Private Room

Semi-Private Room

Intensive Care Unit

Emergency Critical Care; Each Additional 30 Minutes

Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes

Emergency Critical Care; First 30 Minutes

Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes

Emergency Department Visit - Level 2

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity.

Emergency Department Visit - Level 3

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity.

Emergency Department Visit - Level 4

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity, and require urgent evaluation by the physician or other qualified health care professionals but do not pose an immediate significant threat to life or physiologic function.

Emergency Department Visit - Level 5

Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity and pose an immediate significant threat to life or physiologic function.

Gait Training - 15 Minutes

Gait training is a therapeutic procedure that observes and educates an individual in the manner of walking including the rhythm, cadence, step, stride, and speed. The objective of gait training is to strengthen muscles and joints, improve balance and posture, and develop muscle memory. As the lower extremities are retrained for repetitive motion, the body also benefits from the exercise with increased endurance, improved heart/lung function, and reduced or improved osteoporosis. Gait training is an appropriate therapeutic procedure following brain and/or spinal cord injury, stroke, fracture of the pelvis and/or lower extremity, joint injury or replacement of the knee, hip, or ankle, amputation, and for certain musculoskeletal and/or neurological diseases. A treadmill fitted with a safety harness is initially used to ensure safe walking. As the patient gains strength and balance, step training and stair climbing is added to the treatment modality.

Physical Therapy; complex evaluation

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

Physical Therapy; standard evaluation

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

PT Evaluation - Moderate Complexity

A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.

PT to Re-Educate Brain to Muscle Function (15 min)

Therapeutic procedures for neuromuscular reeducation are used to develop conscious control of a single muscle or muscle group and heighten the awareness of the body's position in space, especially the position of the extremities when sitting or standing. Neuromuscular reeducation is employed during the recovery or regeneration stage following severe injury or trauma, cerebral vascular accident, or systemic neurological disease. The goal of therapy is improved range of motion (ROM), balance, coordination, posture, and spatial awareness. Techniques may include proprioceptive neuromuscular facilitation which uses diagonal contract-relax patterns of skeletal muscles to stimulate receptors in the joints that communicate body position to the brain via motor and sensory nerves. Feldenkrais is a method which observes the patient's habitual movement patterns and teaches new patterns based on efficient active or passive repetitive conditioning. Additional techniques that may be useful for neuromuscular reeducation are Bobath concept, which promotes motor learning and efficient motor control, and biomechanical ankle platform system (BAPS) boards.

Physical Therapy 1 or More Regions (15 min)

Manual therapies are skilled, specific, hands-on techniques usually performed by physical therapists, occupational therapists, chiropractors, osteopaths, and/or physiatrists to diagnose and treat soft tissue and joint problems. The goal of manual therapy is to modulate pain and induce relaxation, increase range of motion (ROM), facilitate movement, function, and stability, decrease inflammation, and improve muscle tone and extensibility. Tissue mobilization involves slow, controlled myofascial stretching using deep pressure to break up fibrous muscle tissue and/or connective tissue adhesions. Manipulation is a more forceful stretching of the myofascial tissue that takes the joint just beyond its restricted barrier. Manual lymphatic drainage is a type of light massage employed to reduce swelling by gentle movement of the skin in the direction of lymphatic flow. Manual traction involves the controlled counterforce of the therapist to induce asymptomatic strain by gently stretching muscle and/or connective tissue.

Physical Therapy Exercise; 15 Minutes

Therapeutic exercise is the application of careful, graduated force to the body to increase strength, endurance, range of motion, and flexibility. Increased muscle strength is achieved by the deliberate overloading of a targeted muscle or muscle group and improved endurance is achieved by raising the intensity of the strengthening exercise to the targeted area(s) over a prolonged period of time. To maintain range of motion (ROM) and flexibility requires the careful movement and stretching of contractile and non-contractile tissue that may tighten with injury or neurological disease, causing weakness and/or spasticity. Therapeutic exercise can increase blood flow to the targeted area, reduce pain and inflammation, reduce the risk of blood clots from venous stasis, decrease muscle atrophy and improve coordination and motor control. Therapeutic exercise may be prescribed following acute illness or injury and for chronic conditions that affect physical activity or function.

CPAP Initiation & Management

Continuous positive airway pressure (CPAP) ventilation is used primarily to treat sleep apnea. It may also be prescribed to treat preterm infants whose lungs have not fully developed. CPAP uses a mask or other breathing device that fits over the nose and mouth which is connected via a tube to a CPAP device. The CPAP machine delivers an air mixture at a continuous low level of pressure. The continuous positive airway pressure keeps the airways open and prevents mechanical obstruction of the flow of air caused by relaxation and collapse of airway structures during sleep. This code is used for initial set-up and management. A durable medical device provider delivers the CPAP device and other required equipment to the home or a residential facility. The device is set up and programmed to the settings indicated by the written prescription obtained from the physician or other qualified health care professional. The patient or caregiver is instructed on correct use of the CPAP and then is asked to demonstrate understanding by placing the mask over the mouth and nose and turning on the machine.

Routine EKG - Minimum 12 Leads

An ECG is used to evaluate the electrical activity of the heart. The test is performed with the patient lying prone on the exam table. Small plastic patches are attached at specific locations on the chest, abdomen, arms, and/or legs. Leads (wires) from the ECG tracing device are then attached to the patches. A tracing is obtained of the electrical signals from the heart. Electrical activity begins in the sinoatrial node which generates an electrical stimulus at regular intervals, usually 60 to 100 times per minute. This stimulus travels through the conduction pathways to the sinoatrial node causing the atria to contract. The stimulus then travels along the bundle of His which divides into right and left pathways providing electrical stimulation of the ventricles causing them to contract. Each contraction of the ventricles represents one heart beat. The ECG tracing includes the following elements: P wave, QRS complex, ST segment, and T wave. The P wave, a small upward notch in the tracing, indicates electrical stimulation of the atria. This is followed by the QRS complex which indicates the ventricles are electrically stimulated to contract. The short flat ST segment follows and indicates the time between the end of the ventricular contraction and the T wave. The T wave represents the recovery period of the ventricles. The physician reviews, interprets, and provides a written report of the ECG recording taking care to note any abnormalities.

Spirometry - breathing test

Spirometry is a pulmonary function test that is used to help diagnose the cause of shortness of breath and to monitor existing pulmonary disease, such as chronic bronchitis, emphysema, pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), and asthma. A spirometry device consisting of a mouthpiece and tubing connected to a machine that records and displays results is used to perform the test. The patient inhales deeply and then exhales through the mouthpiece. Inhalation and exhalation measurements are first taken with the patient breathing normally. The patient is then instructed to perform rapid, forceful inhalation and exhalation. The spirometer records the volume of air inhaled, exhaled, and the length of time each breath takes. The test results are displayed on a graph that the physician reviews and interprets in a written report.

Spirometry - medicated breathing procedure

Spirometry with bronchodilation responsiveness is a pulmonary function test that is used to help diagnose the cause of shortness of breath and to monitor existing pulmonary disease, such as chronic bronchitis, emphysema, pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), and asthma. The test is first performed without administration of a bronchodilator. A spirometry device consisting of a mouthpiece and tubing connected to a machine that records and displays results is used to perform the test. The patient inhales deeply and then exhales through the mouthpiece. Inhalation and exhalation measurements are first taken with the patient breathing normally. The patient is then instructed to perform rapid, forceful inhalation and exhalation. The spirometer records the volume of air inhaled, exhaled, and the length of time each breath takes. A bronchodilator medication is administered and the test is repeated. The test results are displayed on a graph that the physician reviews and interprets in a written report.

Stress Test

An ECG is used to evaluate the electrical activity of the heart using treadmill, bicycle exercise, and/or pharmacologically induced stress. Small plastic patches are attached at specific locations on the chest, abdomen, arms, and/or legs. Leads (wires) from the stress ECG device are then attached to the patches. A baseline ECG is obtained. The exercise portion of the study is then initiated. Heart rate and blood pressure are monitored. Staged stress protocol is used and the patient's response to stress is monitored as the stress ECG is recorded. Unless contraindicated, exercise or pharmacological stress continues until the patient is unable to continue or until the target heart rate is achieved. Upon completion of the study, the stress ECG is reviewed and a written interpretation of findings is provided.

Evaluation of Speech Sound Production and Language Comprehenson

Disorders of speech sound production that relate to language comprehension and expression usually manifest before the age of 4 years. Mixed language disorder (receptive and expressive) may be due to brain injury, developmental problems such as autistic spectrum disorders, hearing loss and learning disorders. In receptive language disorders an individual will have problems understanding what has been said, following directions and organizing thoughts. Expressive language disorders can manifest with difficulty putting words together to form coherent sentences, word finding and the use of placeholder words such as ôumö, decreased vocabulary for age, leaving out words when speaking, improper use of tenses (past, present, future) and repetition (echoing) of phrases. Evaluation by a speech-language pathologist (SLP) should include an audiogram to assess hearing (reported separately), formal and informal observation and assessment using standardized testing tools such as Receptive-Expressive Emergent Language Test (REEL).

Speech Therapy

A speech-language pathologist treats a speech, language, voice, communication, and/or auditory processing disorder. Using the information obtained from a separately reportable screening and in-depth evaluation of a speech or language disorder, the clinician develops an individualized treatment plan for the patient. The clinician defines specific treatment goals and sets baseline measures with which to assess the patient's progress. These goals are continuously monitored and fine-tuned throughout the treatment period. Once the goals and baseline measures have been established the clinician uses a number of intervention activities to correct the specific speech or language disorder identified. These can include games, stories, rhymes, drills, and other tasks. If the patient has a speech disorder, the clinician may demonstrate the sounds and have the patient copy the way the clinician moves the lips, mouth, and tongue to make the right sound. A mirror may be used so that the patient can practice making the sound while observing himself or herself in the mirror. Treatment of a language disorder might include help with grammar. If the patient is having difficulty with auditory processing, a game like Simon Says might be used to help improve understanding of verbal instructions.

Swallow Evaluation

An evaluation of the oral and pharyngeal phase of the swallowing function is performed in a patient who is suspected of having oropharyngeal dysphagia. The initial evaluation is typically performed by a dysphagia specialist, usually a speech-language pathologist. This evaluation is performed to determine whether more extensive studies are warranted. Swallowing function is divided into oral, pharyngeal, and esophageal phases. The oral and pharyngeal phases are made up of oral preparation for solid foods (not required for liquids or pureed foods), oral transfer, and initiation of the swallow. Both oral and pharyngeal movements are necessary in preparing, transferring, and swallowing food. The patient is given both solids and liquids to swallow. During oral preparation of solid food the ability of the tongue to move the food from side-to-side so that the solid can be chewed and prepared for swallowing is evaluated. Once the solid food is prepared and transferred to the back of the throat, the swallowing movements are evaluated. Propelling solids or liquids requires a complex set of movements including retraction of the base of the tongue, elevation of the hyolarynx, closure of the velopharyngeus, contraction of the pharynx, opening of the upper esophageal sphincter, and closure of the airway. The speech-language pathologist observes the patient to determine whether solids and liquids are being prepared, transferred, and propelled from the pharynx into the esophagus. A written report of findings is provided.

Swallow Treatment

Swallowing dysfunction and/or oral function are treated in an individual with difficulty passing food or liquid from the mouth or throat into the stomach. A swallowing or oral function disorder can occur in any age group or at any point in the swallowing process as food or liquid passes from the mouth, through the pharynx and esophagus, into the stomach. Swallowing disorders are common in individuals with degenerative neurological disorders such as cerebral palsy, amyotrophic lateral sclerosis (ALS), postpolio syndrome, myasthenia gravis, multiple sclerosis, and Parkinson's disease. A swallowing disorder may also result from neurological damage such as a stroke or head or spinal cord injury, or from a congenital or acquired deformity of the mouth, pharynx, esophagus, or stomach. Medical treatment is provided for a patient with a swallowing or oral function disorder. The diet is modified. Swallowing posture is assessed and modified as needed. Swallowing technique is modified to strengthen oropharyngeal muscle groups and improve the mechanics of swallowing so that food and liquid can pass into the esophagus and then into the stomach without aspiration into the lungs.

Acute Hepatitis Panel

An acute hepatitis panel is obtained to detect and diagnose acute or chronic viral liver infections. Hepatitis A virus (HAV) is highly contagious but usually causes only a mild illness. HAV is found in contaminated food and water but may also be spread person to person by close physical contact. It does not cause a chronic infection and a vaccine is available. Hepatitis B virus (HBV) is found in blood and body fluids and is the most common hepatitis virus contracted. It is a chronic infection and a vaccine is available against HBV. Hepatitis C virus is also found in blood and body fluids, and is chronic, however no vaccine is yet available to protect against this virus. Tests in an acute hepatitis panel should include Hepatitis A antibody, IgM antibody (HAAb IgM Ab), Hepatitis B core antibody, IgM antibody (HBcAb IgM Ab), Hepatitis B surface antigen (HBsAg), and Hepatitis C antibody (by CIA or Interp). Hepatitis A Virus antibody, IgM develops 2-3 weeks post exposure and remains elevated for 2-6 months. Hepatitis B Virus core antibody, IgM is produced in response to the presence of Hepatitis B core antigen. It will be elevated with acute initial infection and during flare up of disease activity in chronic infection. Hepatitis B Virus surface antigen is a protein located on the surface of HBV. Elevated levels of HBsAg may be an early sign of exposure to the virus or indicate an acute or chronic infection. When testing for Hepatitis C antibody, it is not possible to distinguish whether elevated levels are due to active acute infection or a chronic disease state unless differentiated by further testing. A specimen is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative chemiluminescent immunoassay.

Amylase

Laboratory testing for amylase may be performed on blood, urine, and other body fluids. Amylase is an enzyme responsible for the break down of starches into sugar molecules (disaccharides and trisaccharides) and eventually into glucose for energy use by the cells. Amylase is produced in saliva and the pancreas. Abnormal amylase levels may result from pancreatic inflammation or trauma, perforated peptic ulcer, ovarian cyst (torsion), strangulation ileus, macroamylasemia, mumps, and cystic fibrosis. A blood or body fluid sample is obtained. The sample is then tested using quantitative enzymatic methodology.

Analysis for Gastrointestinal Bacteria

A laboratory test is performed to measure Helicobacter pylori antibodies. H. pylori is a bacterium found in contaminated food and water and may be spread person to person. The organism causes chronic inflammation of the gastrointestinal mucosa, primarily in the stomach and duodenum, which leads to erosion or ulcer formation. The seroconversion of IgA and IgG antibodies will occur together within about 60 days of exposure. Elevated titers to both IgA and IgG antibodies in the presence of symptoms may represent an active H. pylori infection. The antibody test should be confirmed with bacterial isolation or other diagnostic tests such as H. pylori breath test, or fecal antigen by EIA. It is also possible to test for IgM antibodies, however the clinical usefulness of this measurement has not been clearly established. A blood sample is obtained by separately reportable venipuncture. Serum is tested for IgA/IgG antibodies using semi-quantitative enzyme immunoassay and for IgM antibodies using semi-quantitative enzyme-linked immunosorbent assay.

Arterial Blood Gases Measurement

A laboratory test is performed to measure one or more components of blood gases. The homeostatic acid-base balance is measured as blood pHùthe number of hydrogen ions (H+) dissolved in the blood. Partial pressure of carbon dioxide (pCO2) is the amount of carbon dioxide dissolved in the blood and reflects how well the lungs can move CO2 out of the body. Partial pressure of oxygen (pO2) is the level of oxygen dissolved in the blood and reflects the exchange of oxygen molecules in the alveoli. Bicarbonate (HCO3) is calculated from pH and pCO2 and is the metabolic component of acid-base balance reflecting the kidney's response to changes in pH. Oxygen saturation (O2 Sat) is the percent of hemoglobin that is carrying oxygen. Calculated O2 saturation uses a mathematical model to determine the percentage of hemoglobin that is carrying oxygen based on the level of pO2. Blood gas monitoring may be performed to evaluate lung function; detect an acid-base imbalance; monitor metabolic, respiratory, and kidney disorders; and evaluate the effectiveness of treatment. A blood sample is obtained by separately reportable venipuncture, heelstick, arterial, or umbilical cord draw.

Bacterial Blood Culture

A blood sample is drawn and placed in a medium conducive to the growth of bacteria. Any bacteria present in the blood sample will then reveal themselves.

Bacterial urine culture; quantitative colony count

"A laboratory test is performed to determine the presence or absence of bacterial colonies in urine and provide a colony count. Bacteria in urine may indicate an acute or chronic urinary tract infection (UTI) including pyelonephritis, cystitis, urethritis, or acute urethral syndrome. A urine sample is obtained by clean catch, mid-stream void or catheterization. Using a calibrated loop, the urine specimen is inoculated onto agar plates and incubated. Quantitative colony counts are determined and potential pathogens are identified. A colony count 10,000 cfu/mL is reported as ""organism present"" and may indicate an infection. Comingled flora of the urethra and mixed organisms in the colony counts are reported as ""mixed flora"" and most often represent contamination."

Basic Metabolic Panel

A basic metabolic blood panel is obtained that includes ionized calcium levels along with carbon dioxide (bicarbonate) (CO2), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN). A basic metabolic panel with measurement of ionized calcium may be used to screen for or monitor overall metabolic function or identify imbalances. Ionized or free calcium flows freely in the blood, is not attached to any proteins, and represents the amount of calcium available to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Total carbon dioxide (bicarbonate) (CO2) level is composed of CO2, bicarbonate (HCO3-), and carbonic acid (H2CO3) with the primary constituent being bicarbonate, a negatively charged electrolyte that works in conjunction with other electrolytes, such as potassium, sodium, and chloride, to maintain proper acid-base balance and electrical neutrality at the cellular level. Chloride is also a negatively charged electrolyte that helps regulate body fluid and maintain proper acid-base balance. Creatinine is a waste product excreted by the kidneys that is produced in the muscles while breaking down creatine, a compound used by the muscles to create energy. Blood levels of creatinine provide a good measurement of renal function. Glucose is a simple sugar and the main source of energy for the body, regulated by insulin. When more glucose is available than is required, it is stored in the liver as glycogen or stored in adipose tissue as fat. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly. Both potassium and sodium are positively charged electrolytes that work in conjunction with other electrolytes to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance and both are essential for maintaining normal metabolic processes. Urea is a waste product produced in the liver by the breakdown of protein from a sequence of chemical reactions referred to as the urea or Krebs-Henseleit cycle. Urea is taken up by the kidneys and excreted in the urine. Blood urea nitrogen, BUN, is a measure of renal function, and helps monitor renal disease and the effectiveness of dialysis.

Bilirubin Level; Direct

A laboratory test is performed to measure total or direct bilirubin. Bilirubin is a pigmented waste product normally produced when red blood cells (RBCs) break down. Non-water soluble (unconjugated) bilirubin is carried on albumin to the liver where it attaches to sugar molecules to become conjugated. Conjugated (direct) bilirubin is water soluble and able to pass from the liver to the small intestine. Further breakdown of bilirubin occurs in the small intestine and it is eventually eliminated in the feces in the form of stercobilin. Total bilirubin is the sum of conjugated (direct) and unconjugated bilirubin. A test for either conjugated or direct bilirubin or total bilirubin may be ordered to diagnose and monitor liver disorders, hemolytic anemia, and newborn (physiologic) jaundice. A blood sample is obtained by separately reportable venipuncture or heel stick. Other body fluids, including cerebral spinal fluid, may be collected and tested for total bilirubin. Serum/plasma is tested using quantitative spectrophotometry.

Blood Glucose Scan

A portable testing device called a glucometer is used at the patient's home or a physician's office to monitor glucose levels in the the blood. Glucose is a monosaccharide (single sugar) used for energy by the body. Certain diseases, such as diabetes, and medications may cause glucose levels to be abnormally high or low. A blood sample is obtained by fingerstick and placed on a test strip. Most commercial glucometers use a chemically treated test strip that produces a small electric current when blood is introduced. The strength of the electrical charge is dependent on the level of glucose in the sample. The glucose level is displayed on the monitoring device in a numeric measurement as mg/dL. This code is only reported when the physician or other healthcare professional uses this type of device in the office or other setting to check glucose levels, not when the patient self-administers the test.

Blood Potassium Level

A blood sample is obtained to measure potassium level. Potassium is a positively charged electrolyte that works in conjunction with other electrolytes, such as sodium, chloride, and carbon dioxide (CO2), to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance. Potassium is found in all body fluids but mostly stored within cells, not in extracellular fluids, blood serum, or plasma. Small fluctuations in blood potassium, either too high (hyperkalemia) or too low (hypokalemia), can have serious, even life-threatening, consequences. Potassium level is used to screen for and monitor renal disease; monitor patients on certain medications, such as diuretics, as well as patients with acute and chronic conditions, such as dehydration or endocrine disorders. Because blood potassium affects heart rhythm and respiratory rate, it is routinely checked prior to major surgical procedures. Potassium is measured by ion-selective electrode (ISE) methodology.

Blood Typing; ABO

A blood specimen is tested to determine blood type (ABO) or Rh(D). Blood is grouped using an ABO blood typing system which identifies four blood types: type A, B, AB, or O. The blood sample is mixed with antibodies against Type A and B blood and then checked to determine if the blood cells agglutinate, or stick together. Type A blood has anti-B antibodies; type B blood has anti-A antibodies; type O blood has antibodies to both A and B; and type AB blood does not have anti-A or anti-B antibodies. Type A blood agglutinates when type B antibodies are introduced. Type B blood agglutinates when type A antibodies are introduced. Type O blood agglutinates when type A or B antibodies are introduced. Type AB blood does not agglutinate when type A or B antibodies are introduced. The blood is then back typed. Blood serum is mixed with blood that is known to be type A or B.

Blood Unit Compatibility Test; Antiglobulin Technique

Coagulation Function Measurement; D-dimer; quantitative

D-dimer testing for fibrin degradation products is performed to help rule out the presence of a thrombus. D-dimer tests are also used to rule-out hypercoagulability. D-dimer has a negative predictive value for these conditions which means that a negative result indicates that there is not an elevated level of fibrin degradation products present in the specimen. A positive result indicates an abnormally high level of fibrin degradation products which may be indicative of a thrombus. It is used to help diagnosis deep vein thrombophlebitis, pulmonary embolus, and stroke. The test is also used to evaluate for hypercoagulability which predisposes the patient to blood clots and to help diagnose disseminated intravascular coagulation (DIC) and monitor the effectiveness of DIC treatment.

Complete Blood Count

An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.

Complete Blood Count/Differential

An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.

Comprehensive Metabolic Panel

A comprehensive metabolic panel is obtained that includes albumin, bilirubin, total calcium, carbon dioxide, chloride, creatinine, glucose, alkaline phosphatase, potassium, total protein, sodium, alanine amino transferase (ALT) (SGPT), aspartate amino transferase (AST) (SGOT), and urea nitrogen (BUN). This test is used to evaluate electrolytes and fluid balance as well as liver and kidney function. It is also used to help rule out conditions such as diabetes. Tests related to electrolytes and fluid balance include: carbon dioxide, chloride, potassium, and sodium. Tests specific to liver function include: albumin, bilirubin, alkaline phosphatase, ALT, AST, and total protein. Tests specific to kidney function include: BUN and creatinine. Calcium is needed to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Glucose is the main source of energy for the body and is regulated by insulin. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly.

Copper level

Creatine Kinase Level

Creatine kinase (CK) also known as, creatine phosphokinase (CPK), is an enzyme found in the heart, brain, skeletal muscle and certain other tissue. The subtypes are known as CK-MM found primarily in skeletal and heart muscle, CK-MB found in heart muscle and CK-BB located in the brain. CK circulating in blood rarely contains CK-BB but is largely comprised of CK-MM or CK-MB. Levels may be elevated following heart muscle damage (heart attack/myocardial infarction) and skeletal muscle injury (trauma, vigorous exercise). Statin drugs that lower cholesterol level and alcohol intake may cause elevated CK blood levels. Only creatine kinase (CK) MB fraction is measured. Testing for this isoenzyme can help identify heart muscle damage following a heart attack (myocardial infarction). A blood test is obtained by separately reportable venipuncture. Serum is tested using chemiluminescent immunoassay.

Cyanocobalamin (Vitamin B-12)

Cyanocobalamin is a vitamer of the B-12 vitamin family and plays an important role in metabolism, red blood cell production and nervous system function. Blood levels of cyanocobalamin are measured. Blood levels may be reduced with pernicious and other forms of anemia, and in individuals who follow a strict vegan diet, have chronic infections (such as HIV) and during pregnancy. A blood sample is obtained by separately reportable venipuncture. Serum is tested using quantitative chemiluminescent immunoassay.

Cyclosporine level

Detection test for clostridium difficile

Ferritin

A blood test is performed to measure ferritin levels. Ferritin is an intracellular protein that stores iron and releases it into circulation in a controlled manner to protect the body against iron overload and iron deficiency. Ferritin levels may be obtained to evaluate for elevated levels caused by excess storage diseases such as hemochromatosis and following multiple transfusions. Levels may also be obtained to evaluate for decreased levels due to iron deficiency. A blood sample is obtained by separately reportable venipuncture. Serum is tested using quantitative chemiluminescent immunoassay.

Folic Acid Level

A blood test is performed to measure folic acid (folate) levels in serum or red blood cells (RBC). Folic acid (folate) may also be referred to as Vitamin B9 and is essential for the growth, division and repair of cells, especially fetal growth during pregnancy and in early infancy. It is also necessary for the production of healthy red blood cells and to prevent anemia at all ages. The test may be used to diagnose anemia or certain neuropathies and to monitor the effectiveness of treatment for these conditions. A blood sample is obtained by separately reportable venipuncture.

Gonadotropin Analysis

A specimen is tested for chorionic gonadotropin (hCG). A qualitative test is performed to test for the presence of absence of hCG only. This test may be performed on blood or urine. Qualitative hCG testing is performed to confirm pregnancy.

Hemoglobin A1c

A blood test is performed to measure glycosylated hemoglobin (HbA1C) levels. Plasma glucose binds to hemoglobin and the HbA1C test measures the average plasma glucose concentration over the life of red blood cells (approximately 90-120 days). HbA1C levels may be used as a diagnostic reference for patients with suspected diabetes mellitus (DM) and to monitor blood glucose control in patients with known DM. HbA1C levels should be monitored at least every 6 months in patients with DM and more frequently when the level is >7.0%. A blood sample is obtained by separately reportable venipuncture. Whole blood is tested using quantitative high performance liquid chromatography/boronate affinity.

Ionized Calcium

A blood sample is taken to measure the amount of ionized or free calcium. Ionized or free calcium is calcium that flows freely in the blood and is not attached to any proteins. Ionized calcium is metabolically active and available to support and regulate heart function, muscle contraction, central nervous system function, and blood clotting. Ionized calcium measurements may be obtained prior to major surgery, in critically ill patients, or when protein levels are abnormal. Ionized calcium is measured by ion selective electrode (ISE) or pH electrode methodology.

Ketone body(s) (eg; acetone; acetoacetic acid; beta-hydroxybutyrate); qualitative

Lactate Dehydrogenase

A blood or body fluid test is performed to measure lactate dehydrogenase (LD) (LDH) levels. LDH is an enzyme present in red blood cells (RBCs) and in the tissue of heart, liver, pancreas, kidney, skeletal muscle, brain and lungs. LDH levels are used as a marker for tissue and RBC damage. Elevated blood levels can be caused by stroke, myocardial infarction, liver disease, pancreatitis, muscular dystrophy, infectious mononucleosis, hemolytic anemia and tumors/cancers such as lymphoma. Elevated cerebral spinal fluid (CSF) levels are usually indicative of bacterial meningitis. LDH levels in pleural and/or pericardial fluid can indicate if the effusion is an exudate, caused by an infection or a transudate caused by fluid pressure problem. A blood sample is obtained by separately reportable venipuncture. Cerebral spinal fluid is obtained by separately reportable lumbar puncture (spinal tap). Pericardial fluid is obtained by separately reportable pericardiocentesis. Fluid from a pleural effusion is obtained by separately reportable thoracentesis. Serum or plasma and all body fluids are tested using quantitative enzymatic methodology.

Lipid Panel

"A lipid panel is obtained to assess the risk for cardiovascular disease and to monitor appropriate treatment. Lipids are comprised of cholesterol, protein, and triglycerides. They are stored in cells and circulate in the blood. Lipids are important for cell health and as an energy source. A lipid panel should include a measurement of triglycerides and total serum cholesterol and then calculate to find the measurement of high density lipoprotein (HDL-C), low density lipoprotein (LDL-C) and very low density lipoprotein (VLDL-C). HDL contains the highest ratio of cholesterol and is often referred to as ""good cholesterol"" because it is capable of transporting excess cholesterol in the blood to the liver for removal. LDL contains the highest ratio of protein and is considered ""bad cholesterol"" because it transports and deposits cholesterol in the walls of blood vessels. VLDL contains the highest ratio of triglycerides and high levels are also considered ""bad"" because it converts to LDL after depositing triglyceride molecules in the walls of blood vessels. A blood sample is obtained by separately reportable venipuncture or finger stick. Serum/plasma is tested using quantitative enzymatic method."

Liver Panel

A hepatic function panel is obtained to diagnose acute and chronic liver disease, inflammation, or scarring and to monitor hepatic function while taking certain medications. Tests in a hepatic function panel should include albumin (ALB), total and direct bilirubin, alkaline phosphatase (ALP), total protein (TP), alanine aminotransferase (ALT, SGPT), and aspartate aminotransferase (AST, SGOT). Albumin (ALB) is a protein made by the liver that helps to nourish tissue and transport hormones, vitamins, drugs, and calcium throughout the body. Bilirubin, a waste product from the breakdown of red blood cells, is removed by the liver in a conjugated state. Bilirubin is measured as total (all the bilirubin circulating in the blood) and direct (the conjugated amount only) to determine how well the liver is performing. Alkaline phosphatase (ALP) is an enzyme produced by the liver and other organs of the body. In the liver, cells along the bile duct produce ALP. Blockage of these ducts can cause elevated levels of ALP, whereas cirrhosis, cancer, and toxic drugs will decrease ALP levels. Circulating blood proteins include albumin (60% of total) and globulins (40% of total). By measuring total protein (TP) and albumin (ALB), the albumin/globulin (A/G) ratio can be determined and monitored. TP may decrease with malnutrition, congestive heart failure, hepatic disease, and renal disease and increase with inflammation and dehydration. Alanine aminotransferase (ALT, SGPT) is an enzyme produced primarily in the liver and kidneys. In healthy individuals ALT is normally low. ALT is released when the liver is damaged, especially with exposure to toxic substances such as drugs and alcohol. Aspartate aminotransferase (AST, SGOT) is an enzyme produced by the liver, heart, kidneys, and muscles. In healthy individuals AST is normally low. An AST/ALT ratio is often performed to determine if elevated levels are due to liver injury or damage to the heart or skeletal muscles. A specimen is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative enzymatic method or quantitative spectrophotometry.

Magnesium Level

A blood, urine, or fecal test is performed to measure magnesium levels. Magnesium is an essential dietary mineral responsible for enzyme function, energy production, and contraction and relaxation of muscle fibers. Decreased levels may result from severe burns, metabolic disorders, certain medications, and low blood calcium levels. A blood sample is obtained by separately reportable venipuncture. Red blood cells (RBCs) are tested using quantitative inductively coupled plasma-mass spectrometry. Serum/plasma is tested using quantitative spectrophotometry. A 24-hour voided urine specimen is tested using quantitative spectrophotometry. A random or 24-hour fecal sample is tested using quantitative spectrophotometry.

Measurement of antibody (IgE) to allergic substance

Lab test for Allergen-specific antibodies

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative; by radioimmunoassay (eg; RIA)

Microscopic Examination of White Blood Cells with Manual Count

A blood smear is performed with microscopic examination with or without a manual differential WBC count. A blood smear is typically performed following an automated test that indicates the presence of abnormal or immature blood cells. It may also be performed when the physician suspects a condition that affects blood cell production, such as anemia. A blood sample is obtained by separately reportable venipuncture. A blood smear is prepared and examined under a microscope by a technician for immature or abnormal cells. The test is performed with a manual differential white blood cell (WBC) count. The technician examines and counts each of the five types of WBCs separately. Neutrophils comprise the majority of WBCs in healthy adults and are differentiated by cytoplasm with pink or purple granules. Eosinophils normally comprise 1-3% of total WBCs and are differentiated in stained smears by their large, red-orange granules. Elevated levels of eosinophils may indicate allergy or parasitic infection. Basophils normally comprise only 1% of total WBCs and are differentiated by their large black granules. Elevated levels of basophils may be indicative of certain leukemias, varicella (chicken pox) infection, or ulcerative colitis. Monocytes are the largest WBCs and act as scavengers to ingest (phagocytize) cellular debris, bacteria, and other particles. Lymphocytes produce antibodies (immunoglobulins) and are differentiated by their homogenous cytoplasm and smooth, round nucleus.

Natriuretic Peptide

The level of the natriuretic peptide in the blood is measured to evaluate heart failure and to differentiate symptoms that might be indicative of heart failure from other disorders that cause similar symptoms. A separately reportable venipuncture is performed and whole blood or plasma collected using EDTA as an anticoagulant. An automated immunoassay is performed using murine monoclonal and polyclonal antibodies against natriuretic peptide. The antibodies are labeled with a fluorescent dye and immobilized on the solid phase. The specimen is placed in the sample chamber and the analysis is run. The physician reviews the results and uses them to make diagnosis and treatment decisions.

PSA Measurement; Total

Prostate specific antigen (PSA) is measured. PSA is a protein produced by normal prostate cells found in serum and exists in both free form and complexed with other proteins. Total PSA is measured ad the total amount of both free and complexed forms. Total PSA levels are higher in men with benign prostatic hyperplasia (BPH), acute bacterial prostatitis, or prostate cancer. Total PSA is used to screen for prostate cancer and evaluate the response to treatment in those with prostate cancer, but cannot be used by itself to definitively diagnose prostate cancer.

Parathormone

A blood or tissue test is performed to measure parathormone (parathyroid hormone, parathyrin) levels. Parathyroid hormone (PTH) is produced by chief cells in the parathyroid gland. The hormone helps to regulate blood calcium levels, absorption/excretion of phosphate by the kidneys and in Vitamin D synthesis in the body. Elevated levels (hyperparathyroidism) may be caused by parathyroid gland tumors or chronic renal failure. Decreased levels (hypoparathyroidism) may result from inadvertent removal (during thyroid gland surgery), autoimmune disorders or genetic inborn errors of metabolism. A blood sample is obtained by separately reportable venipuncture. Parathyroid gland tissue is obtained by separately reportable fine needle aspirate. Serum/plasma or tissue sample are tested using quantitative electrochemiluminescent immunoassay. Plasma is tested for parathyroid hormone, CAP (Cyclase Activating Parathyroid Hormone) using immunoradiometric assay.

Phosphate Level

A blood or urine test is performed to measure inorganic phosphorus (phosphate) levels. Phosphate is an intracellular anion, found primarily in bone and soft tissue. It plays an important role in cellular energy (nerve and muscle function) and the building/repair of bone and teeth. Decreased levels are most often caused by malnutrition and lead to muscle and neurological dysfunction. Elevated levels may be due to kidney or parathyroid gland problems. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested using quantitative spectrophotometry.

Prothrombin Time

Prothrombin time (PT) measures how long it takes for blood to clot. Prothrombin, also called factor II, is one of the clotting factors made by the liver and adequate levels of vitamin K are needed for the liver to produce sufficient prothrombin. Prothrombin time is used to help identify the cause of abnormal bleeding or bruising; to check whether blood thinning medication, such as warfarin (Coumadin), is working; to check for low levels of blood clotting factors I, II, V, VII, and X; to check for low levels of vitamin K; to check liver function, to see how quickly the body is using up its clotting factors. The test is performed using electromagnetic mechanical clot detection. If prothrombin time is elevated and the patient is not on a blood thinning medication, a second prothrombin time using substitution plasma fractions, also referred to as a prothrombin time mixing study, may be performed. This is performed by mixing patient plasma with normal plasma using a 1:1 mix. The mixture is incubated and the clotting time is again measured. If the result does not correct, it may be indicative that the patient has an inhibitor, such as lupus anticoagulant. If the result does correct, the patient may have a coagulation factor deficiency.

Red Blood Cells; Leukocytes Reduced; Each Unit

Red blood cells, leukocytes reduced, each unit

Red Blood Count; Automated Test

An automated reticulocyte count is performed. Reticulocytes are new red blood cells (RBCs) that circulate in the peripheral blood for 1-2 days before losing sufficient RNA to become mature RBCs. A reticulocyte count may be performed when a blood test shows decreased RBCs and/or decreased hemoglobin or hematocrit measurements. The test can help determine if the bone marrow is responding to the body's need for RBCs. Indications for monitoring reticulocytes include vitamin B12 or folate deficiency, kidney disease, chemotherapy, bone marrow transplant, and treatment with erythropoietin or darbepoetin. A blood sample is obtained. A reticulocyte count is performed with an automated blood cell counting instrument. Automated reticulocyte count performed alone is reported. When automated reticulocyte count is performed with direct measurement of one or more cellular parameters, such as reticulocyte hemoglobin content (CHr), immature reticulocyte fraction (IRF), mean reticulocyte volume (MRV), or RNA content is reported. CHr measures the amount of hemoglobin in reticulocytes, which is an indicator of iron utilization for RBC production, and is used to diagnosis iron deficiency. IRF is used to determine whether reticulocytes are being released prematurely and to quantify the proportion of immature reticulocytes. Premature release occurs during periods of high demand for RBCs in chronic kidney disease, following chemotherapy or bone marrow transplant, or in patients with AIDs or malignant disease, as well as other conditions. IRF is calculated as a ratio of immature reticulocytes to the total number of reticulocytes (both immature and mature). MRV looks at the total volume of reticulocytes compared to total red blood cells and is used to evaluate iron utilization. RNA content is evaluated to determine the maturity of circulating reticulocytes.

Antihuman globulin test (Coombs test); direct; each antiserum

Renin (kidney enzyme) level

Rheumatoid factor level

Lab test for Rheumatoid Arthritis factor

Screening Test for Autoimmune Disorder

A blood sample is obtained to screen for the presence of antinuclear antibodies (ANA) or to measure the concentration of antinuclear antibody in the blood, which is referred to as an ANA titer. Antinuclear antibodies are auto-antibodies that bind to structures within the nucleus of cells. Auto-antibodies are a type of antibody that is directed against the body's own tissues. The presence and concentration of antinuclear antibodies may indicate one of several autoimmune disorders that cause inflammation of body tissues including systemic lupus erythematosus, Sjorgren's syndrome, rheumatoid arthritis, polymyositis, scleroderma, Hashimoto's thyroiditis, juvenile diabetes mellitus, Addison disease, vitiligo, pernicious anemia, glomerulonephritis, and pulmonary fibrosis. When testing for antinuclear antibodies, the specimen is typically screened first using an enzyme-linked immunosorbent assay (ELISA) If the screening test is positive, that is if antinuclear antibodies are detected, a titer is then obtained. An antinuclear antibody titer is performed by diluting the blood sample with increasing amounts of a saline solution and retesting until antinuclear antibodies are no longer detectable. ANA titer is expressed as 1:10, 1:20, 1:40, 1:80, etc, with the 1 indicating 1 part blood and the second number indicating the parts of saline solution. A higher second number indicates a higher concentration of antinuclear antibodies in the blood.

Screening Test for Red Blood Cell Antibodies

A blood sample is tested for antibodies directed against red blood cell (RBC) antigens other than A and B antigens. This test may also be referred to as an indirect antiglobulin test (IAT). This test is performed as part of a blood typing and screening test when it is anticipated that a blood transfusion might be required. If an antibody is detected, then separately reportable antibody identification is performed to identify the specific antibodies present. The test may be performed using IAT methodology or another serum technique such as solid phase. If multiple serum techniques are used, each reported separately.

Screening test for Pathogenic Organisms

This test is performed when a specific pathogen is suspected. A blood sample is taken and placed in a medium conducive to the growth of the suspected pathogen. Any colonies that grow in the medium are then examined.

Sirolimus level

Thyroid Hormone; T3 Measurement; Free

A blood sample is tested to determine levels of total triiodothyronine (T3), free T3, or reverse T3. T3 is a hormone made by the thyroid gland that affects almost every metabolic process including body temperature, growth, and heart rate. T3 can either be produced by the thyroid or synthesized by the body from T4. Approximately 95% of T3 is bound to proteins in the blood and is inactive. The remaining 5% is free and active. T3 tests are used to help determine whether the thyroid is functioning properly, to diagnose hyperthyroidism, and to monitor patients with known thyroid disorders. In total T3, which reflects the amount of both bound and free T3, is measured. Total and free T3 are evaluated using electrochemiluminescent immunoassay.

Thyroid hormone evaluation

Thyroxine

A blood sample is obtained and levels of total thyroxin, thyroxine requiring elution as for testing in neonates or free thyroxine are evaluated. Thyroxine, also referred to as T4, is tested to determine whether the thyroid is functioning properly and is used to aid in the diagnosis of overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid function. In free thyroxine levels are tested. Free thyroxine is the amount of active thyroxine in the blood. Free thyroxine levels are considered to be a more accurate indicator of thyroid function. All thyroxine tests use electrochemiluminescent immunoassay methodology.

Thyroxine Measurement

A blood sample is obtained and levels of total thyroxin (84436), thyroxine requiring elution as for testing in neonates (84437), or free thyroxine (84439) are evaluated. Thyroxine, also referred to as T4, is tested to determine whether the thyroid is functioning properly and is used to aid in the diagnosis of overactive (hyperthyroidism) or underactive (hypothyroidism) thyroid function. In 84436, total thyroxine levels are evaluated. Total thyroxine measures the total amount of both bound and unbound (free) thyroxine in the blood. All thyroxine tests use electrochemiluminescent immunoassay methodology. *

Total Protein Level; Urine

A urine test is performed to measure total protein levels. Protein is not normally found in urine and usually indicates damage or disease in the kidneys. Elevated levels are often present in patients with diabetes, hypertension, and multiple myeloma. A 24-hour or random urine sample is obtained and tested using quantitative spectrophotometry.

Triglycerides Level

A test is performed on blood or body fluids to measure triglyceride levels. Triglycerides contain glycerol and 3 fatty acid molecules and are a component of very low density lipoproteins (VLDL) found in blood and chylomicrons (cholesterol, protein, triglycerides) found in lymphatic fluid. They provide an energy source during metabolism and carry any unused dietary fats or calories to the liver and fat cells where they can be stored. Elevated levels may reflect recent carbohydrate and/or fat consumption. Blood samples should be obtained with the patient fasting for 12 hours. A blood sample is obtained by separately reportable venipuncture. Body (lymphatic) fluid is obtained by needle aspiration or incision/drainage of pooled fluid. Serum/plasma and body fluids are tested using quantitative enzymatic methods.

Urinalysis with Examination; using Microscope

A urinalysis is performed by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested. The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed. Bilirubin is a byproduct of the breakdown of red blood cells by the liver. Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation). A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys' ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope. The urine sample is placed in a test tube and centrifuged. The sediment is resuspended. A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria.

Urinalysis; Automated Test

A urinalysis is performed by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested. The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed. Bilirubin is a byproduct of the breakdown of red blood cells by the liver. Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation). A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys' ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope. The urine sample is placed in a test tube and centrifuged. The sediment is resuspended. A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria.

Vitamin D-3 Level

Blood levels of 25-hydroxyvitamin D are used to primarily to determine whether a deficiency of Vitamin D or abnormal metabolism of calcium is the cause of bone weakness or malformation. Vitamin D is a fat soluble vitamin that is absorbed from the intestine like fat, and 25-hydroxyvitamin D levels are also evaluated in individuals with conditions or diseases that interfere with fat absorption, such as cystic fibrosis, Crohn's disease, or in patients who have undergone gastric bypass surgery. A blood sample is obtained. Levels of 25-hydroxyvitamin D3 and 25-hydroxyvitamin D2 are evaluated using chemiluminescent immunoassay. The test results may be the sum of Vitamin D3 and D2 or the results may include fractions of D3 and D2 as well as the sum of these values.

Ultrasound Heart

The physician performs complete transthoracic real-time echocardiography with image documentation (2-D) including M-mode recording, if performed, with spectral Doppler and color flow Doppler echocardiography. Cardiac structure and dynamics are evaluated using a series of real-time tomographic images with multiple views recorded digitally or on videotape. Time-motion (M-mode) recordings are made as needed to allow dimensional measurement. Blood flow and velocity patterns within the heart, across valves and within the great vessels are evaluated by color flow Doppler. Normal blood flow patterns through these regions have a characteristic pattern defined by direction, velocity, duration, and timing throughout the cardiac cycle. Spectral Doppler by pulsed or continuous wave technique is used to evaluate antegrade flow through inflow and outflow tracts and cardiac valves. Multiple transducer positions or orientations may be required. The physician reviews the echocardiography images and orders additional images as needed to allow evaluation of any abnormalities. Digital or videotaped images are then reviewed by the physician. Abnormalities of cardiac structure or dynamics are noted. The extent of the abnormalities is evaluated and quantified. Any previous cardiac studies are compared to the current study and any quantitative or qualitative changes are identified. The physician provides an interpretation of the echocardiography with a written report of findings.

Ultrasound Veins of Both Arms or Legs

A vascular ultrasound study is performed to evaluate veins in the extremities. A duplex scan uses both B-mode and Doppler studies. A clear gel is placed on the skin of the extremity over the region to be studied. A B-mode transducer is placed on the skin and real-time images of the veins are obtained. A Doppler probe within the B-mode transducer provides information on the pattern and direction of blood flow in the veins. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the veins when the probe is moved over the region being studied. The Doppler probe produces sound waves that bounce off blood cells moving within the veins. The reflected sound waves are sent to an amplifier that makes the sound waves audible. The pitch of the sound waves changes if there is reduced blood flow, or ceases altogether if a vessel is completely obstructed. A computer converts the sound waves to images that are overlaid with colors to produce video images showing the speed and direction of blood flow as well as any obstruction. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function. The duplex scan may include a baseline evaluation followed by additional scans obtained with compression or using other maneuvers that alter blood flow. The physician reviews the duplex scan and provides a written interpretation of findings.

Ultrasound Veins of One Arm or Leg

A vascular ultrasound study is performed to evaluate veins in the extremities. A duplex scan uses both B-mode and Doppler studies. A clear gel is placed on the skin of the extremity over the region to be studied. A B-mode transducer is placed on the skin and real-time images of the veins are obtained. A Doppler probe within the B-mode transducer provides information on the pattern and direction of blood flow in the veins. The B-mode transducer produces ultrasonic sound waves that move through the skin and bounce off the veins when the probe is moved over the region being studied. The Doppler probe produces sound waves that bounce off blood cells moving within the veins. The reflected sound waves are sent to an amplifier that makes the sound waves audible. The pitch of the sound waves changes if there is reduced blood flow, or ceases altogether if a vessel is completely obstructed. A computer converts the sound waves to images that are overlaid with colors to produce video images showing the speed and direction of blood flow as well as any obstruction. Spectral Doppler analysis is performed to provide information on anatomy and hemodynamic function. The duplex scan may include a baseline evaluation followed by additional scans obtained with compression or using other maneuvers that alter blood flow. The physician reviews the duplex scan and provides a written interpretation of findings.

Ultrasound scan of abdominal; pelvic; and/or scrotal arterial inflow and venous outflow

Bone Density Scan (DEXA Scan)

These codes report dual-energy x-ray absorptiometry (DXA) for bone density study. Measuring bone mass or bone mineral density (BMD) is done to diagnose for bone disease, evaluate bone disease progression, or monitor the results of treatment, particularly for osteoporosis, which puts a bone at higher risk of fracture. The radiation dose of DXA is around 1/30th of that in a standard chest x-ray. DXA involves aiming two x-ray beams of different energy levels at the bones in alternate pulses. Soft tissue absorption is subtracted out, and the BMD is determined by the bone's absorption of each beam in the projected area. The DXA scan measurement is then compared to a same sex standard of bone density at age 30, since the maximum BMD occurs at age 30 in both males and females. The difference between the measured BMD and the sex-matched, average 30-year-old standard is known as the T score. A T score between -1.0 and -2.4 diagnoses osteopenia, while a T score of -2.5 or less indicates osteoporosis.

CT Abdomen & Pelvis with Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the abdomen and pelvis. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans. The CT scan is then performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the abdomen and pelvis. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data which is then displayed on the monitor as two-dimensional cross-sectional images of the abdomen or pelvis. The physician reviews the data and images as they are obtained and may request additional sections to provide more detail on areas of interest.

CT Abdomen & Pelvis with and without Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the abdomen and pelvis. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans. The CT scan is then performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the abdomen and pelvis. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data which is then displayed on the monitor as two-dimensional cross-sectional images of the abdomen or pelvis. The physician reviews the data and images as they are obtained and may request additional sections to provide more detail on areas of interest.

CT Abdomen & Pelvis without Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the abdomen and pelvis. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans. The CT scan is then performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the abdomen and pelvis. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data which is then displayed on the monitor as two-dimensional cross-sectional images of the abdomen or pelvis. The physician reviews the data and images as they are obtained and may request additional sections to provide more detail on areas of interest.

CT Angiogram Chest with and without Contrast

A computed tomographic angiography (CTA) of the noncoronary vessels of the chest is performed with contrast material including image postprocessing. Noncontrast images may also be obtained and are included when performed. CTA provides images of the blood vessels using a combination of computed tomography (CT) and angiography with contrast material. When angiography is performed using CT, multiple images are obtained and processed on a computer to create detailed, two-dimensional, cross-sectional views of the blood vessels. These images are then displayed on a computer monitor. The patient is positioned on the CT table. An intravenous line is inserted into a blood vessel, usually in the arm or hand. Non-contrast images may be obtained. A small dose of contrast is injected and test images are obtained to verify correct positioning. The CTA is then performed. Contrast is injected at a controlled rate and the CT table moves through the CT machine as the scanning is performed. After completion of the CTA, the radiologist reviews and interprets the CTA images of the noncoronary vessels of the chest.

CT Angiogram Head with and without Contrast

A computed tomographic angiography (CTA) of the head is performed with contrast material including image postprocessing. Noncontrast images may also be obtained and are included when performed. CTA provides images of the blood vessels using a combination of computed tomography (CT) and angiography with contrast material. When angiography is performed using CT, multiple images are obtained and processed on a computer to create detailed, two-dimensional, cross-sectional views of the blood vessels. These images are then displayed on a computer monitor. The patient is positioned on the CT table. An intravenous line is inserted into a blood vessel, usually in the arm or hand. Non-contrast images may be obtained. A small dose of contrast is injected and test images are obtained to verify correct positioning. The CTA is then performed. Contrast is injected at a controlled rate and the CT table moves through the CT machine as the scanning is performed. After completion of the CTA, the radiologist reviews and interprets the CTA images of the head.

CT Angiogram Neck with and without Contrast

A computed tomographic angiography (CTA) of the neck is performed with contrast material including image postprocessing. Noncontrast images may also be obtained and are included when performed. CTA provides images of the blood vessels using a combination of computed tomography (CT) and angiography with contrast material. When angiography is performed using CT, multiple images are obtained and processed on a computer to create detailed, two-dimensional, cross-sectional views of the blood vessels. These images are then displayed on a computer monitor. The patient is positioned on the CT table. An intravenous line is inserted into a blood vessel, usually in the arm or hand. Non-contrast images may be obtained. A small dose of contrast is injected and test images are obtained to verify correct positioning. The CTA is then performed. Contrast is injected at a controlled rate and the CT table moves through the CT machine as the scanning is performed. After completion of the CTA, the radiologist reviews and interprets the CTA images of the neck.

CT Arm without Contrast

Diagnostic computed tomography (CT) is done on the upper extremity to provide detailed visualization of the tissues and bone structure of the arm. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the arm can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the upper extremity. The physician reviews the CT scan, notes any abnormalities, and provides a written interpretation of the findings. The physician reviews the images to look for suspected problems with the arm such as locating tumors, abscesses, or masses; evaluating the bones for degenerative conditions, fractures, or other injury following trauma; and finding the cause of pain or swelling.

CT Chest with Contrast

Diagnostic computed tomography (CT) is done on the thorax. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and reconstructs a 3D image. Thin, cross-sectional 2D and 3D slices are then produced of the targeted organ or area. The patient is placed inside the CT scanner on the table and images are obtained of the thorax to look for problems or disease in the lungs, heart, esophagus, soft tissue, or major blood vessels of the chest, such as the aorta. The physician reviews the images to look for suspected disease such as infection, lung cancer, pulmonary embolism, aneurysms, and metastatic cancer to the chest from other areas.

CT Chest without Contrast

Diagnostic computed tomography (CT) is done on the thorax. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and reconstructs a 3D image. Thin, cross-sectional 2D and 3D slices are then produced of the targeted organ or area. The patient is placed inside the CT scanner on the table and images are obtained of the thorax to look for problems or disease in the lungs, heart, esophagus, soft tissue, or major blood vessels of the chest, such as the aorta. The physician reviews the images to look for suspected disease such as infection, lung cancer, pulmonary embolism, aneurysms, and metastatic cancer to the chest from other areas.

CT Cranial Cavity without Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In this study, CT scan of the eye socket (orbit); region that houses the pituitary gland (sella); region at the base of the skull (posterior fossa); or any portion of the ear (outer, middle, or inner) is obtained. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans, after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest. The physician reviews the CT scan, notes any abnormalities, and provides a written interpretation of the findings.

CT Face with Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In this study, CT scan of the maxillofacial area is obtained. The maxillofacial area includes the forehead (frontal bone), sinuses, nose and nasal bones, jaw (maxilla and mandible). The only facial region not included in this study is the orbit. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans, after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

CT Face without Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In this study, CT scan of the maxillofacial area is obtained. The maxillofacial area includes the forehead (frontal bone), sinuses, nose and nasal bones, jaw (maxilla and mandible). The only facial region not included in this study is the orbit. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans, after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

CT Head Brain with and without Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In this study, CT scan of the head or brain is performed. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

CT Head Brain without Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In this study, CT scan of the head or brain is performed. The patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

CT Neck without Contrast

Computerized tomography, also referred to as a CT scan, uses special x-ray equipment and computer technology to produce multiple cross-sectional images of the region being studied. In a CT scan of the soft tissues of the neck, the patient is positioned on the CT examination table. An initial pass is made through the CT scanner to determine the starting position of the scans, after which the CT scan is performed. As the table moves slowly through the scanner, numerous x-ray beams and electronic x-ray detectors rotate around the body region being examined. The amount of radiation being absorbed is measured. As the beams and detectors rotate around the body, the table is moved through the scanner. A computer program processes the data and renders the data in two-dimensional cross-sectional images of the body region being examined. This data is displayed on a monitor. The physician reviews the data as it is being obtained and may request additional sections to provide more detail of areas of interest.

CT Pelvis without Contrast

Diagnostic computed tomography (CT) is done on the pelvis to provide detailed visualization of the organs and structures within or near the pelvis, such as kidneys, bladder, prostate, uterus, cervix, vagina, lymph nodes, and pelvic bones. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of organs within the pelvis can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the pelvis area. The physician reviews the images to gather information for specified purposes such as diagnosing or monitoring cancer, evaluating the pelvic bones for fractures or other injury following trauma, locating abscesses or masses found during physical exam, finding the cause of pelvic pain, providing more detailed information before surgery, and evaluating the patient after surgery.

CT Spine Cervical without Contrast

Diagnostic computed tomography (CT) is done on the cervical spine. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the spine can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the cervical spine.

CT Spine Lumbar without Contrast

Diagnostic computed tomography (CT) is done on the lumbar spine. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the spine can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the lumbar spine. The physician reviews the images to look for suspected problems with the spine such as bone disease, and evaluate for fractures or other injuries as well as birth defects of the spine in children.

CT Spine Thoracic without Contrast

Diagnostic computed tomography (CT) is done on the thoracic spine. CT uses multiple, narrow x-ray beams aimed around a single rotational axis, taking a series of 2D images of the target structure from multiple angles. Contrast material is used to enhance the images. Computer software processes the data and produces several images of thin, cross-sectional 2D slices of the targeted organ or area. Three-dimensional models of the spine can be created by stacking multiple, individual 2D slices together. The patient is placed inside the CT scanner on the table and images are obtained of the thoracic spine. The physician reviews the images to look for suspected problems with the spine such as bone disease, and evaluate for fractures or other injuries as well as birth defects of the spine in children.

CT scan of pelvis before and after contrast

Cardiac Nuclear Stress Testing

Myocardial perfusion imaging is a nuclear medicine procedure used to evaluate the heart muscle and blood flow to the heart. An intravenous line is inserted into a vein in the hand or arm. ECG leads are placed and a blood pressure cuff is placed on the arm. The patient lies flat on a table in the procedure room for myocardial perfusion imaging performed at rest. For a stress study, the patient is either on a treadmill or bike or an injection of a pharmacologic agent is administered to stress the heart. A radionuclide, also called a tracer, is injected into the intravenous line and allowed to circulate. The radionuclide localizes in healthy heart tissue. Ischemic heart tissue does not absorb the radionuclide. Images of the heart and great vessels are obtained using single photon emission computed tomography (SPECT). When SPECT images are obtained, the scanner rotates around the body to obtain images in multiple planes. The physician evaluates heart wall motion to determine how effective the heart muscle is in pumping blood through the heart and to the peripheral vascular system. Ejection fraction, which is the percentage of blood pumped out of the heart to the peripheral vascular system, is measured using either a first pass or gated technique. In a first pass technique, images are obtained as the blood circulates through the heart during the first pass of the radionuclide. In a gated technique, a series of images are obtained between heart beats. Using electrical signals from the heart, the camera captures a series of images as the heart rests, creating very sharp, high resolution images. Additional images are obtained as needed. The physician reviews the images, calculates the ejection fraction and quantifies other parameters of heart function based on the distribution of the radionuclide. The physician then provides a written report of findings.

Chest X-Ray; 2 Views

A radiologic examination of the chest is performed. Chest radiographs (X-rays) provide images of the heart, lungs, bronchi, major blood vessels (aorta, vena cava, pulmonary vessels), and bones, (sternum, ribs, clavicle, scapula, spine). The most common views are frontal (also referred to as anteroposterior or AP), posteroanterior (PA), and lateral. To obtain a frontal view, the patient is positioned facing the x-ray machine. A PA view is obtained with the patient's back toward the x-ray machine. For a lateral view, the patient is positioned with side of the chest toward the machine. Other views that may be obtained include apical lordotic, oblique, and lateral decubitus. An apical lordotic image provides better visualization of the apical (top) regions of the lungs. The patient is positioned with the back arched so that the tops of the lungs can be x-rayed. Oblique views may be obtained to evaluate a pulmonary or mediastinal mass or opacity or to provide additional images of the heart and great vessels. There are four positions used for oblique views including right and left anterior oblique, and right and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views. A lateral decubitus view is obtained with the patient lying on the side; the patient's head rests on one arm, and the other arm is raised over the head with the elbow bent. Images are recorded on hard copy film or stored electronically as digital images. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.

Chest X-Ray; Single View

A radiologic examination of the chest is performed. Chest radiographs (X-rays) provide images of the heart, lungs, bronchi, major blood vessels (aorta, vena cava, pulmonary vessels), and bones, (sternum, ribs, clavicle, scapula, spine). The most common views are frontal (also referred to as anteroposterior or AP), posteroanterior (PA), and lateral. To obtain a frontal view, the patient is positioned facing the x-ray machine. A PA view is obtained with the patient's back toward the x-ray machine. For a lateral view, the patient is positioned with side of the chest toward the machine. Other views that may be obtained include apical lordotic, oblique, and lateral decubitus. An apical lordotic image provides better visualization of the apical (top) regions of the lungs. The patient is positioned with the back arched so that the tops of the lungs can be x-rayed. Oblique views may be obtained to evaluate a pulmonary or mediastinal mass or opacity or to provide additional images of the heart and great vessels. There are four positions used for oblique views including right and left anterior oblique, and right and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views. A lateral decubitus view is obtained with the patient lying on the side; the patient's head rests on one arm, and the other arm is raised over the head with the elbow bent. Images are recorded on hard copy film or stored electronically as digital images. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.

MRA Head without Contrast

Magnetic resonance angiography (MRA) is performed on the head without contrast materials, with contrast materials, and without contrast materials followed by contrast materials. MRA is a noninvasive radiology procedure used to evaluate arterial and venous vessels for conditions such as atherosclerotic stenosis, arterial dissection, acute thrombosis, aneurysms or pseudo-aneurysms, vascular loops, vascular malformations/tumors, or arterial causes of pulsatile tinnitus. MRA may be performed following vascular surgery on the intracranial vessels to assess vascular status. MRA uses a magnetic field and pulses of radiowave energy to provide images of the blood vessels. Multiple images, 1-2 mm in thickness, are obtained and then processed using an array algorithm to produce maximum intensity projections (MIPs). MIPs are similar to subtraction angiograms. Areas of interest are identified by the radiologist and coned down to produce detailed views of the arteries. This post-processing of the images is performed by a technologist. The MIPs are reviewed by the radiologist along with the initial MRA images. The radiologist provides a written interpretation of findings.

MRI Arm Joint without Contrast

Magnetic resonance imaging is done on a joint of the upper or lower arm. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the joint. MRI scans on joints of the upper extremity are often done for injury, trauma, unexplained pain, redness, or swelling, and freezing of a joint with loss of motion. MRI scans provide clear images of areas that may be difficult to see on CT.

MRI Brain with and without Conrast

Magnetic resonance imaging is done on the brain. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. MRI of the brain provides reliable information for diagnosing the presence, location, and extent of tumors, cysts, or other masses; swelling and infection; vascular disorders or malformations, such as aneurysms and intracranial hemorrhage; disease of the pituitary gland; stroke; developmental and structural anomalies of the brain; hydrocephalus; and chronic conditions and diseases affecting the central nervous system such as headaches and multiple sclerosis.

MRI Brain without Contrast

Magnetic resonance imaging is done on the brain. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. MRI of the brain provides reliable information for diagnosing the presence, location, and extent of tumors, cysts, or other masses; swelling and infection; vascular disorders or malformations, such as aneurysms and intracranial hemorrhage; disease of the pituitary gland; stroke; developmental and structural anomalies of the brain; hydrocephalus; and chronic conditions and diseases affecting the central nervous system such as headaches and multiple sclerosis.

MRI Leg Joint without Contrast

Magnetic resonance imaging is done on a joint of the upper or lower leg. Magnetic resonance is a noninvasive, non-radiating imaging technique that uses the magnetic properties of hydrogen atoms in the body. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which processes the signals and converts the data into tomographic, 3D images with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the joint. MRI scans on joints of the lower extremity are often done for injury, trauma, unexplained pain, redness, or swelling, and freezing of a joint with loss of motion. MRI scans provide clear images of areas that may be difficult to see on CT. The physician reviews the images to look for information that may correlate to the patient's signs or symptoms. MRI provides reliable information on the presence and extent of tumors, masses, or lesions within the joint; infection, inflammation, and swelling of soft tissue; muscle atrophy and other anomalous muscular development; and joint effusion and vascular necrosis.

MRI Pelvis without Contrast

Magnetic resonance imaging (MRI) is done on the pelvis and organs within the pelvic area. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and converts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. Small coils that help transmit and receive the radiowaves may be placed around the hip area. MRI scans of the pelvis are often done for injury, trauma, birth defects, or unexplained hip or pelvic pain.

MRI Spin Lumbar with and without Contrast

Magnetic resonance imaging (MRI) is done on the cervical, thoracic, or lumbar spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and coverts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back/neck pain is unsuccessful and more aggressive treatments are considered or following surgery. Images are taken first without contrast and again after the administration of contrast to see the spinal area better. The physician reviews the images to look for specific information that may correlate to the patient's symptoms, such as abnormal spinal alignment; disease or injury of vertebral bodies; intervertebral disc herniation, degeneration, or dehydration; the size of the spinal canal to accommodate the cord and nerve roots; pinched or inflamed nerves; or any changes since surgery.

MRI Spine Cervical with and without Contrast

Magnetic resonance imaging (MRI) is done on the cervical, thoracic, or lumbar spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and coverts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back/neck pain is unsuccessful and more aggressive treatments are considered or following surgery. Images are taken first without contrast and again after the administration of contrast to see the spinal area better. The physician reviews the images to look for specific information that may correlate to the patient's symptoms, such as abnormal spinal alignment; disease or injury of vertebral bodies; intervertebral disc herniation, degeneration, or dehydration; the size of the spinal canal to accommodate the cord and nerve roots; pinched or inflamed nerves; or any changes since surgery.

MRI Spine Cervical without Contrast

Magnetic resonance imaging (MRI) is done on the cervical spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and converts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back/neck pain is unsuccessful and more aggressive treatments are considered or following surgery.

MRI Spine Lumbar without Contrast

Magnetic resonance imaging (MRI) is done on the lumbar spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and coverts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back pain is unsuccessful and more aggressive treatments are considered or following surgery. The physician reviews the images to look for specific information that may correlate to the patient's symptoms, such as abnormal spinal alignment; disease or injury of vertebral bodies; intervertebral disc herniation, degeneration, or dehydration; the size of the spinal canal to accommodate the cord and nerve roots; pinched or inflamed nerves; or any changes since surgery.

MRI Spine Thoracic without Contrast

Magnetic resonance imaging (MRI) is done on the thoracic spinal canal and contents. MRI is a noninvasive, non-radiating imaging technique that uses the magnetic properties of nuclei within hydrogen atoms of the body. The powerful magnetic field forces the hydrogen atoms to line up. Radiowaves are then transmitted within the strong magnetic field. Protons in the nuclei of different types of tissues emit a specific radiofrequency signal that bounces back to the computer, which records the images. The computer processes the signals and converts the data into tomographic, 3D, sectional images in slices with very high resolution. The patient is placed on a motorized table within a large MRI tunnel scanner that contains the magnet. MRI scans of the spine are often done when conservative treatment of back/neck pain is unsuccessful and more aggressive treatments are considered or following surgery.

Screening Mammography; Bilateral

Bilateral screening mammography is done with computer-aided lesion detection (CAD), when performed. Mammography is the radiographic imaging of the breast using low-dose ionizing radiation. The x-rays used in mammography have a longer wavelength than those typically used for bone imaging. A screening mammogram is done on asymptomatic women for early breast cancer detection when there are no known palpable masses. This is done on both breasts with two views taken on each side. The breast is compressed between planes on a machine dedicated strictly to mammography. This evens out the dense tissue and holds the breast still for a better quality image. Computer-aided detection uses algorithm analysis of the image data obtained from the mammographic films, with or without digitization of the radiographic images. The mammographic picture of the breast is used by scanning the x-ray film with a laser beam, usually converting the scanned image of the analog film into digital data for the computer first, then employing a methodical, step-by-step pattern of analyzing the data on video display for unusual or suspicious areas.

Stomach emptying study

Ultrasound Abdomen - Complete

A real time abdominal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained. The ultrasonic wave pulses directed at the abdomen are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the abdomen and provides a written interpretation.

Ultrasound Abdomen - Limited

A real time abdominal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained. The ultrasonic wave pulses directed at the abdomen are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the abdomen and provides a written interpretation.

Ultrasound Behind Abdominal Cavity - Limited

A real time retroperitoneal ultrasound is performed with image documentation. The patient is placed supine. Acoustic coupling gel is applied to the skin of the abdomen. The transducer is pressed firmly against the skin and swept back and forth over the abdomen and images obtained of the retroperitoneal area. The ultrasonic wave pulses directed at the retroperitoneum are imaged by recording the ultrasound echoes. Any abnormalities are evaluated to identify characteristics that might provide a definitive diagnosis. The physician reviews the ultrasound images of the retroperitoneum and provides a written interpretation.

Ultrasound Guidance for Insertion of Needle

Ultrasound guidance including imaging supervision and interpretation is performed for needle placement during a separately reportable biopsy, aspiration, injection, or placement of a localization device. A local anesthetic is injected at the site of the planned needle or localization device placement. A transducer is then used to locate the lesion, site of the planned injection, or site of the planned placement of the localization device. The radiologist constantly monitors needle placement with the ultrasound probe to ensure the needle is properly placed. The radiologist also uses ultrasound imaging to monitor separately reportable biopsy, aspiration, injection, or device localization procedures. Upon completion of the procedure, the needle is withdrawn and pressure applied to control bleeding. A dressing is applied as needed. The radiologist then provides a written report of the ultrasound imaging component of the procedure.

Ultrasound Head Neck

An ultrasound examination of soft tissues of the head and neck is performed with image documentation. The thyroid, parathyroid, or parotid glands and surrounding soft tissue may be examined. Ultrasound visualizes the body internally using sound waves far above human perception bounce off interior anatomical structures. As the sound waves pass through different densities of tissue, they are reflected back to the receiving unit at varying speeds and converted into pictures displayed on screen. A linear scanner or mechanical sector scanner is used to evaluate the shape, size, border, internal architecture, distal enhancement, color flow, and echogenicity of the soft tissue structures of the head and neck as well as any lesions or masses. The echogenicity is compared to that of the surrounding muscle tissue. The physician reviews the images and provides a written interpretation.

Ultrasound Joint Soft Tissue - Complete

Ultrasound, also referred to as sonography and echography, is a non-invasive imaging technique that uses high-frequency sound waves to evaluate tissues and structures. Nonvascular structures of the extremities that may be evaluated by ultrasound include periarticular soft tissue masses, muscles, tendons, nerves, ligaments, and joints. Common conditions that can be detected or evaluated by ultrasound include cystic lesions, solid tumors, abscesses, joint effusion, tendon tears, tendonitis, tenosynovitis, nerve compression, and stress fractures. Acoustic coupling gel is applied to the extremity to be examined. An ultrasound probe is placed against the skin and moved over the target joint area to be examined as sound waves pass through and bounce off extremity tissues and structures. The sound waves are reflected back to the receiving unit at varying speeds and converted into images. Longitudinal, transverse, and oblique images are obtained. The physician reviews the images and provides a written interpretation.

Ultrasound Pelvis

A real time pelvic (non-obstetric) ultrasound is performed with image documentation to evaluate the uterus and cervix, ovaries, fallopian tubes, and bladder. Conditions evaluated include pelvic pain, abnormal bleeding, and palpable masses, such as ovarian cysts, uterine fibroids, or other pelvic masses. The patient presents with a full bladder. Acoustic coupling gel is applied to the skin of the lower abdomen. The transducer is pressed firmly against the skin and swept back and forth over the lower abdomen and images obtained of the uterus, ovaries, and surrounding pelvic structures. The ultrasonic wave pulses directed at the pelvic structures are imaged by recording the ultrasound echoes. Any abnormalities are evaluated. The physician reviews the ultrasound images and provides a written interpretation.

Ultrasound Scrotum

An ultrasound examination of the scrotum and its contents is a non-invasive procedure that uses a transducer probe placed firmly against the skin to deliver high frequency sound waves and create a gray scale and/or color (Doppler) image of the internal anatomy. Ultrasound may be used to detect scrotal masses/tumors and undescended testicle(s), as well as to evaluate testicular torsion, scrotal injury or trauma, hydrocele(s), varicocele(s), and male infertility. Ultrasonic conduction gel is applied to the scrotum and the transducer probe is held against the skin and swept over the area. The images produced are captured on a screen and viewed in real-time and/or saved for later analysis.

Ultrasound guidance for accessing into blood vessel

Ultrasound; abdominal aorta; real time with image documenation; screening study for abdominal aortic aneurysm (AAA)

X-Ray Ankle; 3 Views

A radiologic examination of the ankle images the bones of the distal lower extremities including the tibia, fibula, and talus. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Ankle x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the ankle include front to back anteroposterior (AP), lateral (side), oblique (semi-prone position with body and leg partially rotated), and stress study with traction placed on the joint manually.

X-Ray Both Hips and Pelvis; 2 Views

A radiologic examination is done on both the left and the right hip, which may also include the pelvis. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, infection, or tumor. Hip standard views that are taken most frequently include the front to back anteroposterior view taken with the patient lying supine and the legs straight, rotated slightly inward; the lateral ‘frog-leg’ view, taken with the hips flexed and abducted and the knees flexed with the soles of the feet placed together; a cross table view with the unaffected hip and knee flexed at a 90 degree angle out of the way and the beam aimed perpendicular to the long axis of the femur on the affected side. Another type of lateral view is taken with the hip flexed 45 degrees and abducted 45 degrees and the beam aimed perpendicular to the table. A front to back view of the hips in a pelvic view is often taken with the patient supine and both legs rotated slightly inward about 15 degrees.

X-Ray Elbow; 3 Views

A radiologic examination of the elbow is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. X-rays of the elbow are usually considered necessary to assess for fractures or dislocations when the normal range of motion for extension, flexion, supination, and pronation cannot be carried out. Most acute disruptions of the elbow joint can be diagnosed by conventional x-ray examination, with the minimum number of views including the front to back anteroposterior projection with the elbow in as full extension as possible, and the side, or lateral image taken in flexion. A complete series of images also includes an oblique view of the radial head-capitellar image to help diagnose suspected subtle fractures involving the radial head or in cases of acute pain and trauma. The patient needs to be able to hold the elbow in full extension for the front view and in 90 degree flexion for the oblique and lateral views as much as possible.

X-Ray Esophagus

Oral contrast material is swallowed and the passage of the contrast is observed fluoroscopically as it passes through the pharynx and/or esophagus. Once the lumen of the pharynx and/or esophagus is completely coated with contrast material, still radiographic images are obtained. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.

X-Ray Foot; 3 Views

A radiologic examination of the foot images the bones of the distal lower extremity and may include the tibia, fibula, talus, calcaneus, cuboid, navicular, cuneiform, metatarsals, and phalanges. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Foot x-rays may also be used to determine whether there is satisfactory alignment of foot bones following fracture treatment. Standard views of the foot include top to bottom dorsal planter (DP), lateral (side), oblique (semi-prone position with body and leg partially rotated), and stress study with traction placed on the joint manually.

X-Ray Forearm; 2 Views

A radiologic examination of the forearm is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. Frontal views, or back to front (PA) views and lateral views are necessary to show the radius and ulna and assess the extent and direction of injury. Since the radius and ulna are anatomically connected at both ends of the bones with ligaments, the two bones function in a manner that makes the forearm considered as a single unit when assessing injury. The two standard views taken for x-ray examination of the forearm include the anteroposterior (AP) view, and the lateral view.

X-Ray Hand; 3 Views

A radiologic examination of the hand is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, or tumors. Hand x-rays are also used to help determine the 'bone age' of children and assess whether any nutritional or metabolic disorders may be interfering with proper development. The posteroanterior projection is taken with the palm down flat and may show not only the metacarpals, phalanges, and interphalangeal joints, but the carpal bones, radius, and ulna as well. Lateral views may be taken with the hand placed upright, resting upon the ulnar side of the palm and little finger with the thumb on top, ideally with the fingers supported by a sponge and splayed to avoid overlap. Oblique views can be obtained with the hand placed palm down and rolled slightly to the outside with the fingertips still touching the film surface. The beam is angled perpendicular to the cassette for oblique projections and aimed at the middle finger metacarpophalangeal joint.

X-Ray Knee; 1-2 Views

A radiologic examination of the knee images the femur, tibia, fibula, patella, and soft tissue. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Knee x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the knee include front to back anteroposterior (AP), lateral (side), and back to front posteroanterior (PA) with variations in the flexion of the joint, and weight bearing and non-weight bearing postures.

X-Ray Knee; 3 Views

A radiologic examination of the knee images the femur, tibia, fibula, patella, and soft tissue. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Knee x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the knee include front to back anteroposterior (AP), lateral (side), and back to front posteroanterior (PA) with variations in the flexion of the joint, and weight bearing and non-weight bearing postures.

X-Ray Knee; 4 or More Views

A radiologic examination of the knee images the femur, tibia, fibula, patella, and soft tissue. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Knee x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the knee include front to back anteroposterior (AP), lateral (side), and back to front posteroanterior (PA) with variations in the flexion of the joint, and weight bearing and non-weight bearing postures.

X-Ray Pelvis; 2 Views

A radiologic examination of the sacrum and coccyx is done with at least 2 views obtained. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. Routine views include an anteroposterior (AP) or posteroanterior (PA) view of the sacrum, an AP or PA view of the coccyx, and lateral sacrum/coccyx views. For the sacral view, the patient's pelvis needs to be positioned correctly so the sacrum and sacroiliac joints are symmetrical. Because the coccyx has a forward curvature in relation to the sacrum, it is not automatically visualized when taking an AP view of the sacrum, and so another positioning is done for the coccyx. For lateral views, the patient stands sideways with feet shoulder width apart and arms crossed at the shoulders. Lateral imaging shows the entire 5th lumbar vertebra, the sacrum, and the coccyx. Good sacrum and coccyx imaging requires patient preparation with an empty bladder, clean colon, and removal of clothing in favor of wearing a gown. This is due to the difficulty these obstructions can cause in achieving a good radiographic image. Shielding is done for males, but is not possible for female patients.

X-Ray Ribs One Side; 2 Views

Rib radiographs (x-rays) are typically obtained following trauma to the rib cage to determine if fractures or other internal injuries are present. The most common views of the ribs are anteroposterior (AP) (frontal) and oblique. There are four positions used for oblique views: right anterior oblique, left anterior oblique, right posterior oblique, and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area that is being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views.

X-Ray Shoulder; 2 Views

A radiologic examination of the shoulder is done. The shoulder is the junction of the humeral head and the glenoid of the scapula. Standard views include the anteroposterior (AP) view and the lateral 'Y' view, named because of the Y shape formed by the scapula when looking at it from the side. An axial view can also be obtained for further assessment when the patient is able to hold the arm in abduction. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

X-Ray Upper Arm; 2 Views

A radiologic examination of the humerus is done with a minimum of 2 views taken. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The surgical neck of the humerus is the most common site of fracture. Shaft fractures are often associated with some kind of pathological lesion. X-rays of the humerus can be taken to detect deformities or lesions in the upper arm, such as cysts, tumors, late stage infection, or other diseases as well as a broken bone. The standard views of the humerus include the front to back anteroposterior view and the side, or lateral view.

X-Ray Upper Spine; 4-5 Views

A radiologic exam is done of the cervical spine. Anteroposterior and lateral views are the most common projections taken. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.

X-Ray Wrist; 3 Views

A radiologic examination of the wrist is done. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, arthritis, foreign body, infection, or tumor. Wrist standard views include the front to back anteroposterior (AP) or back to front posteroanterior (PA) projection; the lateral view with the elbow flexed and the hand and wrist placed thumb up; and oblique views. Oblique views are obtained with the hand and wrist either supinated or pronated with the hand slightly flexed so the carpal target area lies flat, and then rotating the wrist 45 degrees externally or internally. A more specialized image may be obtained for assessing carpal tunnel. For the carpal tunnel view, the forearm is pronated with the palm down, and the wrist is hyperextended as far as possible by grasping the fingers with the opposite hand and gently hyperextending the joint until the metacarpals and fingers are in a near vertical position.

X-Ray of Both Sides of Ribs; Including Chest; Minimum of 4 Views

Rib radiographs (x-rays) are typically obtained following trauma to the rib cage to determine if fractures or other internal injuries are present. The most common views of the ribs are anteroposterior (AP) (frontal) and oblique. There are four positions used for oblique views: right anterior oblique, left anterior oblique, right posterior oblique, and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area that is being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views.

X-Ray of Middle Spine; 3 Views

A radiologic exam is done of the thoracic spine. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. X-rays are taken of the thoracic spine to evaluate for back pain or suspected disease or injury. Films are taken from differing views that commonly include anteroposterior, lateral, posteroanterior, and a swimmer's view for the upper thoracic spine in which the patient reaches up with one arm and down with the other as if taking a swimming stroke.

X-ray Ribs One Side; Minimum 3 Views

Rib radiographs (x-rays) are typically obtained following trauma to the rib cage to determine if fractures or other internal injuries are present. The most common views of the ribs are anteroposterior (AP) (frontal) and oblique. There are four positions used for oblique views: right anterior oblique, left anterior oblique, right posterior oblique, and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area that is being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views.

X-ray of paranasal sinus; complete; minimum of 3 views

X-ray of upper digestive tract with contrast