MRI Procedures Table
Tricom and AC MRI Procedures List
|
Facility Locations ------------> |
|
|
AC MR Oval Bore 74cm |
AC Open MR 45cm/84cm |
Tricom MR Wide Bore 70cm |
Tricom Mobile MR 60cm |
CHS |
|
Weight Limits |
CPT |
Contrast |
550lbs |
500lbs |
500lbs |
300lbs |
Prep |
|
Equipment |
|
|
Oval 1.5T |
Hitachi 0.3T |
GE 3.0T |
GE 1.5T |
|
|
Procedure |
|
|
AC-MR |
AC Open |
TC-MR |
TC-Mobile |
|
|
Abdomen (MRI) |
74181 |
w/o |
45 mins |
60 mins |
45 mins |
45 mins |
No Food 6 Hours if have to take meds can have a sip of water |
|
|
74183 |
w/&w/o |
75 mins |
75 mins |
45 mins |
45 mins |
No Food 6 Hours if have to take meds can have a sip of water |
|
Abdomen (MRA Renal) |
74185 |
w/&w/o |
45 mins |
NO |
45 mins |
NO |
No Food 6 Hours if have to take meds can have a sip of water |
|
MRCP |
S8037 |
w/o |
30 mins |
NO |
30 mins |
NO |
NPO 6 Hours + No gum, mints, cigarettes, chewing tobacco |
|
Abdomen + MRCP |
BC-1272 |
w/o |
45 mins |
NO |
45 mins |
NO |
NPO 6 Hours + No gum, mints, cigarettes, chewing tobacco |
|
|
BC-1273 |
w/&w/o |
75 mins |
NO |
60 mins |
60 mins |
NPO 6 Hours + No gum, mints, cigarettes, chewing tobacco |
|
Enterography (Ab / Pelvis) |
BC-927 |
w/&w/o |
NO |
NO |
NO |
NO |
NO |
|
Pelvis (MRI) |
72195 |
w/o |
45 mins |
60 mins TECH APPROVAL |
45 mins |
45 mins |
No prep |
|
**Tech Must Approve Open MRI Pelvis** |
72197 |
w/&w/o |
75 mins |
75 mins TECH APPROVAL |
60 mins |
60 mins |
No Food 4 Hours |
|
Abdomen & Pelvis |
BC-342 |
w/o |
90 mins |
120 mins TECH APPROVAL |
90 mins |
90 mins |
No Food 6 Hours if have to take meds can have a sip of water |
|
Abdomen & Pelvis |
BC-344 |
w/&w/o |
150 mins |
150 mins TECH APPROVAL |
120 mins |
120 mins |
No Food 6 Hours if have to take meds can have a sip of water |
|
Lumbar Plexus |
BC-427 |
w/o |
45 mins |
NO |
45 mins |
NO |
No Prep |
|
Brain (MRI) *Always w/&w/o for Rad Discretion* |
70551 |
w/o |
30 mins |
45 mins |
30 mins |
30 mins |
No prep No Hairspray/Gel/Pins/Make-Up |
|
|
70553 |
w/&w/o |
45 mins |
60 mins |
45 mins |
45 mins |
No Food 4 Hours No Hairspray/Gel/Pins/Make-Up |
|
Brain (MRI + MRA) **Must be scheduled separately** Do Not use BC-112 |
70544 70551 |
w/o |
30 mins |
75 mins |
30 mins |
30 mins |
No Food 4 Hours No Hairspray/Gel/Pins/Make-Up |
|
**Must be scheduled separately** Do Not use BC-114 |
70544 70553 |
w/&w/o |
60 mins |
90 mins |
60 mins |
60 mins |
No Food 4 Hours No Hairspray/Gel/Pins/Make-Up |
|
Brain (MRA Head) *Always w/o* |
70544 |
w/o |
15 mins |
30 mins |
15 mins |
15 mins |
No prep No Hairspray/Gel/Pins/Make-Up |
|
Brain (MRV Head) *Always w/&w/o* |
BC-357 |
w/&w/o |
45 mins |
90 mins |
45 mins PREFER MOBILE |
45mins |
No Food 4 Hours No Hairspray/Gel/Pins/Make-Up |
|
Brain + Orbits (MRI) *Always w/&w/o for Rad Discretion* |
BC-110 |
w/&w/o |
75 mins |
120 mins |
75 mins |
75 mins |
No Food 4 Hours No Hairspray/Gel/Pins/Make-Up |
|
Brain & IACs (MRI) *Always w/&w/o for Rad Discretion* |
BC-348 |
w/&w/o |
60 mins |
75 mins |
60 mins |
60 mins |
No Food 4 Hours No Hairspray/Gel/Pins/Make-Up |
|
Mini IACs (MRI) *always w/o* |
BC-377 |
w/o |
15 mins |
30 mins |
15 mins |
15 mins |
No Prep |
|
Dedicated IACs (MRI) *Always w/&w/o* |
BC-348 |
w/&w/o |
30 mins |
45 mins |
30 mins |
30 mins |
No Food 4 Hours No Hairspray/Gel/Pins/Make-Up |
|
Brain & Pituitary (MRI) *Always w/&w/o for Rad Discretion* |
BC-349 |
w/&w/o |
60 mins |
No |
60 mins |
60 mins |
No Food 4 Hours No Hairspray/Gel/Pins/Make-Up |
|
Brain Seizure / Convulsions (MRI) |
BC-1388 |
w/&w/o |
60 mins |
No |
60 mins |
60 mins |
No Food 4 Hours No Hairspray/Gel/Pins/Make-Up |
|
Neuroquant Brain MRI *** ALWAYS W/O CONTRAST *** |
70551 + 73677-MR |
w/o |
NO |
NO |
NO |
NO |
N/A |
|
MRA Neck (carotids) *** PREFER W/&W/O CONTRAST *** |
70549 |
w/&w/o |
45 mins |
No |
45 mins |
45 mins
|
No Food 4 Hours |
|
Neck (soft tissue MRI) |
BC-229 |
w/o |
30 mins |
105 mins |
30 mins |
30 mins |
No Prep |
|
|
BC-228 |
w/&w/o |
45 mins |
120 mins |
45 mins |
45 mins |
No Food 4 Hours |
|
Cervical Spine (MRI) |
72141 |
w/o |
30 mins |
45 mins |
30 mins |
30 mins |
No Prep |
|
|
72156 |
w/&w/o |
45 mins |
75 mins |
45 mins |
45 mins |
No Food 4 Hours |
|
Shoulder (MRI) |
Lt: BC-156 |
w/o |
45 mins |
45 mins |
45 mins |
45 mins |
No Prep |
|
|
Lt: BC-154 |
w/&w/o |
60 mins |
75 mins |
60 mins |
60 mins |
No Food 4 Hours |
|
|
Lt: BC-155 |
w/ |
30 mins |
No |
45 mins |
45 mins |
No Food 4 Hours |
|
|
Rt: BC-212 |
w/o |
45 mins |
45 mins |
45 mins |
45 mins |
No Prep |
|
|
Rt: BC-210 |
w/&w/o |
60 mins |
75 mins |
60 mins |
60 mins |
No Food 4 Hours |
|
|
Rt: BC-211 |
w/ |
30 mins |
No |
45 mins |
45 mins |
No Food 4 Hours |
|
Brachial Plexus (MRI) |
Lt: BC-551 |
Always w/&w/o |
60 mins |
No |
60 mins |
No |
No Food 4 Hours |
|
|
Rt: BC-552 |
Always w/&w/o |
60 mins |
No |
60 mins |
No |
No Food 4 Hours |
|
TMJ (MRI) |
70336 |
Always w/o |
60 mins |
No |
No |
No |
No Prep |
|
Elbow (MRI) ONLY put on Open MRI with notated TECH or RADIOLOGIST APPROVAL |
Lt: BC-126 |
w/o |
45 mins |
90 mins |
45 mins |
45 mins * NO ELBOWS ON MOBILE 7/14/22 * |
No Prep |
|
|
Lt: BC-124 |
w/&w/o |
60 mins |
120 mins |
60 mins |
60 mins * NO ELBOWS ON MOBILE 7/14/22 * |
No Food 4 Hours |
|
|
Lt: BC-125 |
w/ |
30 mins |
No |
45 mins |
45 mins * NO ELBOWS ON MOBILE 7/14/22 * |
No Food 4 Hours |
|
|
Rt: BC-182 |
w/o |
45 mins |
90 mins |
45 mins |
45 mins * NO ELBOWS ON MOBILE 7/14/22 * |
No Prep |
|
|
Rt: BC-180 |
w/&w/o |
60 mins |
120 mins |
60 mins |
60 mins * NO ELBOWS ON MOBILE 7/14/22 * |
No Food 4 Hours |
|
|
Rt: BC-181 |
w/ |
30 mins |
No |
45 mins |
45 mins * NO ELBOWS ON MOBILE 7/14/22 * |
No Food 4 Hours |
|
Upper Extremity Non-Joint (MRI) (Forearm/Radius/Ulna & Humerus/Bicep) |
Lt: BC-549 |
w/o |
45 mins |
No |
45 mins |
No |
No Prep |
|
|
Lt: BC-551 |
w/&w/o |
60 mins |
No |
60 mins |
No |
No Food 4 Hours |
|
|
Rt: BC-550 |
w/o |
45 mins |
No |
45 mins |
No |
No Prep |
|
|
Rt: BC-552 |
w/&w/o |
60 mins |
No |
60 mins |
No |
No Food 4 Hours |
|
Wrist (MRI) |
Lt: BC-171 |
w/o |
No |
No |
45 mins |
No |
No Prep |
|
|
Lt: BC-169 |
w/&w/o |
No |
No |
60 mins |
No |
No Food 4 Hours |
|
|
Lt: BC-170 |
w/ |
No |
No |
45 mins |
No |
No Food 4 Hours |
|
|
Rt: BC-227 |
w/o |
No |
No |
45 mins |
No |
No Prep |
|
|
Rt: BC-225 |
w/&w/o |
No |
No |
60 mins |
No |
No Food 4 Hours |
|
|
Rt: BC-226 |
w/ |
No |
No |
45 mins |
No |
No Food 4 Hours |
|
Finger (MRI) |
BC-186 through BC-191 |
w/o |
No |
No |
45 mins |
No |
No Nail Polishes |
|
|
|
w/&w/o |
No |
No |
60 mins |
No |
No Food 4 Hours, No Nail Polishes |
|
|
|
w/o |
No |
No |
45 mins |
No |
No Nail Polishes |
|
|
|
w/&w/o |
No |
No |
60 mins |
No |
No Food 4 Hours, No Nail Polishes |
|
Hand (MRI) |
Lt: BC-144 |
w/o |
No |
No |
45 mins |
No |
No Nail Polishes |
|
|
Lt: BC-142 |
w/&w/o |
No |
No |
60 mins |
No |
No Food 4 Hours, No Nail Polishes |
|
|
Rt: BC-200 |
w/o |
No |
No |
45 mins |
No |
No Nail Polishes |
|
|
Rt: BC-198 |
w/&w/o |
No |
No |
60 mins |
No |
No Food 4 Hours, No Nail Polishes |
|
Thoracic Spine (MRI) |
72146 |
w/o |
45 mins |
60 mins **<250lbs** |
45 mins |
45 mins |
No Prep |
|
|
72157 |
w/&w/o |
60 mins |
90 mins **<250lbs** |
60 mins |
60 mins |
No Food 4 Hours |
|
Lumbar Spine (MRI) |
72148 |
w/o |
30 mins |
45 mins **<300lbs** |
30 mins |
30 mins |
No Prep |
|
|
72158 |
w/&w/o |
45 mins |
75 mins **<300lbs** |
45 mins |
45 mins |
No Food 4 Hours |
|
Sacrum / SI Joints (Pelvis MRI) |
BC-427 |
w/o |
45 mins |
90 mins |
45 mins |
45 mins |
No Prep |
|
Hip - Bilateral (MRI) ** DO NOT BUNDLE HIP MRI in CHS ** |
Bilat: |
w/o |
No |
No |
No |
No |
N/A |
|
|
Bilat: |
w/&w/o |
No |
No |
No |
No |
N/A |
|
Hip (MRI) |
Lt: BC-147 |
w/o |
45 mins |
60 mins **<300lbs** |
45 mins |
45 mins |
No Prep |
|
|
Lt: BC-145 |
w/&w/o |
60 mins |
90 mins **<300lbs** |
60 mins |
60 mins |
No Food 4 Hours |
|
|
Lt: BC-146 |
w/ |
45 mins |
No |
45 mins |
45 mins |
No Food 4 Hours |
|
|
Rt: BC-203 |
w/o |
45 mins |
60 mins **<300lbs** |
45 mins |
45 mins |
No Prep |
|
|
Rt: BC-201 |
w/&w/o |
60 mins |
90 mins **<300lbs** |
60 mins |
60 mins |
No Food 4 Hours |
|
|
Rt: BC-202 |
w/ |
45 mins |
No |
45 mins |
45 mins |
No Food 4 Hours |
|
Knee (MRI) |
Lt: BC-153 |
w/o |
30 mins |
45 mins **<250lbs** |
30 mins |
30 mins |
No Prep |
|
|
Lt: BC-151 |
w/&w/o |
45 mins |
75 mins **<250lbs** |
45 mins |
45 mins |
No Food 4 Hours |
|
|
Lt: BC-152 |
w/ |
No |
No |
45 mins |
45 mins |
No Food 4 Hours |
|
|
Rt: BC-209 |
w/o |
30 mins |
45 mins **<250lbs** |
30 mins |
30 mins |
No prep |
|
|
Rt: BC-207 |
w/&w/o |
45 mins |
75 mins **<250lbs** |
45 mins |
45 mins |
No Food 4 Hours |
|
|
Rt: BC-208 |
w/ |
No |
No |
45 mins |
45 mins |
No Food 4 Hours |
|
Lower Extremity Non-Joint (MRI) (Femur or Tib/Fib) |
Lt: BC-162 |
w/o |
45 mins |
No |
45 mins |
45 mins |
No Prep |
|
|
Lt: BC-160 |
w/&w/o |
60 mins |
No |
60 mins |
60 mins |
No Food 4 Hours |
|
|
Rt: BC-218 |
w/o |
45 mins |
No |
45 mins |
45 mins |
No prep |
|
|
Rt: BC-216 |
w/&w/o |
60 mins |
No |
60 mins |
60 mins |
No Food 4 Hours |
|
Thigh / Femur (MRI) |
Lt: BC-129 |
w/o |
45 |
|
45 |
45 |
No Prep |
|
|
Lt: BC-127 |
w/&w/o |
60 |
|
60 |
60 |
No Food 4 Hours |
|
|
Rt: BC-185 |
w/o |
45 |
|
45 |
45 |
No Prep |
|
|
Rt: BC-183 |
w/&w/o |
60 |
|
60 |
60 |
No Food 4 Hours |
|
Ankle (MRI)
|
Lt: BC-123 |
w/o |
45 mins |
No |
45 mins |
45 mins |
No Prep |
|
|
Lt: BC-121 |
w/&w/o |
60 mins |
No |
60 mins |
60 mins |
No Food 4 Hours |
|
|
Lt: BC-122 |
w/ |
45 mins |
No |
45 mins |
45 mins |
No Food 4 Hours |
|
|
Rt: BC-179 |
w/o |
45 mins |
No |
45 mins |
45 mins |
No Prep |
|
|
Rt: BC-177 |
w/&w/o |
60 mins |
No |
60 mins |
60 mins |
No Food 4 Hours |
|
|
Rt: BC-178 |
w/ |
45 mins |
No |
45 mins |
45 mins |
No Food 4 Hours |
|
Foot (MRI)
|
Lt: BC-138 |
w/o |
60 mins |
No |
45 mins |
45 mins |
No Nail Polishes |
|
|
Lt: BC-136 |
w/&w/o |
75 mins |
No |
60 mins |
60 mins |
No Food 4 Hours, No Nail Polishes |
|
|
Rt: BC-194 |
w/o |
60 mins |
No |
45 mins |
45 mins |
No Nail Polishes |
|
|
Rt: BC-192 |
w/&w/o |
75 mins |
No |
60 mins |
60 mins |
No Food 4 Hours,No Nail Polishes |
|
Toe (MRI) |
Lt: BC-165 (joint) Lt: BC-167 (non-joint) |
w/o |
45 mins |
No |
45 mins |
45 mins |
No Nail Polishes |
|
|
Lt: BC-163(joint) Lt: BC-168 (non-joint) |
w/&w/o |
60 mins |
No |
60 mins |
60 mins |
No Food 4 Hours,No Nail Polishes |
|
|
Rt: BC-219 (joint) Rt: BC-222 (non-joint) |
w/o |
45 mins |
No |
45 mins |
45 mins |
No Nail Polishes |
|
|
Rt: BC-220 (joint) Rt: BC-223 non-joint |
w/&w/o |
60 mins |
No |
60 mins |
60 mins |
No Food 4 Hours, No Nail Polishes |
|
Run Off (MRA Abd+BLE) |
BC-230 |
w/&w/o |
No |
No |
No |
No |
No |
|
Chest (MRI) |
71550 |
w/o |
45 mins |
No |
45 mins |
No |
No Food 4 Hours |
|
|
71552 |
w/&w/o |
60 mins |
No |
60 mins |
No |
No Food 4 Hours |
|
Chest (MRA) |
71555 |
w/&w/o |
No |
No |
ASK TECH |
No |
No |
|
Prostate Fusion (MRI) ** NO Hip Replacements ** NO Pelvic reconstruction due to injury |
BC-1027 |
w/ |
No |
No |
DO NOT SCHEDULE |
No |
No Food 2 hours Bentyl 1hr prior (get from rdoc) |
|
Prostate (MRI) ** NO Hip Replacements ** NO Pelvic reconstruction due to injury |
BC-1280 |
w/ |
No |
No |
30 mins
|
No |
24hrs SEE CHS PROSTATE PREP (Laxatives + Bentyl) |
|
** NO Hip Replacements ** NO Pelvic reconstruction due to injury |
BC-781 |
w/&w/o |
No |
No |
60 mins
|
No |
24hrs SEE CHS PROSTATE PREP (Laxatives + Bentyl) |
|
Breast (Unilateral MRI) |
77046 |
w/o |
No |
No |
No |
No |
No |
|
|
77048 |
w/&w/o |
No |
No |
No |
No |
No |
|
Breast (Bilateral MRI) |
77047 |
w/o |
No |
No |
No |
No |
No |
|
|
77049 |
w/&w/o |
No |
No |
No |
No |
No |
|
Breast Biopsy (MR guidance) |
BC-1310 (CPT 19085) |
n/a |
No |
No |
No |
No |
No |