Requested Exam Date and Time: ______Location: □Gastonia (M/Th/F) □Belmont (T/W)
Scheduled Date and Time:______(Please arrive 20 minutes early)
Authorization #:______Insurance:______
When obtaining authorizations, select location preferred using the following numbers: Group NPI 1356324487 Tax ID # 560988142
Patients Full Name: ______D.O.B.: ______Height:______Weight:______
Social Security# ______Home Phone #______Other Phone: ______
Ordering Physician: ______Physician signature: ______
Scheduled by: ______Phone:______Email: ______
Previous studies / location:______Send CD with Patient?:______
Special Instructions / Needs:______
Please list relevant surgery:______
History of Cancer?:______
Metal objects in body?:______□ Pacemaker? □ Aneurysm clip? □ Implant? □ Stent?
□ Orbital x-rays required for History of metal work □ Claustrophobia (prescribed medications require driver)
□ Any chance of Pregnancy? If so, date of LMP:______□ Allergies:______
______
Diagnosis/Symptoms:______
______
______
HEAD/NECK: MRI BRAINCPT ICD-9
□MRI - brain w/o 70551____
□MRI - brain with 70552______
□MRI - brain w/o & w 70553______
□MRI- other – IAC / Pituitary / Trigeminal______
HEAD/NECK: MRI ORBIT FACE & NECK
□MRI - TMJ 70336______
□MRI - orbit,face,neck w/o 70540______
□MRI - orbit,face,neck with 70542______
□MRI - orbit,face,and neck w/o & w 70543______
MAGNETIC RESONANCE ANGIOGRAPHY, HEAD
□MRA - head w/o 70544______
□MRA - neck w/o 70547______
□MRA - neck with 70548______
□MRA - neck w/o & w 70549______
SPINE: MRI SPINAL CANAL
□MRI - C-spine w/o 72141______
□MRI - C-spine with 72142______
□MRI - C-spine w/o & w 72156______
□MRI - L-spine w/o 72148______
□MRI - L-spine with 72149______
□MRI - L-spine w/o & w 72158______
□MRI - T-spine w/o 72146______
□MRI - T-spine with 72147______
□MRI - T-spine w/o& w 72157______
□MRI – sacrum______
□MRI – other______
MRI EXTREMITIES /JOINT* CPT ICD-9
□R □L MRI - upper extremity (OTJ) w/o 73218______
□R □L MRI - upper extremity (OTJ) with 73219______
□R □L MRI - upper extremity (OTJ) w/o & w 73220______
□R □L MRI - upper extremity (joint); w/o 73221______
□R □L MRI - upper extremity (joint); with 73222______
□R □L MRI - upper extremity (joint); w/o & w 73223______
□R □L MRA -upper extremity, with or w/o 73225______
□R □L MRI - lower extremity (OTJ) w/o 73718______
□R □L MRI - lower extremity (OTJ) with 73719______
□R □L MRI - lower extremity (OTJ) w/o & w 73720______
□R □L MRI - lower extremity (joint); w/o 73721______
□R □L MRI - lower extremity (joint); with 73722______
□R □L MRI - lower extremity (joint); w/o & w 73723______
□R □L MRA -lower extremity, with or w/o 73725______
□MRI – other: ______
BODY : CHEST
□MRI - chest w/o 71550______
□MRI - chest with 71551______
□MRI - chest w/o & w 71552______
□MRA – chest / aorta______71555______
BODY : ABDOMEN/ PELVIS
□MRI - abdomen; w/o 74181______
□MRI - abdomen; with 74182______
□MRI - abdomen; w/o & w 74183______
□MRA - abdomen, with or w/o 74185______
□MRI - pelvis w/o 72195______
□MRI - pelvis with 72196______
□MRI - pelvis w/o & w 72197______
□MRA - pelvis with or w/o 72198______
Contrast requires a Creatinine for anyone over 60, diabetes, kidney disease, chemotherapy, etc… This can be done onsite prior to start of exam.
Extremities / Joints with history of infection, abscess, ulcer, cyst or mass usually require contrast agent per radiologist.
Federal Necessity: Federal Regulations require that only the tests that are necessary for diagnosis and treatment of a patient’s condition be ordered. The ICD-9 code is required to prove medical necessity.
ICD-9DESCRIPTION
MRI TEMPOROMANDIBULAR JOINT TOTAL
524.60TEMPOROMANDIB JT DIS NOS
526.9JAW DISEASE NOS
718.08ARTIC CARTIL DIS-JT NEC
MRI ORBIT FACE & NECK TOTAL
190.1MALIGN NEOPL ORBIT
784.2SWELLING IN HEAD & NECK
785.6ENLARGEMENT LYMPH NODES
524.60TEMPOROMANDIB JT DIS NOS
784.0HEADACHE
225.2BEN NEO CEREBR MENINGES
193.MALIGN NEOPLE THYROID
MAGNETIC RESONANCE ANGIOGRAPHY, HEAD;
433.10CARTD ART OCC NO INFARC
784.0HEADACHE
747.81CEREBROVASCULAR ANOMALY
437.3NONRUPT CEREBRAL ANEURYM
436.CVA
780.4DIZZINESS AND GIDDINESS
434.91CEREBR ART OCC W INFARC
435.9TRANS CEREB ISCHEMA NOS
437.1AC CEREBROVASC INSUF NOS
348.8BRAIN CONDITIONS NEC
780.39OTHER CONVULSIONS
433.30MUL PRECER OCC NO INFARC
331.9CEREB DEGENERATION NOS
348.0CEREBRAL CYSTS
MRI – BRAIN
784.0HEADACHE
436.0CVA
780.4DIZZINESS AND GIDDISNESS
433.10CAROTD ART OCC NO INFARC
780.39OTHER CONVULSIONS
331.9CEREB DEGENERATION NOSE
348.8BRAIN CONDITIONS NEC
434.91CEREBR ART OCC W INFARC
437.1AC CEREBROVASC INSUF NOS
437.3NONRUPT CEREBRAL ANEURYM
474.81CEREBROVASCULAR ANOMALY
348.0CERBRAL CYSTS
348.4COMPRESSION OF BRAIN
780.99OTHER GENERAL SYMPTOMS
721.0CERVICAL SPONDYLOSIS
435.9TRANS CEREB ISCHEMIA NOS
346.90MIGRAINE NOS/NOT INTRACBL
437.1AC CEREBROVASC INSUF NOS
331.7CEREB DEGEN IN OTH DIS
434.90CEREBR ART OCC NO INFARC
721.00CERVICAL SPONDYLOSIS
191.2MAL NEO TEMPORAL LOBE
478.1NASAL & SINUS DIS NEC
389.10SENSORNEUR HEAR LOSS NOS
191.3MAL NEO TEMPORAL LOBE
780.99OTHER GENERAL SYMPTOMS
434.91CEREBR ART OCC W INFARCT
162.9MAL NEO BRONCH/LUNG NOS
346.90MIGRAINE NOS/NOT INTRCBLE
722.4CERVICAL DISC DEGEN
780.2SYNCOPE AND COLLAPSE
172.9MALIG MELANOMA SKIN NOS
721.8SPINAL DISCORDERS NEC
225.0BENIGN NEOPLASM BRAIN
781.0ABN INVOLUN MOVEMENT NEC
793.0ABN FINDING-SKULL & HEAD
722.2DISC DISPLACEMENT NOS
340.MUTILPLE SCLEROSIS
780.4DIZZINESS AND GIDDINESS
780.39OTHER CONVULSIONS
225.2BEN NEO CEREBR MENINGES
348.8BRAIN CONDITIONS NEC
784.0HEADACHE
198.3SEC MAL NEO BRAIN/SPINE
191.9MALIG NEO BRAIN NOS
784.2SWELILNG IN HEAD & NECK
191.1MALIG NEO FRONTAL LOBE
331.9CEREB DEGENERATION NOS
227.3BENIGN NEO PITUITARY
348.9BRAIN CONDISTIONS NOS
225.1BENIGN NEO CRANIAL NERVE
747.81CEREBROVASCULAR ANOMALY
191.0MALIGN NEOPLE CEREBRUM
348.0CEREBRAL CYSTS
174.9MALIGN NEOPLE BRAST NOS
253.8PITUITARY DISCORDER NEC
781.2ABNORMALITY OF GAIT
433.10CARTD ART OCC NO INFARC
437.3NONRUPT CEREBRAL ANEURYM
437.9CEREBROVASC DISEASE NOS
436.CVA
388.30TINNITUS NOS
782.0SKIN SENATION DISTURB
435.9TRANS CEREB ISCHEMIA NOS
345.90EPILEPSY NOS-NOT INTRACT
191.6MAL NEO CEREBELLUM NOS
253.9PITUITARY DISORDER NOS
348.5CEREBRAL EDEMA
350.1TRIGEMINAL NEURALGIA
723.1CERVICAL GIA
780.93MEMORY LOSS
781.3LACK OF COORDINATION
431.INTRACEREBRAL HEMORRHAGE
368.8VISUAL DISTURBANCES NEC
ICD-9DESCRIPTION
MRI CHEST
786.6CHEST SWELLING/MASS/LUMP
425.4PRIM CARDIOMYOPATHY NEC
786.05SHORTNESS OF BREATH
786.6CHEST SWELLING/MASS/LUMP
358.00MYASTENIA GRAVIS WITHOUT (ACUTE)
EXACERBATION
424.1AORTIC VALVE DISORDER
786.05SHORTNESS OF BREATH
162.9MAL NEO BRONCH/LUNG NOS
212.1BENIGN NEO LARYNX
427.9CARDIAC DYSRHTHMIA NOS
785.1PALPITATIONS
786.05SHORTNESS OF BREATH
425.4PRIM CARDIOMYOPATHY NEC
427.1PAROX VENTRIC TACHCARD
780.2SYNCOPE AND COLLAPSE
424.0MITRAL VALVE DISORDER
212.7BENIGN NEOPLASM HEART
401.9HYPERTENSION NOS
423.9PERICARDIAL DISEASE NOS
424.1AORTIC VALVE DISORDER
427.31VOCAL PARAL UNILAT TOTAL
429.3BLOOD IN STOOL
478.32SWELLING IN HEAD & NECK
578.1MALIG NEO CORPUS UTERI
784.2AMYLOIDOSIS
423.9PERICARDIAL DISEASE NOS
425.9SECOND CARDIOMYOPATH NOS
427.2PAROX TACHYCARDIA NOS
427.69PREMATURE BEATS NEC
511.9PLEURAL EFFUSION NOS
746.89CONG HEART ANOMALY NEC
785.6ENLARGEMENT LYMPH NODES
MRI-ABDOMEN/PELVIS
599.2URETHRAL DIVERTICULUM
719.45JOINT PAIN-PELVIS
721.3LUMBOSACRAL SPONDYLOSIS
724.79DISORDER OF COCCYX NEC
618.0PROPLAPSE OF VAGINAL WALL
621.8DISORDERS OF UTERUS NEC
722.2DISC DISPLACEMENT NOS
616.0CERVICTIS
218.9UTERINE LEIOMYOMA NOS
571.5CIRRHOSIS OF LIVER NOS
585.CHRONIC RENAL FAILURE
477.1STRICTURE OF ARTERY
719.45JOINT PAIN-PELVIS
620.2OVARIAN CYST NEC/NOS
185.MALIGN NEOPL PROSTATE
195.3MALIGN NEOPL PELVIS
599.7HEMATURIA
621.8DISORDERS OF UTERUS NEC
197.7SECOND MALIG NEO LIVER
593.2CYST OF KIDNEY, ACQUIRED
571.5CIRRHOSIS OF LIVER NOS
573.8LIVER DISORDERS NEC
789.5ASCITES
593.9RENAL & URETERAL DIS NOS
789.2SPLENOMEGALY
574.20CALCULUS-GB-NO CYSTITIS
593.9RENAL & URETERAL DIS NOS
MRI-BREAST
611.72LUMP OR MASS I N BREAST
174.9MALIGN NEOPLE BREAST NOS
793.80ABNORMAL MAMMOGRAM, UNSPEC
611.72LUMP OR MASS IN BREAST
174.9MALIGN NEOPL BREAST NOS
233.0CA IN SITU BREAST
793.80ABNORMAL MAMMOGRAM, UNSPEC
174.4MAL NEO BREAST UP-OUTER
676.30BREAST DIS PREG NEC-UNSP
V10.3HX OF BREAST MALIGNANCY
V16.3FAMILY HX-BREAST MALIG
MRI-SPINAL CANAL
721.0CERVICAL SPONDYLOSIS
722.4CERVICAL DISC DEGEN
723.0CERVICAL SPINAL STENOSIS
723.1CERVICAL GIA
721.8SPINAL DISORDERS NEC
722.0CERVICAL DISC DISPLACMENT
722.2LUMBOSACRAL SPONDYLOSIS
721.3SYRINGOMYELIA
336.0CERV SPONDYL W MYELOPATH
721.1MYELOPATHY NEC
336.8COMPRESSION OF BRAIN
348.4LUMB/LUMBOSAC DISC DEGEN
722.52POSTLAMINECT SYND-CERV
722.81SPINAL STENOSIS-LUMBAR
724.02BRACHIAL NEURITIS NOS
723.4BRACHIAL NEURITIS NOS
344.00QUADRIPLEGIA NOS
336.0SYRINGOMYELIA
721.2THORACIC SPONDYLOSIS
722.11THORACIC DISC DISPLACMENT
344.1PARAPLEGIA NOS
721.3LUMBOSACRAL SPONDYLOSIS
722.4CERVICAL DIS DEGEN
722.51THORACIC DISC DEGEN
722.82POSTLAMINECT SYND-THORAC
721.0CERVICAL SPONDYLOSIS
721.3LUMBOSACRAL SPONDYLOSIS
722.52LUMB/LUMBOSAC DIS DEGEN
ICD-9DESCRIPTION
721.3LUMBOSACRAL SPONDYLOSIS
722.52LUMB/LUMBOSAC DIS DEGEN
722.10LUBAR DISC DISPLACEMENT
724.02SPINAL STENOSIS-LUMBAR
722.2DISC DISPLACEMENT NOS
722.83POSTLAMINECT SYND-LUMBAR
340.MULTIPLE SCLEROSIS
721.0CERVICAL SPONDYLOSIS
722.4CERVICAL DISC DEGEN
721.8SPINAL DISORDERS NEC
723.1CERVICALGIA
722.2DISC DISPLACEMENT NOS
723.0CERVICAL SPINAL STENOIS
722.81POSTLAMINECT SYND-CERV
722.0CERVICAL DISC DISPLACEMENT
336.8MYELOPATHY NEC
721.1SYRINGOMYELIA
780.4CERV SPONDYL W MYELOPATH
336.9DIZZINESS AND GIDDINESS
225.3BENIGN NEO SPINAL CORD
348.8BRAIN CONDITIONS NEC
353.2CERVICAL ROOT LESION NEC
MRI-ANY JOINT/NON JOINT EXTREMETY
842.12SPRAIN METACARPOPHALANG
171.2MAL NEO SOFT ISSUE ARM
228.09HEMANGIOMA NEC
719.03JOINT EFFUSION-FOREARM
171.2MAL NEO SOFT TISSUE ARM
214.8LIPOMA NEC
238.1UNC BEHAV NEO SOFT TISSU
719.01JOINT EFFUSION-SHLDER
782.2LOCAL SUPRICIAL SWELLING
238.0UNC BEHAVE NEO BONE
727.05TENOSYNOV HAND/WRIST NEC
727.41GANGLION OF JIONT
727.49BURSAL CYST NEC
831.00DISLOC SHOULDER NOS-CLOS
840.0SPRAIN ACROMIOCLAVICULAR
842.00SPRAIN OF WRIST NOS
719.02JOINT EFFUSION-UP/ARM
726.19ROTATOR CUFF DIS NEC
727.04RADIAL STYLOID TENOSYNOV
729.5PAIN IN LIMB
719.06JOINT EFFUSION-L/LEG
719.07JOINT EFFUSION-ANKLE
727.51POPLITEAL SYNOVIAL CYST
717.7CHONDROMALACIA PATELLAE
719.45JOINT PAIN-PELVIS
719.46JOINT PAIN-L/LEEG
719.47JOINT PAIN-ANKLE
733.90BONE & CARTILAGE DIS NOSE
272.7LIPIDOSES
355.71CAUSALGIA OF LOWER LIMB
715.16LOC PRIM OSTEOART/L-LEG
715.97OSTEOARTHROS NOS/ANKLE
727.06TENOSYNOVTISIS FOOT/ANKLE
729.81SWELLING OF LIMB
730.36PERIOSTITIS-L/LEG
782.3EDEMA
717.7CHRONDROPMALACIA PATELLAE
719.06JOINT EFFUSION-L/LEG
836.0TEAR MED MENISC KNEE-CUR
719.45JOINT PAIN-PELVIS
726.10ROTATOR CUFF SYND NOS
719.41JOINT PAIN-SHLDER
719.01JOINT EFFUSION-SHLDER
726.0ADHESIVE CAPSULIT SHLDER
719.43JOINT PAIN-FOREARM
840.9SPRAIN SHLDER/ARM NOS
715.91OSTEOARTHR NOS SHLDER
719.03JOINT EFFUSION-FOREARM
840.4SPRAIN ROTATOR CUFF
840.6SPRAIN SUPRASPINATUS
719.42JOINT PAIN-UP/ARM
726.11CALCIF TENDITINTIS SHLDER
726.12BICIPITAL TENOSYNOVITIS
727.43GANGLION NOS
715.04GEN OSTEOARTHROS-HAND
715.11LOC PRIM OSTEOART-SHLDER
171.3MAL NEO SOFT TISSUE LEG
170.7MAL NEO LONG BONES LEG
171.9MAL NEO SOFT TISSUE NOS
782.3EDEMA
719.06JOINT EFFUSION-L/LEG
719.07JOINT EFFUSION-ANKLE
198.5SECONDARY MALIG NEO BONE
213.7BEN NEO LONG BONES LEG
214.8LIPMO NEC
228.01HEMANGIOMA SKIN
308.9ACUTE STRESS REACT NOS
719.46JOINT PAIN-L/LEG
729.5PAIN IN LIMB
729.81SWELLING OF LIMB
733.95STRESS FRACTURE OF OTHER BONE
782.2LOCAL SUPRFICIAL SWELLING
731.0OSTEITIS DEFORMANS NOS
733.90BONE & CARTILAGE DIS NOS
717.2DERANG POST MED MENISCUS
719.46JOINT PAIN-L/LEG
719.07JOINT EFFUSION-ANKLE
727.51POPLITEAL SYNOVIAL CYST
836.1TEAR LAT MENISC KNEE-CUR
733.42ASEPTIC NECROSIS FEMUR
ICD-9 DESCRIPTION
COMERADOAGRAPHY
336.0SYRINGOMYELIA
348.4COMPRESSION OF BRAIN
722.81POSTLAMINECT SYND-CERV
336.8MYELOPATHY NEC
722.4CERVICAL DISC DEGEN
349.2DISORDER OF MENINGES NEC
721.0CERVICAL SPONDYLOSIS
722.82POSTLAMINECT SYND-THORAC
344.1PARAPLEGIA NOS
723.1CERVICALGIA
741.01SPIN BIF W HYDRCEPH-CERV
723.0CERVICAL SPINAL STENOSIS
344.00QUADRIPLEGIA NOS
336.9SPINAL CORD DISEASE NOS
722.83POST LAMINECT SYND-LUMBAR
722.0CERVICAL DISC DISPLACMNT
225.3BENIGN NEO SPINAL CORD
322.9MENINGITIS NOS
721.8SPINAL DISORDERS NEC
722.2DISC DISPLACEMENT NOS
756.15CONGEN FUSION OF SPINE
741.00SPIN BIF W HYDROCEPH NOS
191.9MALIG NEO BRAIN NOS
191.1MALIG NEO FRONTAL LOBE
191.2MAL NEO TEMPORAL LOBE
348.8BRAIN CONDISTIONS NEC
784.2SWELLING IN HEAD & NECK
191.0MALIGN NEOPL CEREBRUM
191.7MAL NEO BRAIN STEM
239.6BRAIN NEOPLASM NOS
780.39OTHER CONVULSIONS
OTHER:
This list is not all-inclusive, but is a guide only. All diagnosis codes must be coded to the highest level of specificity. The ordering provider represents that the diagnostic information provided with EACH test accurately reflects his/her current knowledge of the nature of severity of complaint or condition, and that this information can be substantiated by the patient’s medical record.
MRI Exam Preparation
Due to the strong magnet used in the MRI scanner, it is extremely important for the safety of the patient to obtain accurate information before performing the MRI exam.
The system does not use ionizing radiation, simply radiofrequency waves and magnetic fields.
Here is a link with more specific MRI Safety information:
(
The actual exam time lasts on average 30 to 45 minutes. The complete length of stay from arrival to departure is about one hour.
Registration is completed just prior to the start of the MRI exam. The MRI scan table has a weight limit of 550 pounds.
Please review the following information below.
Patient:
Please bring a copy of your photo ID and insurance card(s).
Please inform us of any types of surgery and/or any known metal or implant inside the body.
Please leave personal belongings at home.
Please limit makeup and jewelry, and please no makeup for Head and Neck exams.
Please try to wear clothes without zippers and metallic embroidery if possible.
Please let us know if you have any special needs while under our care.
Please let us know if you could possibly be pregnant, or are currently breastfeeding.
Please do not eat or drink anything for 4 hours prior to your exam time for abdomen and/or pelvis related studies only. All other exams do not require fasting.
If you feel you are claustrophobic, please discuss with your physician the option of receiving an oral medication to take just prior to your arrival and have a driver bring you to and from your MRI appointment.
oThe scanner is quite spacious, with a 70 centimeter opening and much shorter overall length, which greatly reduces the claustrophobia effect.
oMost exams from the waist down can be done feet first. Head and neck to mid chest usually require to be done head first.
Provider:
Please provide the following patient information when scheduling:
MRI is body part specific. Please list the exact area to be scanned on your order.
- Date of birth; social security number; phone number.
- Patient height, weight.
- Any chance of pregnancy.
- Previous surgeries, especially to area of interest.
- History of cancer
- History of metal or foreign implants within the body from any surgeries or accidents.
- If the patient has worked around metal (welder, machine shop), he/she must arrive 30 minutes prior to appointment for x-ray clearance (at no charge).
- Patients with pacemakers, certain types of bio-stimulators, drug infusion devices, or ferrous (magnetic) aneurysm clips cannot have an MRI exam.
- If patient is claustrophobic please discuss the options of an oral sedative to take prior to the exam time.
- If patient requires a sedative, referring physician should order prescription (PO meds).
- Please bring any relevant films and/or reports from non CaroMont facilities if possible.
Exam Ordering
- The table weight limit is 550 pounds.
- An Order Form is also available online and is submitted electronically via secure email.
- You can also download an Order form (link), and fax it to us at 704 671.7755.
- It is most common to order exams as either without (w/o) (no contrast) or without & with contrast, when contrast is requested.
- Normally the only exams ordered as with contrast would be MRA (MR Angiography) of the neck or abdomen or pelvis. MRA of the Head does not require contrast.
- Arthrograms of the hip or shoulder or of a joint are ordered as with contrast.
- Currently some newer technology should be available soon which will further improve vessel visualization without the use of contrast materials, which may be beneficial for some patients.
Contrast Injection
- Some exams require the injection of a contrast material to help improve visualization of the brain, spine, and vascular system to name a few. The medication is FDA approved and is considered quite safe. It is administered intravenously usually halfway through the exam. Please be well hydrated on the day of your exam unless we request otherwise.
- Patients with known diabetes, kidney dysfunction, cancer or anyone over the age of 60 may require us to obtain a simple blood test upon arrival to check the creatinine level as an extra precaution to assure proper usage of the contrast media. We can accept a creatinine level done at another medical office if it has been completed in the past 10 days.
- Please let us know if you are currently breastfeeding. It is recommended to discontinue this up to 72 hours after contrast injection.
Routine Radiologist preferred MRI Exam Protocol for MRISC
The best method is to order as ‘MRI ____ with and/or without contrast’ and add a note stating: ‘Contrast at Radiologist discretion’. This allows greater flexibility and does not require another call to the insurance company to change an authorization for example. However the referring physician certainly has the right to order with any specific request as indicated.
A patient having a history of known cancer, infection, abscess, cyst, or mass most often require
the use of contrast, where the exam should be ordered as ‘without and/or with contrast’.
- MRI Brain without and with contrast. 70553. Most all brains need to be done without and with contrast
- MRA Brain without contrast. 70554
- MRV Brain without contrast 70554
- MRI Cervical Spine without contrast (even with history of cervical surgery). 72141
- MRA Neck with contrast. 70548
- MRI Lumbar spine without and with contrast for history of low back surgery. 72158
- MRI / MRA Abdomen without and with contrast. MRI 74183, MRA 74185
- MRCP does not require contrast. 74181
- MRI / MRA Pelvis without and with contrast. MRI 72197, MRA 72198
- Basically all MRA exams are without and with contrast except MRA Head, where contrast is not required.
- MR Arthrography of any joint is always ordered as with contrast. Upper 73222, Lower 73722