1, 2 Many of these are 4 cm or less in diameter (clinical stage T1a) and termed small renal masses (SRMs). 44 0 obj <> endobj @\N Recommended additional reformats: coronal and sagittal of each postcontrast scan series; 3-mm reconstruction section thickness without overlap. NB: This article is intended to outline some general principles of protocol design. Kidney Flow & Function Single Study Without Pharmacological Intervetion With Lasix Kidney Vascular Multi Liver Liver W/Vascular Flow Liver/Spleen Scan p,PPD9DL{O,!s]7mV6Rlzu_aB[v RKov/ The patient had MRI w/o contrast for the HIP right side and MRI w/o contrast of the Knee right side. [QUOTE="bnmoody, post: 392628, member: 265484"] Nephrographic phase also may improve the assessment of enhancement in poorly vascular tumors. Thirty patients undergoing four-phase renal CT scans for assessment of renal lesions (>10 mm) were included in the study. 0000009995 00000 n 97 0 obj <> endobj The suggested imaging protocols are based on expert consensus, with the goal of balancing diagnostic efficacy and radiation exposure ( Table1 ). > IMG 238. I can't find anything on the federal register stating p Read a CPT Assistant article by subscribing to. <> CPT Code 73721, Diagnostic Radiology (Diagnostic Imaging) Procedures, Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities - . >, Any electrically, magnetically or mechanically activated implant (e.g. NB: This article is intended to outline some general principles of protocol . Metallic foreign body in the eye 0000007963 00000 n CT protocols should be tailored to different clinical indications, balancing diagnostic accuracy and radiation exposure. Appt Reason CPT CodeCPT CodeCPT CodeCPT Code 11801 SW 90 Street Suite 102 Miami FL 33186 Tel: 305/270-6001 Fax: 305/270-6955 MRI Chest and Left Scapula W/O&W/Contrast 71552 73220 A9579 . x]_sLHkG38NL&CsT[N4V" bISM-bw:=V7]nN~=\,O-o;|rqE&,Lr!O?$O|HD\|B_r~"gjf{x^'fv_'%|ONKE.5p%ujTd"gGVd The Society of Abdominal Radiology (SAR) Disease-Focused Panel (DFP) on RCC is a multi-institutional working group aimed at addressing the unmet needs in the clinical care, research, and education in RCCs. HlMr >/ > For the assessment of cystic kidney disease IV contrast generally is needed for the characterization, staging, surveillance, and post-treatment follow-up of renal tumors. Recent data also suggest that well-defined homogeneous renal mass with attenuation 30 HU or less on the portal venous phase CT can be considered benign cysts and require no additional imaging. Diphenhydramine (Benadryl) (optional): 50 mg PO to be taken 1 hour prior to exam. Call 855-SAFE-RAD to schedule a radiology exam. startxref 70547. <> At the time the article was created Andrew Murphy had no recorded disclosures. Monitor that patient is breath-holding. 5 ). , Although multiphase CT for tumor subtyping is promising, there are no prospective studies to date that have validated the reported enhancement threshold. Corticomedullary phase typically is acquired 40 seconds to 70seconds after IV contrast injection (see Fig. CT EXAM CPT CODE REFERENCE Use this reference to quickly determine the correct exam for your patients based on the Trigger when contrast reaches SMA. With and without Abdomen Only (Pancreatic Protocol) ?,)NA 7 ). If the patient has a MRI [U]Joint[/U] you can code [B]multiple[/B] studies [U](Upper: 73221-73223) (Lower: 73721-73723). 0000011400 00000 n During this phase, there is intense enhancement of the renal cortex, allowing differentiation between the cortex and the medulla. The specifics will vary depending on MRI hardware and software, radiologist's and referrer's preference, institutional protocols . Everyone's choice for imaging imaginghealthcare.com 2020 CPT Code Exam Ordering Guide T 858 658 6500 F 866 558 4329 IHS Radiology Medical Group - Tax ID# 47-3394746 q-5GXRR{uj[qma..v.Q Dj QcU)0M'(_5Acc:4A1g59{P ClWk38?l4 VL K;~ZDm*HI(cCccsFGZvcW |w`90nT`GaGX -mY Q#x\G)!oMZJ,BCd3s HYmVgU*# n(7g(m SeH+ZFZ l5nbsOY>p]9;? 2001-2023 Oregon Health & Science University. ADVERTISEMENT: Supporters see fewer/no ads. Computed tomography (CT) protocols for renal mass evaluation should be tailored to the clinical indications with careful considerations of balancing diagnostic accuracy and radiation dose. > (, CT in a 69-year-old man with a papillary RCC demonstrating improved enhancement assessment on the nephrographic phase compared with the corticomedullary phase. >, A satisfactory written consent form must be taken from the patient before entering the scanner room Instruct the patient to hold their breath during image acquisition. UB@&^v0c&]IG'#4-;j84j8BB"a6z2L0f#MG5ZP6l#AlX*k%rm9 R8XAe+S7"kTPPOA^vd@b/[wO;R}cH3@4B nMEz|pHj-ZBuQZr)AC6>*dZ3Yd'~AqClWIA{7^l!T American Hospital Association ("AHA"), Appropriate Use Criteria (AUC) in Coding, Reimbursement, and Clinical Practice. Indeterminate renal mass, renal adenocarcinoma, metastasis, monitoring of known renal mass. The injection rate is suggested at 2 mL/s to 5mL/s. This phase is helpful for identifying RCC involvement of the collecting system as well as diagnosing primary malignancy arising from the collecting system, such as urothelial carcinoma involving the kidney ( Fig. 8 ); therefore, tumor contrast enhancement is more conspicuous on the nephrographic phase compared with the earlier corticomedullary phase. X:/QEZfG Those that are homogeneous with HU greater than 70 are hemorrhagic or proteinaceous cysts ( Fig. Contrast material is excreted into the renal collection system, ureters, and bladder in this phase, allowing better visualization of these structures. <>/ExtGState<>/XObject<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/Annots[ 14 0 R 15 0 R] /MediaBox[ 0 0 792 612] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Hematuria (CT Urogram, CT IVP) CT Hematuria Protocol CT/IVP w & wo 74178 MRI Abdomen and Pelvis w . Planning must be done in the breath hold T1 vibe coronal because the diaphragm will push down the upper abdominal organs during inhalation and change the position of the kidneys from the initial localizer scans. BODY PART REASON FOR EXAM PROCEDURE NOTES CPT CODE HEAD AND NECK Sella/Pituitary Pituitary dysfunction Adenoma, Sellar or suprasellar mass MRI HEAD W AND W/O CONTRAST (UMC order appears as MRI BRAIN W AND W/O CONTRAST) 70553 Inner Ear (IAC) CPA tumor <>>> If RENAL FAILURE (Creatinine over 1.8)-ORDER EXAM WITHOUT CONTRAST. Our podiatrist states that she can report reading for MRI, if patient is bringing in the MRI disc with images and she read it [COLOR="#EE82EE"][/COLOR] Ok, so this seems silly, however, sometimes when reviewing information, there is not always a cut and dry answer to questions. Check before giving contrast. 0000002341 00000 n The excretory phase may be helpful for distinguishing urothelial cancers from RCCs and parapelvic or peripelvic cysts from hydronephrosis and for diagnosing calyceal diverticula. Computed tomography (CT) and MR imaging with intravenous (IV) contrast are the mainstays of renal mass evaluation. 0000031716 00000 n CPT Code 74170. Renal mass (cyst or solid) Transitional cell carcinoma of kidney Abnormal findings mri aBdomen: Adrenal MRI Abdomen with and without contrast 74183 Adrenal mass or lesion Hypertension Pheochromocytoma Determined by Radiologist Body mrcP: Biliary MRI Abdomen with and without contrast 74183 Abdominal pain Jaundice 0000003129 00000 n Breathe the patient slowly so they have time to follow instructions. View the CPT code's corresponding procedural code and DRG. . Ask the patient to undress and change into a hospital gown . 11 The vast majority of asymptomatic adrenal masses are benign, and patients . Minimize SENSE if there is mottling in the center of the image. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-94873, View Raymond Chieng's current disclosures, see full revision history and disclosures, iodinated contrast-induced thyrotoxicosis, saline flush during contrast administration, CT NCAP (neck, chest, abdomen and pelvis), CT angiography of the cerebral arteries (protocol), CT angiography of the circle of Willis (protocol), cardiac CT (prospective high-pitch acquisition), CT transcatheter aortic valve implantation planning (protocol), CT colonography reporting and data system, CT kidneys, ureters and bladder (protocol), CT angiography of the splanchnic vessels (protocol). For others, it may consist of a corticomedullary phase (40-60 second delay) and/or an excretory phase (5-10 minute delay). 97 29 . i Furthermore, imaging plays a key role in the presurgical planning of renal tumors and in surveillance after surgery or systemic therapy for advanced RCCs. 4 0 obj 0000005493 00000 n If possible provide a chaperone for claustrophobic patients (e.g. Ensure kidneys are well-centered in coil to ensure good signal at dome. codes. Prednisone: 50 mg PO (three doses total) to be taken 13 hours, 7 hours and 1 hour prior to appointment. 66 0 obj <>/Filter/FlateDecode/ID[]/Index[44 37]/Info 43 0 R/Length 103/Prev 145237/Root 45 0 R/Size 81/Type/XRef/W[1 2 1]>>stream > ydm7!d~!T. The corticomedullary and excretory phases together with the precontrast-phase and nephrographic-phase images may be helpful to subtype renal masses. > Hematuria, > Acquisition: axial, 3-mm reconstruction section thickness with or without 50% overlap. These are fast single shot localisers with under 25s acqusition time which are excellent for localising abdominal structures. Notes: Indeterminate adrenal lesions are typically discovered incidentally on contrast enhanced Patient with renal insufficiency or hemodialysis; Rib mass/fracture (bony chest) Patient pregnant; MRA/MRV Chest w/ and w/o contrast . Do not start scan until the patient has stopped breathing. 0000025763 00000 n SA`00, pCR hj~ ?g Diagnostic Radiology (Diagnostic Imaging) Procedures, Diagnostic Radiology (Diagnostic Imaging) Procedures of the Lower Extremities, Copyright 2023. > Prednisone: 50 mg PO (three doses total) to be taken 13 hours, 7 hours and 1 hour prior to appointment. The recommended dose of gadolinium DTPA injection is 0.1 mmol/kg, i.e. Metal shrapnel or bullet, > Combat the #1 denial reason - mismatched CPT-ICD-9 codes - with top Medicare carrier and private payer accepted diagnoses for the chosen CPT code. 80 0 obj <>stream The purpose of this exam is to assess the location and composition of a renal mass. 8 ). > 0000042057 00000 n Patients with hives or rash must be pre-medicated for an IV contrast CT scan (not oral contrast). Power inject 2mL/sec. For example, renal masses that are homogeneous and have Hounsfield units (HU) measuring fluid density (between 10 HU and 20 HU) on noncontrast-enhanced CT are benign simple cysts. 0000009361 00000 n [U]Non-joint [/U]studies are to be We have a separate company with an MRI unit and we were approved by Medicare. Subscribe to Anesthesia Coder today. Many institutions will perform this around 5 minutes to demonstrate opacification of the ureters, mid-diaphragm to the iliac crest (covering kidneys), mid-diaphragm to the iliac crest (covering kidneys), contrast injection considerations (bolus tracking), level of the diaphragmatic hiatus or first lumbar vertebra at the aorta, 100 mL of non-ionic contrastat 3 to 5 mL/s (a higher flow rate will equal greater enhancement), 20-30 seconds post bolus trigger (30-40 s after injection), mid-diagram to lesser trochanter (covering entire renal system), pseudoenhancement, an artifact encountered where the calculated density of a lesion is inaccurately increased, is a problem often noted in renal mass scans,dual-energy CT via virtual monoenergetic images at a KeV range of 80 Kev to 90 KeV can minimize beam hardeningand partial volumingand overcome this issue, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Ferromagnetic surgical clips or staples Given the indolent nature of papillary RCCs in general, these may be appropriate for active surveillance rather than surgical resection, especially in patients who are poor surgical candidates. Position the patient over the spine coil and place the body coil over the abdomen (xiphoid process down to anterior superior iliac spine) PelviS: renal STone ProToCol . 2. Phase oversampling and, in the case of 3D blocks, slice oversample, must be used to avoid wrap around artefacts. Note: NPO 4 hours. Note the weight of the patient, > Check the positioning block in the other two planes. > (, CT in a 64-year-old man with a renal mass illustrating the utility of excretory phase in delineating involvement of the collecting system. 1]5EoI]gdiv2_G+jkD7FbdXZQ?pJoeA;8J:0*2g;_o. Adding a U prior to the IV makes the exam ultralow dose, o BCT 02UIV abd pelv w/IV contrast, ultralow dose. 0000004668 00000 n Office of Civil Rights Investigations and Compliance. > carcinoma) 0000011681 00000 n MRI Abdomen with or without contrast 74183 Hematuria (blood in urine) Renal mass (cyst or solid) Transitional cell carcinoma of kidney Abnormal findings on other imaging studies Yes Body . CT is the most commonly used modality for the detection and characterization of renal masses as well as presurgical planning and post-therapy surveillance. H= {,# $9N2)vELLc# qTxPec%={nv.lU'V{sMR7v';c9c%F. More CPT Codes: CT | Solar Medicine | PET/CT | PET/MR | Ultrasound Breast/Chest/Cardiac MRI Musculoskeletal MRI Brain/Spine MRI Each testing takes about 45 minutes of scanning. y;?5Zr|e~fhlw`m@b]z"tKp+#14^w]^wwt22*Z#OlA?rv1HDXM\m w`,3UE~^X_~1E1(S8lyLV7qL6D"98%eM-r!zU a,qN*)[6%Tz\ mv9xBFk$K/c1?gz3?t{A#!=)01ST`ipFY{\1>c$&34pR ?@Q6/g_1%H5zY^wm@2>^K~oY!QEm.f2Gw;rty^W=D *l !%/"2vGVc>|~{OmL tR7tH]VVB 50A'1|e8 Scanner preference: 1.5T AJR Am J Roentgenol. T2 tse breath hold (TRUFI or HASTE)coronal 4mm, Plan the coronal slices on the axial plane; angle the position block parallel to the mid line along the right and left kidneys. Computed tomography (CT) and MR imaging are mainstays for renal mass characterization, presurgical planning of renal tumors, and surveillance after surgery or systemic therapy for advanced renal cell carcinomas. Spinal MRI (mass in the spinal canal at the T12-S3 level) 11 November 2020: . Note: This article is intended to outline some general principles of protocol design. <>/Metadata 1078 0 R/ViewerPreferences 1079 0 R>> Similarly, on a single-phase postcontrast CT, renal masses that are homogeneous and measure fluid density are simple cysts. Renal Mass Characterization/Surgical Planning (if in conjunction with Pelvis CT w/contrast CPT Code 74178, IMG 783) Pancreatic mass characterization/surgical planning (if in conjunction . CNobM*KUfBC*w3!Nh!R=: jq`?xL_,NI{F1&p=P;e! > HCC Renal Mass or Cyst Transitional Cell Carcinoma of Kidney Increased Liver . trailer > With increasing utilization of cross-sectional imaging such as ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI), the detection rates of an incidental kidney lesion have increased over time [].While most incidental kidney lesions can be left alone as they will have no clinical consequences, some are pathologies (eg, renal cell carcinoma, renal . hoHaBRtMd0)iC{$;;] p%@;N)pWPMHsBi\sC: cRxoAYU&%o>tLT0* &AQCI>u. Renal tumors are incidentally discovered at an increasing frequency due to the widespread use of cross-sectional imaging. Offer earplugs or headphones, possibly with music for extra comfort Intracranial aneurysm clips (unless made of titanium) . hb```f``e`e`cd@ A(G x{LonCI%[p]W-m=J;::*$. stream <> Tumor/Mass/Cancer/Mets Note: MRI is more sensitive Yes ortho CT Extremity without contrast Upper Extremity Lower Extremity 73200 . Angiomyolipomas (AMLs) can be diagnosed confidently once intralesional macroscopic fat has been identified in the absence of other worrisome findings, such as intralesional calcification. % > For the assessment of benign renal lesions (e.g. If the patient has a MRI [U]Joint[/U] you can code [B]multiple[/B] studies [U](Upper: 73221-73223) (Lower: 73721- Hello, trying to get some help on understanding the use of modifier 26. Prednisone: 50 mg PO (three doses total) to be taken 13 hours, 7 hours and 1 hour prior to appointment. CT Abdomen without contrast (CPT 74150) or CT Abdomen and Pelvis without contrast (CPT 74176) if there is renal insufficiency/failure, or a documented allergy to contrast. The precontrast and nephrographic phase images are used to evaluate for changes of tumor size or enhancement characteristics in cases of active surveillance or detecting enhancing tumor in post-treatment settings ( Fig. z'po/^&-ZI J^4$1(60j Description by CPT Code* CPT Code Sacrum Sacral Insufficiency Fracture No MRI Sacrum wo 72196 SacralIliitis Tumor/Mass/Cancer/Mets Yes MRI Sacrum w/ & w/o 72197 Wrist Arthrogram TFCC tear Scaphoid nonunion Yes ** MR Upper Ext joint w/ Contrast Injection - Wrist 73222 25246 Intercarpal Ligaments Soft tissue ganglia Yes ** Rad exam - wrist 73115 It is most often comprised of a non-contrast, nephrogenic phase and excretory phase. 6 ) or identify vascular anomalies, such as pseudoaneurysm and arteriovenous fistula. I agree with what t Radiologist is performing MRI RT foot and ankle - the report talks about both areas. oD}tw.. Precontrast CT in a 62-year-old man shows a homogeneous hyperdense renal lesion (, CT in a 46-year-old man illustrates various enhancement phases in the kidneys. M}]JS+9uG7^E@h z/EZZ?_Fefmz-@vfpri)6KdK3:DHT8L2F1: Renal masses increasingly are found incidentally during work-up for nonrenal indications, largely due to the frequent use of medical imaging. > For the assessment of xanthogranulomatous pyelonephritis . The aim of this study is to investigate the feasibility of eliminating the nephrographic phase from the four-phase renal computed tomography (CT) imaging to a three-phase protocol without affecting its diagnostic value. 2 0 obj Protocol 1 Indications: Indeterminate renal mass Recommended scan series: Pre-contrast: kidneys only, axial, 3mm reconstruction section thickness with or without 50% overlap Nephrographic phase: kidneys only, axial, 3mm reconstruction section thickness with or without 50% overlap, at 100-120 second delay Optional additional scan series: An appropriate angle must be given in the sagittal plane (perpendicular to the long axis of kidney). h0 `UP i@`hhXXfrh%3.b+%|s?lpz@/a'A"VvCzl< This modality enables the radiologist to detect intra-tumor fat resulting in a loss of signal intensity. 74185. Procedure code. More CPT Codes: MRI | Nuclear Medicine | PET/CT | PET/MR | Ultrasound, Prep: NPO 2 hours for all studies w/ contrastArrival time: 30 minutes prior to exam for registration and prep, Dissection (if in conjunction with Abdomen and Pelvis CT w/contrast please see Chest w/ and w/o contrast and Abdomen Pelvis w/contrast (CPT Code 74177, IMG 698). It outlines all sequences and protocols currently applied in our MRI section. Excretory phase is obtained at 7 minutes to 10minutes after IV contrast injection. 0000007179 00000 n 0000008946 00000 n The renal mass CT protocol is a multi-phasic contrast-enhanced examination for the assessment of renal masses. Trigger & track. > Nephrographic phase is the most sensitive for detecting renal lesions. %%EOF Radiographics. 1 0 obj CPT ETO CYC DXR: Craniospinal (25.5 Gy) + Local (25.5 Gy) Check the positioning block in the other two planes. At the time the article was last revised Raymond Chieng had In the setting of advanced RCCs, tumor extension into the renal vain or inferior vena cava may be best assessed on the nephrographic phase as well. 3 ). Do not interleave images. hb```b``)a`e``ld`@ 4">kvv6*g^.i#wVz7_[/P=6w,t9ijtOT ~+IbInz/?^zPY\ w The renal vasculature also enhances intensely in this phase, which can provide additional information for surgical planning if needed ( Fig. 0 In a click, check the DRG's IPPS allowable, length of stay, and more. For some departments and/or radiologists, a renal mass protocol may only include a non-contrast, nephrogenic phase exam. allergy) and time constraints. MRA carotid w/o contrast. 1. CLINICAL GUIDELINES EXAM DESCRIPTION CT/CTA CPT CODES EXAM DESCRIPTION MRI/MRA CPT CODES Abdominal mass CT Abdomen & Pelvis w 74177 MRI Abdomen w & wo 74183 . Coil: Torso Coil. The code(s) have to match the requesting provider's order, which looks to be an "MRI RT FOOT". The combination of these phases may be modified depending on the clinical indications, such as for initial lesion characterization, surgical or ablation planning, or post-treatment follow-up. 4 ) compared with postcontrast CT or MR imaging. Measurement of HU change after contrast administration using the earlier corticomedullary phase in a papillary RCC may result in erroneous categorization of the lesion as a nonenhancing cyst (see Fig. 0000000016 00000 n > 2 B). Pregnancy (risk vs benefit ratio to be assessed) INTRODUCTION. 3 0 obj Check the positioning block in the other two planes. Multiplanar reformats in the coronal and sagittal planes of each postcontrast scan series also can be done with 3-mm reconstruction section thickness without overlap. <<9D26B84D59B5D04CBD15A8A60877983D>]/Prev 685671>> 4 0 obj JJW1iXC2wH(5Rm>^'cxTI YDLN!{4]. Sheth S & Fishman E. Multi-Detector Row CT of the Kidneys and Urinary Tract: Techniques and Applications in the Diagnosis of Benign Diseases. 0000018234 00000 n Within the next several years providers will be required to observe appropriate use criteria AUC as a condition of payment when reporting certain services for Medicare beneficiaries. 0000009557 00000 n Slices must be sufficient to cover both kidneys anterior to posterior. /1 G,G5?I7 L3 level), Suggested protocol, parameters and planning. Although the specifics of a renal protocol CT vary by institutions, the following phases in their various combinations commonly are used: precontrast phase, corticomedullary phase, nephrographic phase, and excretory phase ( Fig. What CPT would you use 73718 or 73721 - I know I cannot code for both. MRI renal mass protocol v1.0 Society of Abdominal Radiology Disease Focused Panel on Renal Cell Carcinoma Zhen Jane Wang, MD, Project Leader Matthew S. Davenport, MD, Co-Chair Stuart G. Silverman, MD, Co-Chair Hersh Chandarana, MD Ankur Doshi, MD Gary M. Israel, MD John R. Leyendecker, MD Ivan Pedrosa, MD, PhD Steve Raman, MD Erick M. Remer, MD stream Kang S, Huang W, Pandharipande P, Chandarana H. Solid Renal Masses: What the Numbers Tell Us. 0000010636 00000 n Protocols listed have been reviewed and approved by a radiologist. Prep: Patient should not have caffeine 24 hours prior to exam; NPO 2 hours for all studies w/ contrast, Arrival time: 30 minutes prior to exam for registration and prep, Prep: NPO 2 hours for all studies w/ contrast, Prep: NPO 4 hours; may drink clear liquids up to 30 minutes prior to exam, CPT Code 72240 (Precert CPT Code 72240 & 72126), CPT Code 72255 (Precert CPT Code 72255 & 72129), CPT Code 72265 (Precert CPT Code 72265 & 72132), CPT Code 73700 (specify unilateral or bilateral), CPT Code 73701 (specify unilateral or bilateral). For prepartial nephrectomy or preablation planning of renal masses that have been previously completely characterized, the primary goal is to delineate the tumor and vascular anatomy. bYBqbQ-)(?x%r0810 For indeterminate renal masses, the field of view can be restricted to the kidneys only, with precontrast and nephrographic (obtained at 100-second to 120-second delay) phases considered essential for this indication. relative or staff ) (, Presurgical planning CT in a 65-year-old man with a left renal tumor. ), T1 In-opposed phase breath hold axial 4mm. Despite aggressive treatment in early stages of the disease, a clear positive effect in reducing kidney cancer-specific mortality is . Search across Medicare Manuals, Transmittals, and more. However, this article will cover the optional,corticomedullary phase too. Instruct the patient to keep still The group has suggested standardized CT protocols for renal mass evaluation based on different clinical indications, as described later. Current Procedural Terminology CPT 2022 MAGNETIC RESONANCE IMAGING - MRI COMPUTED TOMOGRAPHY - CT MAGNETIC RESONANCE ANGIOGRAHY - MRA MAGNETIC RESONANCE VENOGRAPHY - MRV . An appropriate angle must be given in the sagittal plane (parallel to the long axis of kidney). endobj Arrive 90 minutes prior to exam for registration and prep. MR imaging protocols should take advantage of the improved soft tissue contrast for renal tumor diagnosis and staging. Explain the procedure to the patient MRI Kidneys and Renal Arteries W/O & W/Contrast 74183 74185 A9579 MRI Kidneys W/O & W/Contrast 74183 A9579 Plan the axial slices on the coronal plane; angle the position block parallel to the right and left renal pelvis. I am having controversial answers in our practice in reference to duplicate billing for code 72721. Instruct the patient to hold their breath during image acquisition. Obtained at 100 seconds to 120seconds after IV contrast injection, the timing for this contrast-enhancement phase is later than the typical portal venous phase, allowing for uniform enhancement of the renal parenchyma and in general providing the highest tumor to background distinction compared with the other phases ( Fig.