CT ORDERING GUIDE

Body Part Reason for exam Oral IV contrast Procedure to pre-cert CPT code
prep
Chest/Thorax General Chest Chest Pain
Shortness of Breath None Yes CTA CHEST W IV 71275
Pulmonary Emboli
Pneumonia None Yes CT THORAX/CHEST W IV 71260
Cough
Lung Nodule None None CT THORAX/CHEST W/O 71250
CONTRAST
Cancer restaging Cancer Restaging
(any cancer) None Yes CT THORAX/CHEST W IV 71260
Chest mass
Esophageal Cancer Oral
Hi Resolution Interstitial Disease CT THORAX/CHEST W/O
Fibrosis None None CONTRAST - Please specify Hi 71250
Bronchiectasis resolution protocol only
COPD/Emphysema
Hemoptysis CT THORAX/CHEST W IV - Please
Sarcoidosis None Yes specify additional series with Hi 71260
resolution reconstructions
Abdomen/ General Abdominal Pain
Pelvis Mass Yes Yes CT ABDOMEN & PELVIS W 74160
All Cancer Staging CONTRAST and
(Except melanoma 72193
or carcinoid)

Cancer Staging Yes Yes CT ABDOMEN AND PELVIS W & 74170

Melanoma and WO CONTRAST and
Carcinoid 72193

Gastrointestinal Crohns Disease

Ulcerative Colitis
IBD
Appendicitis Yes Yes CT ABDOMEN & PELVIS W 74160
Diverticulitis CONTRAST and
Abscess 72193
Hernia (ventral,
umbilical, inguinal)
Obstruction
Colon Protocol Yes Yes CT ABDOMEN & PELVIS W 74160
(Colon Cancer, poly, Rectal CONTRAST (Please order with and
post surgical) contrast Rectal Contrast) 72193
Liver Post Embolization
Hemangioma Yes Yes CT ABDOMEN W & W/O 74170
Hepatoma CONTRAST
Hepatitis
Cirrhosis
Renal Stone Study None None CT ABDOMEN PELVIS W/O 74150 and
CONTRAST 72192
Hematuria painless
Transitional Cell Yes Yes CT ABDOMEN AND PELVIS W & 74170
Carcinoma of Kidney WO CONTRAST and
Renal Mass (Cyst vs. 72193
Solid)
Adrenal Adrenal Mass Water Yes CT ABDOMEN W & W/O 74170
CONTRAST
Pancreas Pancreatic Mass Water Yes CT ABDOMEN W & W/O 74170
Pancreatitis CONTRAST
Bladder Tumor staging and Water Yes CT ABDOMEN & PELVIS W 74160 and
follow up CONTRAST 72193
 Body Part Reason for exam Oral IV contrast Procedure to pre-cert CPT code
prep
CT Abdominal Aorta Aneurysm (diagnosis
Angiography and surgical planning) Water or Yes CTA ABDOMEN W IV 74175
Mesenteric ischemia None
Renal artery stenosis
Aorta Dissection CT CHEST, ABDOMEN AND 71250,
Intramural None Yes PELVIS WITHOUT + 74150,
hematoma CTA CHEST W IV AND CTA 72192
Complicated ABDOMEN W IV (Please order 71275 and
aneurysm both exams) 74175
Chest pain
Pulmonary Pulmonary embolism
arteries Pulmonary None Yes CTA CHEST W IV 71275
hypertension
Hemoptysis
Lower Peripheral Artery None Yes CTA PELVIS W/RUNOFFS 75635
extremities Disease
Musculoskeletal Upper and Pain None None
Lower Arthritis CT EXTREMITY UPPER W/O 73200 or
Extremities Fracture BONE ROUT OR EXT LOWER W/O 73700
Fusion CONTRAST
Malunion
Upper and Infection None Yes CT EXT UPPER W/IV OR EXT 73201 or
Lower Tumor/mass/cancer LOWER W/CONTRAST 73701
Extremities
Spine Pain None None SPINE CERVICAL W/O CONTRAST 72125 or
Fracture THORACIC SPINE W/O 72128 or
Trauma CONTRAST 72131
Fusion LUMBAR SPINE W/O CONTRAST
Infection None Yes CERVICAL SPINE W/CONTRAST 72126 or
Mass THORACIC SPINE W/CONTRAST 72129 or
(If MRI LUMBAR SPINE W/CONTRAST 72132
contraindicated)
Pelvis/Hips/ Pain None None
Acetabulum Fracture CT PELVIS W/O CONTRAST 72192
Arthritis
Tumor None Yes CT PELVIS W/IV CONTRAST 72193
Infection