Outpatient Radiology Order Form DEPARTMENT OF RADIOLOGY
Outpatient Radiology Order Form DEPARTMENT OF RADIOLOGY
Outpatient Radiology Order Form DEPARTMENT OF RADIOLOGY
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
CT Bone Lengths (Scanogram) (No IV)<br />
Ultrasound (US) Service Code CPT Code<br />
R<br />
R<br />
CT Scan Service Code CPT Code<br />
L<br />
L<br />
CT Brain without (Trauma)<br />
CT Brain with / without (Mass)<br />
CT Facial Bones (Fracture) No IV<br />
CT Orbits (FX) 0016<br />
70480<br />
CT Sinus without Contrast<br />
CT Sinus VTI (without Contrast)<br />
CT Temporal Bones (iac) (Mastoid Air Cells) without Contrast<br />
CT Dental Scan (without Contrast)<br />
US Soft Tissue Neck / Thyroid 726 - 6042 76536<br />
US Chest<br />
US Breast<br />
US Abdomen<br />
US Aorta<br />
US Kidney<br />
726 - 6024<br />
724 - 5004<br />
726 - 6011<br />
726 - 6038<br />
726 - 6037<br />
76604<br />
76645<br />
76700<br />
76770<br />
76770<br />
US Pregnant Uterus 1st Tri 726 - 6032 76805<br />
US Pregnant Uterus 2nd. 3rd Tri 726 - 6031 76810<br />
Fetal Biophysical Profile 726 - 6028 76818<br />
US Transvaginal Pelvis 726 - 6064 76830<br />
US Pelvis Non OB<br />
US Scrotum<br />
726 - 6033<br />
726 - 6039<br />
76856<br />
76870<br />
US Superficial Structure (location requested) 726 - 6104 76882<br />
US Infant Hip<br />
US Neonatal Head<br />
726 - 6082<br />
726 - 6041<br />
76885<br />
76506<br />
Infant Pylorus (Pyloric Stenosis) 726 - 6012 76705<br />
Infant Spine<br />
US Carotid Arteries<br />
726 - 6043<br />
726 - 6026<br />
76800<br />
93880<br />
US Extremity Veins Bilateral Arm or Leg 726 - 6006 93970<br />
US Extremity Veins Unilateral (DVT) 726 - 6005 93971<br />
ABI/PVR Arm/Leg<br />
Mandible<br />
Maxilla<br />
CT Angio Neck (Occlusion, Stenosis) with Contrast<br />
CT Soft Tissue Neck with Contrast (Mass, Abscess)<br />
CT Chest / abd / Pelvis with Contrast (Met Eval)<br />
CT Chest / abd with Contrast (Dissection) (Yes IV) (No Oral)<br />
CT Chest (Pulmonary Embolism) with Contrast<br />
CT Chest Routine with Contrast (Nodule, Mass)<br />
CT Chest Hi Resolution (without Contrast) R/O ILD<br />
CT Chest (Non Contrast)<br />
CT Cervical Spine without Contrast<br />
CT Thoracic Spine without Contrast<br />
CT Lumbar Spine without Contrast<br />
CT Upper Extremity without Contrast R L<br />
CT Lower Extremity without Contrast R L<br />
CT abd / Pelvis (AAA) (Yes IV) (No Oral)<br />
726 - 6048<br />
93922<br />
Aterial-Duplex Arm/Leg 726 - 6007 93926<br />
0013<br />
0015<br />
0018<br />
0032<br />
0032<br />
0068<br />
0018 / 0104<br />
0081<br />
0022<br />
0025 / 0010 / 0040<br />
0083 / 0010<br />
0025<br />
0025<br />
0024<br />
0024<br />
0042<br />
0001<br />
0038<br />
0003<br />
0006<br />
0010 / 0040<br />
CT Abdomen and Pelvis with Contrast (Diverticulitis, Appy, Pain, Met Eval) (Yes IV) (Yes Oral) 0010 / 0040 74177<br />
CT Abdomen and Pelvis without Contrast (Renal Stone) (No Oral)<br />
CT Abdomen and Pelvis (Endograft Stent Protocol) (Yes IV) (No Oral)<br />
CT Urogram with and without Contrast (Yes IV) (No Oral)<br />
CT Pelvis without Contrast (Fracture Only) (No IV) (No Oral)<br />
CT Angiogram Femoral Runoff with IV Contrast (No Oral)<br />
CT Angiogram Circle of Willis with Contrast (Aneurysm, Vasculitis)<br />
CT Calcium Scoring (No IV)<br />
0009 / 0027<br />
0082 / 0040<br />
0011 / 0039 / 0104<br />
0027<br />
0100<br />
0080<br />
0102<br />
0076<br />
73700<br />
Nuclear Medicine / Endocrine System Service Code CPT Code<br />
Brain Imaging Spect<br />
727 - 7022<br />
78607<br />
Thyroid Imaging / Uptake with scan 727 - 7051 78007<br />
Kidney Imaging Vascular Flow & Funct. 727 - 7032 78707<br />
Kidney Imaging Vascular Flow & Funct. w/Lasix 727 - 7145 78708<br />
Kidney Imaging Vascular Flow & Funct. w/Captopril 727 - 7145 78708<br />
Liver & Spleen Imaging / Static Only 727 - 7036 78215<br />
Hepatobiliary System Imaging With CCK 727 - 72163 78227<br />
Gastric Emptying Study<br />
Without CCK 727 - 70282 78226<br />
727 - 7025<br />
78264<br />
Bone and / or Joint Imaging Ltd. Area 727 - 7014 78300<br />
Bone and / or Joint Imaging Whole Body 727 - 7013 78306<br />
Bone and / or Joint Imaging - 3 Phase 727 - 7018 78315<br />
Bone and / or Joint Tomography Spect 727 - 7017 78320<br />
Cardiac Blood Pool Imaging Multi (MUGA) 727 - 7024 78472<br />
Myocardial Perfusion Imaging (Gated SPECT) 727 - 72049 78452<br />
V/Q Scan (Perfusion/Ventilation) 727 - 72171 78582<br />
Pulmonary Quantification 727 - 71728 78598<br />
White Blood Cell<br />
Indium<br />
Ceretec<br />
Parathyroid<br />
<strong>RADIOLOGY</strong> SCHEDULING<br />
70450<br />
70470<br />
70486<br />
70486<br />
70486<br />
70480<br />
70486 / 76376<br />
70498<br />
70491<br />
71260 / 74160 / 72193<br />
71275 / 74160<br />
71260<br />
71260<br />
71250<br />
71250<br />
72125<br />
72128<br />
72131<br />
73200<br />
73700<br />
74177<br />
74176<br />
74177<br />
74178<br />
72192<br />
75635<br />
70496<br />
727 - 7120<br />
727 - 7177<br />
727 - 7116<br />
78805<br />
78805<br />
78070<br />
THE CHESTER COUNTY HOSPITAL .... . . . . 610-431-5131<br />
701 East Marshall Street, West Chester, PA<br />
General <strong>Radiology</strong>, GI Fluoroscopy, Ultrasound, CT Scanning, MRI, Nuclear Medicine,<br />
and Radiation Therapy.<br />
THE CHESTER COUNTY HOSPITAL<br />
FERN HILL MEDICAL CAMPUS . . . . . . . . . . . ..... . . . . 610-431-5131<br />
Fern Hill Medical Building<br />
915 Old Fern Hill Road, Bldg D, Suite 400, West Chester, PA<br />
General <strong>Radiology</strong>, Digital Mammography, Ultrasound, Dexa Scan, CT Scanning, MRI.<br />
THE CHESTER COUNTY HOSPITAL<br />
<strong>RADIOLOGY</strong> AT KENNETT SQUARE .... . . . . 610-431-5131<br />
Kennett Medical Campus<br />
402 McFarlan Road, Suite 204, Kennett Square, PA<br />
General <strong>Radiology</strong>, Digital Mammography, Ultrasound, Dexa Scan, CT Scanning, MRI.<br />
THE CHESTER COUNTY HOSPITAL<br />
<strong>RADIOLOGY</strong> AT EXTON .............. . . . . . . 610-431-5131<br />
The Commons at Oaklands<br />
700 West Lincoln Highway, Exton, PA<br />
General <strong>Radiology</strong>, Ultrasound, Digital Mammography, CT Scanning, Dexa Scan.<br />
PENN PET/CT<br />
AT THE CHESTER COUNTY HOSPITAL .... . . . . 610-495-0060<br />
701 East Marshall, West Chester, PA<br />
For directions visit: www.chestercountyhospital.org<br />
*To order an MRI Study, use the MRI specific order form.
Change language