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We provide on-site and remote medical imaging services (Teleradiology Services) in Los Angeles; if we can be of any assistance, please don't hesitate to contact us.

Resources:

• American Imaging Management Guidelines - by Exam
• MR-Tip.com:  Search for an exam, check out the "Common Indications"
  
  
  
  General Indications - All Body Parts
  
  
• CT Findings need further characterization
• Meniscal Injury
• Pain, Refractory to conservative medical treatment for 2 months
• Pain, Refractory to physical therapy for 2 months
• Ligamentous Injury (ACL, Joints, etc)
• Focal Neurologic Deficit
• Fracture, Occult, Not visualizable on x-ray
• Spinal Cord Compression
• Treatment Planning and improved localization (Surgery, Radiation, etc..)
• DISC DISEASE FOR SURGICAL EVALUATION
• FURTHER CHARACTERIZATION OF CT FINDING
• MRI Findings need further characterization
• Numbness, Focal
• Pain radiating to upper extremity
• Pain radiating to lower extremity
• PAIN REFRACTORY TO 6 WEEKS CONSERVATIVE MEDICAL THERAPY
• PAIN REFRACTORY TO 6 WEEKS PHYSICAL THERAPY
• PET Findings need further characterization
• SOFT TISSUES NEED FURTHER CHARACTERIZATION AFTER CT
• SOFT TISSUE PATHOLOGY POORLY EVALUATED BY CT
• SPINAL CORD COMPRESSION
• TENDON TEAR
• Tingling
• US Findings need further characterization
• XR Findings need further characterization
• Weakness, Focal

Questionable Indications:

• Activities of Daily Living Disrupted
• Disruption of activities of daily living.
• Disc Bulge
• Limited Range of Motion
• Motor Vehicle Accident
• Pain
• Trauma

Unacceptable Indications:

• Bowel pathology (intestines)

MR Brain

• Cerebrovascular Accident, Stroke
• Brain Tumor, Initial Diagnosis
• Brain Tumor, Follow up change
• Congenital Disorder
• Brain Tumor, Improved Localization

MR Knee:

• ACL Tear
• Meniscal Tear
• Pain Refractor to Physical Therapy for 2 months
• Pain Refractory to Conservative Medical Therapy for 2 Months; X-ray inconclusive

CPT Codes / HCPCS Codes / ICD-9 Codes

Magnetic resonance of knee:

CPT codes covered if selection criteria are met:

• 73721 - 73723

Other CPT codes related to the CPB:

• 27427 - 27429
• 29870 - 29889

ICD-9 codes covered if selection criteria are met:

171.3 Malignant neoplasm of connective tissue of lower limb, including hip

195.5 Malignant neoplasm of lower limb

215.3 Other benign neoplasm of lower limb, including hip

238.0 Neoplasm of uncertain behavior of bone and articular cartilage

717.0 Old bucket handle tear of medial meniscus

717.1 Derangement of anterior horn of medial meniscus

717.2 Derangement of posterior horn of medial meniscus

717.3 Other and unspecified derangement of medial meniscus

717.40 - 717.49 Derangement of lateral meniscus

717.5 Derangement of meniscus, not elsewhere classified

717.6 Loose body in knee

718.86 Other joint derangement, not elsewhere classified

719.06 Effusion of joint, lower leg

719.46 Pain in joint, lower leg

730.16 Chronic osteomyelitis of lower leg

732.7 Osteochondritis dissecans

733.49 Other aseptic necrosis of bone

836.0 - 836.2 Tear of cartilage or meniscus of knee

ICD-9 codes not covered for indications listed in the CPB:

714.0 - 714.9 Rheumatoid arthritis and other inflammatory polyarthropathies

715.16 Osteoarthrosis, localized, primary, lower leg

715.26 Osteoarthrosis, localized, secondary, lower leg

715.36 Osteoarthrosis, localized, not specified whether primary or secondary

715.96 Osteoarthrosis, unspecified whether generalized or localized

717.7 Chondromalacia of patella

717.81 - 717.89 Other internal derangement of knee

Other ICD-9 codes related to the CPB:

717.9 Unspecified internal derangement of knee

MRI of extremities:

CPT codes not covered for indications listed in the CPB:

73218 - 73223

73718 - 73723


ICD-9 codes not covered for indications listed in the CPB:

714.0 - 714.9 Rheumatoid arthritis and other inflammatory polyarthropathies


Reference

http://www.aetna.com/cpb/medical/data/100_199/0171.html



MR Pelvis ICD-9 Codes:

• Uterine Mass
• Ovarian Mass
• Pelvic Lymphadenopathy
• Pelvic Bony lesion
• NOT INDICATED:  bowel

MR SHOULDER:

• Labral tear
• Rotator Cuff Tear
  • Shoulder Impingement
  • Labral Tear

Spine - All parts

• Neurological deficit, evidence of radiculopathy, cauda equina compression
• Primary tumors or drop metastases
• Infection/inflammatory disease, multiple sclerosis
• Postoperative evaluation of lumbar spine: disk vs. scar
• Evaluation of syrinx
• Localized back pain with no radiculopathy (leg pain)

Resource:  http://www.mr-tip.com/serv1.php?type=db1&dbs=Lumbar%20Spine%20MRI

Results are read by an on-site radiologist or a teleradiologist.

Spine, Cervical

723.40 Cervical spine radiculopathy

• Lower Extremity Weakness, Numbness, Tingling
• Spinal Cord Mass
• Lumbar Disc Bulge
• Severe Foraminal Stenosis

Spine, Thoracic

• Thoracic spine sprain/strain 847.1
• Dermatomal Symptoms of Extremity pain, tingling
• Spinal Cord Compression

Spine, Lumbar

• Spinal Cord Compression
• Neurologic deficits, evidence of radiculopathy, acute spinal cord compression (e.g., sudden bowel/bladder disturbance)
• Suspected systemic disorders (primary tumors, drop metastases, osteomyelitis)
• Postoperative evaluation of lumbar spine: disk vs. scar
• Localized back pain with no radiculopathy (leg pain)

Resource:http://www.mr-tip.com/serv1.php?type=db1&dbs=Lumbar%20Spine%20MRI