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Johns Hopkins Medical Imaging

Order Wisely: MSK MRI

MRI Ordering Tips

It is recommended to document on your order: “This order may be modified according to Imaging department written protocol including the administration of contrast.” This will allow us to make the necessary modifications recommended by our radiologist and will ensure the order meets our departmental policies. If this verbiage is not on the order, we will be unable to modify and we will need to reach out for new orders.

If ordering a contrast study, please always place the order as MRI w/wo contrast. If the order is written as MRI w/ contrast, we will need to reach out to the ordering provider for a new order stating with and without contrast.

MARS (Metal Artifact Reduction Sequence)

  • Area of interest has a Joint replacement or Significant Fixation Hardware (A small amount of metal, such as a screw from ACL repair, does not require a MARS study)
  • MARS Tumor studies are only performed at JHH
  • Place order for correct body part and Specify MARS in ordering comments
  • Limited to one body part per appointment. If multiple areas need to be imaged, separate orders and appointments will be necessary. (Example - the patient has a femur rod that extends from hip joint to knee joint, and you are requesting hip to knee imaging; this will need to be done in 2 separate appointments and will require orders for a lower extremity joint and a lower extremity non joint)

MSK Tumor Studies should be ordered with and without contrast unless contraindicated.

MSK Tumor Study Ordering Recommendation Example
Bone Tumors of Long Bones (Femur, Humerus, etc) To cover entire long bone, order “Joint w/wo & Non-joint w/wo Charge” For bone tumor of left femur, order:
  • IMG3064 CPT73723 MRI lower extremity left joint w/wo

    AND
  • IMG3052 CPT73720 MRI lower extremity left excluding joint w/wo
Soft Tissue Tumors and Nerve Tumors Covers only one mass/area of interest.

For multiple areas of interest or mass, specify and order all body parts needed. 		For soft tissue tumor around the left ankle, order:
  • IMG3064 CPT73723 MRI lower extremity left joint w/wo
For masses in both the area of the left ankle & higher up in the Tib/Fib, order an ADDITIONAL:
  • IMG3052 CPT73720 MRI lower extremity left excluding joint w/wo

Varying Body Part MSK Studies

MSK Study Guidelines Specific Ordering Exams
Muscle Tear Must specify/order the appropriate body part. For pectoralis, order:
  • IMG275 CPT71550 MRI chest wo
Neurography studies Typically ordered without contrast and will need a charge for the appropriate body part or parts.
Osteomyelitis Order without contrast.

For abscess/fluid collection or devitalized soft tissue/bone, order w/wo contrast.
Long Bone Stress Fracture Used for any long bone. Must specify/order appropriate body part. For Tibial Stress Fracture order:
  • IMG3045 CPT73718 right
  • IMG3044 CPT73718 left
For Humerus Stress Fracture order:
  • IMG3017 CPT73218 right
  • IMG3018 CPT73218 left
Specific Body Part MSK Studies
MSK Study Guidelines Specific Ordering Exams
Ankle
  • Achilles tendonitis
  • Achilles tear – please specify, as this requires additional imaging sequences
  • Hindfoot
  • Calcaneus
  • MARS Ankle – only specify MARS when patient has significant metal hardware
  • Tarsal Tunnel Neurography
  • IMG1405 CPT73721 ankle right wo
  • IMG1407 CPT73721 ankle left wo
Brachial Plexus
  • Neurography (wo contrast)
  • Neurography Tumor (w/wo contrast)
  • Both charges include a c-spine & chest charge

    IMG1333 CPT71550,72141 brachial plexus wo
  • IMG3350 CPT71552,72156 brachial plexus w/wo
Brachial Plexus and Arm
  • Neurography
 Use charges above and add below charges based on area of interest:

Humerus:
  • IMG3017 CPT73218 upper extremity right excluding joint wo
  • IMG3018 CPT73218 upper extremity left excluding joint wo
Elbow:
  • IMG1329 CPT73221 elbow right wo
  • IMG1330 CPT73221 elbow left wo
Chest
  • Chest wall
  • Intercostal Neuralgia – add IMG281 T-spine wo
  • Long Thoracic – add IMG279 C-spine wo
  • Muscle tear Pectoralis
  • Scapula
  • Sternoclavicular joints
  • Sternum
  • IMG275 CPT71550 chest wo
Cubital Tunnel and Forearm or Upper Arm
  • Neurography wo
Must specify upper arm or forearm in comments.
  • IMG3368 CPT73218,73221 cubital tunnel and forearm or upper arm right wo
  • IMG3369 CPT73218,73221 cubital tunnel and forearm or upper arm left wo


    Must specify upper arm or forearm in comments
Elbow
  • Cubital tunnel
  • Neurography
  • MARS Elbow – only specify MARS when patient has significant metal hardware
  • Pitcher’s elbow / Tommy John diagnosis
  • IMG1329 CPT73221 elbow right wo
  • IMG1330 CPT73221 elbow left wo
Femoral Anteversion/Tibial Torsion (Bilateral Hips, Knees, Ankles)
  • Femoral Anteversion/Tibial Torsion
  • IMG4444 CPT73721 Femoral Anteversion wo
Finger/Hand/Thumb
  • Injury
  • IMG3017 CPT73218 upper extremity right excluding joint wo
  • IMG3018 CPT73218 upper extremity left excluding joint wo
Forefoot/Midfoot
  • Hallux sesamoid
  • Hallux Valgus
  • Morton's Neuroma
  • Neurography
  • Osteoarthritis
  • Pain
  • Stress Fracture
  • Tarsal Tunnel
  • IMG3045 CPT73718 lower extremity right excluding joint wo
  • IMG3044 CPT73718 lower extremity left excluding joint wo
Hindfoot
  • Calcaneus
  • IMG1405 CPT73721 ankle right wo
  • IMG1407 CPT73721 ankle left wo
Hip
  • MARS (specify in comments; only specify MARS when patient has significant metal hardware or joint replacement)
  • Pain
  • Strain
  • IMG1409 CPT73721 hip right wo
  • IMG1410 CPT73721 hip left wo
Hip Perfusion/Perthes Scanned with and without contrast of the affected side.
  • IMG3065 CPT73723 right
  • IMG3064 CPT73723 left
Intercostal Neuralgia
  • Neurography
  • IMG275 CPT71550 MRI chest wo
  • IMG281 CPT72146 T-spine wo
Knee
  • MARS (specify in comments; only specify MARS when patient has significant metal hardware or joint replacement)
  • Internal derangement
  • Peroneal nerve
  • Soleal Sling
  • Bakers' cyst
  • Meniscus tear
  • ACL
  • Neurography
  • IMG1406 CPT73721 knee right wo
  • IMG1408 CPT73721 knee left wo
Long Thoracic
  • Long Thoracic Neurography
  • Spinal Accessory Nerve
  • Scapular Winging/Sprengel Shoulder
  • IMG275 CPT71550 MRI chest wo
  • IMG279 CPT72141 C-spine wo
Lumbo-sacral Plexus (includes l-spine & Pelvis)
  • Neurography (wo contrast)
  • Neurography Tumor (w/wo contrast)
  • IMG3372 CPT72148,72195 lumbo-sacral plexus wo
If thigh coverage is needed wo:
  • IMG3045 CPT73718 lower extremity right excluding joint wo
  • IMG3044 CPT73718 lower extremity left excluding joint wo
  • IMG3373 CPT72158,72197 lumbo-sacral plexus w/wo
If thigh coverage is needed w/wo:
  • IMG3053 CPT73720 lower extremity right excluding joint w/wo
  • IMG3052 CPT73720 lower extremity left excluding joint w/wo
Myositis
  • Myositis
 Pelvis & Thighs:
  • IMG3363 CPT72195,73718 myositis
Shoulders:
  • IMG3017 CPT73218 upper extremity right excluding joint wo
  • IMG3018 CPT73218 upper extremity left excluding joint wo
Pelvis
  • Athletic Pubalgia
  • Bony Pelvis
  • Pudendal Neuralgia
  • Sacroiliitis
  • Sacrum and coccyx
  • SI Joints
  • IMG289 CPT72195 pelvis wo
Pelvis & Thigh
  • Neurography (wo contrast)
  • Neurography Tumor (w/wo contrast)
  • IMG289 CPT72195 pelvis wo
  • IMG3045 CPT73718 lower extremity right excluding joint wo
  • IMG3044 CPT73718 lower extremity left excluding joint wo
  • IMG3375 2197,73720,73720 Pelvis and Thighs w/wo
Popliteal Entrapment
  • Popliteal entrapment
  • IMG3065 CPT73723 lower extremity right joint w/wo
  • IMG3064 CPT73723 lower extremity left joint w/wo
  • IMG1421 CPT73725, C8914 MRA lower extremity bilateral w/wo
If contrast is contraindicated, please order:
  • IMG1406 CPT73721 knee right wo
  • IMG1408 CPT73721 knee left wo
Rheumatology Should be ordered with and without contrast unless MRI contrast is contraindicated.



 Rheumatology Hand: Rheumatology Hand orders will cover the hand and wrist. Only the Upper extremity Excluding Joint w/wo Contrast charge is needed. If ordering Bilateral, each must be scheduled on separate days.
  • IMG3021 CPT73220 upper extremity right
  • IMG3022 CPT73220 upper extremity left
Rheumatology Feet/Ankles: Rheumatology Feet/Ankles will need both joint and non-joint with and without orders. If ordering Bilateral, each must be scheduled on separate days.
  • IMG3065 CPT73723 lower extremity right joint
  • IMG3064 CPT73723 lower extremity left joint
  • IMG3053 CPT73720 lower extremity right excluding joint w/wo
  • IMG3052 CPT73720 lower extremity left excluding joint w/wo
Shoulder
  • MARS (specify in comments; only MARS with significant metal hardware or joint replacement)
  • Chronic Pain
  • Fracture
  • Rotator Cuff
  • Subscapular Neurography
  • Scapula
  • IMG1331 CPT73221 shoulder right wo
  • IMG1332 CPT73221 shoulder left wo
Thoracic Sympathetic Chain (C1–T5/T6)
  • Neurography (wo contrast)
  • Neurography Tumor (w/wo contrast)
  • IMG281 CPT72146 T-spine wo
  • IMG286 CPT72157 T-spine w/wo
Vascular Anomaly
  • Requires one MRA charge
 Needs an MRI charge for each area of coverage including joint and/or non-joint 
Wrist
  • Carpal tunnel
  • Fracture
  • Pain
  • SL ligament
  • TFCC
  • IMG1327 CPT73221 wrist right wo
  • IMG1328 CPT73221 wrist left wo

This guide is for informational purposes only and does not constitute medical or legal advice, and is not intended for use in the diagnosis or treatment of individual conditions. The guide is not comprehensive and is provided as an example only, and should not be used as a substitute for the exercise of professional judgment, including but not limited to, in connection with any billing, imaging, CPT or other orders or healthcare claims related matter. The mention of any test, protocol, product, service, organization, activity, or therapy should not be construed as an endorsement by Johns Hopkins or its affiliates. This information is provided without representations or warranties of any kind, express or implied, all of which are disclaimed. Johns Hopkins and its affiliates assume no responsibility for any injury or damage to persons or property, delays or loss of revenue/income arising out of or related to the guide.