-2602 and/or Fax Requisition to 203-276-4590
BODY PART REASON FOR EXAM Alzheimer's, Dementia, Memory Loss Mental Status Changes, Confusion Headache Without Focal Symptoms Seizures (Children) Stroke, CVA, TIA Trauma Cranial Nerve Lesions Dizziness, Vertigo Headache With Focal Symptoms HIV IAC/Hearing Loss Infection Multiple Sclerosis Neurofibromatosis (Other Phakomatoses) Pituitary Lesion, Elevated Prolactin Seizures (Adult New Onset) Tumor / Mass / Cancer / Mets Vascular Lesions Vision Changes Stroke, CVA, TIA Aneurysm, Dissection Stroke, CVA, TIA, Dissection Brachial Plexopathy Nerve Avulsion Tumor / Mass / Cancer / Mets Stroke, CVA, TIA, Dissection Grave's Disease Trauma Exophthalmos, Proptosis Pseudotumor Tumor / Mass / Cancer / Mets Vascular Lesions Infection Pain Tumor / Mass / Cancer / Mets Vocal Cord Paralysis PROCEDURE TO PRE-CERT MRI Brain Without Contrast CPT CODE 70551
MRI - Brain
MRI Brain Without and With Contrast
70553
MRA - Brain MRA - Neck MRI - Brachial Plexus MRA - Arch & Great Vessels
MRA Brain Without Contrast MRA Neck Without Contrast MRI Chest / Mediastinum Without and With Contrast MRA Without and With Contrast MRI Orbits / Face / Neck Without Contrast
70544 70547 71552 70549 70540
MRI - Orbits
MRI Orbits / Face / Neck Without and With Contrast
70543
STAMFORD HOSPITAL DEPARTMENT OF RADIOLOGY MRI - MRA ORDERING GUIDE - NEUROLOGY (HEAD / NECK / SPINE)
TO SCHEDULE AN APPOINTMENT: Call 203-276-2602 and/or Fax Requisition to 203-276-4590
BODY PART REASON FOR EXAM Arm / Shoulder Pain and/or Weaknees Degenerative Disease Neck Pain Disc Herniation Post-op Fusion Radiculopathy Syrinx Discitis Osteomyelitis Multiple Sclerosis Myelopathy Tumor / Mass / Cancer / Mets Vascular Lesions, AVM Back Pain Compression Fracture (No History of Malig/Mets) Degenerative Disease Disc Herniation Radiculopathy Trauma Vertebroplasty Planning (with NO Hx Malig) MRI - Spine - Thoracic Compression Fracture (With History of Malig/Mets) Discitis Osteomyelitis Multiple Sclerosis Myelopathy Syrinx Tumor / Mass / Cancer / Mets Vascular Lesions AVM Vertebroplasty Planning (with Hx Malig) PROCEDURE TO PRE-CERT MRI Brain Without Contrast MRI Cervical Without Contrast CPT CODE 70551 72141
MRI - Spine - Cervical
MRI - Brain
MRI Cervical Without and With Contrast
72156
MRI Thoracic Spine Without Contrast
72146
MRI Thoracic Spine Without and With Contrast
72157
STAMFORD HOSPITAL DEPARTMENT OF RADIOLOGY MRI - MRA ORDERING GUIDE - NEUROLOGY (HEAD / NECK / SPINE)
TO SCHEDULE AN APPOINTMENT: Call 203-276-2602 and/or Fax Requisition to 203-276-4590
BODY PART REASON FOR EXAM Back Pain Compression Fracture (No History of Malig/Mets) Degenerative Disease Disc Herniation Radiculopathy Sciatica Spondylolysis / Spondylolisthesis Stenosis Trauma Vertebroplasty Planning (No Hx Malig) Compression Fracture (With History of Malig/Mets) Discitis Osteomyelitis Post-op Tumor / Mass / Cancer / Mets Vertebroplasty Planning (with Hx Malig) PROCEDURE TO PRE-CERT MRI Brain Without Contrast CPT CODE 70551
MRI Lumbar Spine Without Contrast
72148
MRI - Spine - Lumbar MRI - Brain
MRI Lumbar Spine Without and With Contrast
72158