Ordering Guide
Please call our office at 352-795-9200 during business hours (M-F 8:30am-5pm, excluding Holidays) and/or fax a physician order form/script as provided below to 352-795-6460.
This Ordering Guide is meant to assist physicians when ordering a medical imaging exam with Citrus Diagnostic Center. The guide includes common indications as well as recommendations for the most appropriate examination.
Patients Come First
Examinations may be further tailored to a patient’s specific condition. When ordering an exam, please include the clinical question/specific condition in question so that the appropriate imaging can be performed.
Physician Order Form
Ordering Guide
Breast Imaging
Breast Imaging
| General | |
| Asymptomatic women age 40 and over, unless pregnant or lactating (wait six months after breastfeeding) | Annual screening mammogram |
| Patient with a New Lump or Focal Pain | |
| Age 30 and over | Bilateral diagnostic mammogram, with targeted ultrasound if needed (provide size, o’clock position, and distance from the nipple) |
| Age 29 and under | Unilateral targeted breast ultrasound (provide size, o’clock position, and distance from the nipple) |
| History of Breast Cancer | |
| Asymptomatic women with a personal history of breast cancer within the past five years | Annual diagnostic mammogram |
| Asymptomatic women with a personal history of breast cancer occuring more than five years ago | Annual diagnostic mammogram |
| Nipple Discharge | |
| Bloody or clear | Consider surgical consult (for possible ductogram) |
| Elderly Patients | |
| Asymptomatic, symptomatic, and/or history of breast cancer | Perform screening or diagnostic mammogram as appropriate if patient is physically able, has an expected life span of: 5-7 years (consider in light of current age/health status), and will follow through on additional testing and suggested treatment plans should breast cancer be diagnosed |
| Male Patients | |
| Male patients with breast mass/symptoms | Bilateral diagnostic mammogram, with targeted ultrasound if needed (provide size and o’clock position) |
| Consider High-Risk Screening Breast MRI if your patient is/has: | |
|
Note: Screening MRI is in addition to – not as a replacement for- annual screening mammography |
Breast Imaging ICD-10 Codes (Most Common)
| ICD-10 Codes | Description |
| Screening Mammograms | |
| Z12.31 | Screening Mammogram – Asymptomatic Screening Mammogram – High Risk |
| Abnormal Mammograms | |
| R92.0 | Abnormal Mammogram – Microcalcification |
| R92.2 | Abnormal Finding Inconclusive Mammogram |
| R92.1 (Calcification) R92.8 (Other) |
Abnormal Findings – Other |
| Breast Symptoms | |
| N60.0 | Solitary Cyst of Breast |
| N60.1_* | Diffuse Cystic Mastopathy |
| * specify laterality – 1 = Right 2 = Left 9 = Unspecified | |
| N63 | Unspecified Lump or Mass in Breast |
| N64.4 | Breast Pain or Tenderness |
| N64.5_* | Other Signs or Symptoms of the Breast |
| * 1 = Induration of Breast 2 = Nipple Discharge 3 = Retraction of Nipple 9 = Other Signs/Symptoms in Breast) |
|
| N64.89 | Other Signs or Symptoms of the Breast |
| History of Breast Cancer | |
| Z85.3 | History of Breast Cancer |
| Z80.3 | Family History of Breast Cancer |
Nipple Discharge
Classify
- Color
- Onset
- Spontaneous
- Elicited
- Unilateral or bilateral
- Single duct
Initial work-up
- Bilateral diagnostic and Ultrasound mammogram
- Standard views with Spot Mag subareolar breast in CC and ML/LM
- Subareolar Ultrasound
- Negative work-up
- Possible surgical consultation
- Ductogram
- MRI
- Duct excision
Palpable Lump
| Under 30 Years Old | |
| If Ultrasound Shows a Very Suspicious Finding | Mammogram may be requested by the radiologist (extremely rare) Biopsy may be indicated and performed before a mammogram If benign, no mammogram needed |
| If Ultrasound is Negative | Clinical correlation is next step. If very strong clinical suspicion, mammogram could be obtained as a planning tool prior to biopsy |
| If Ultrasound is Benign (e.g. Cyst) | Clinical follow up |
| If Ultrasound is Probably Benign | Short follow up Ultrasound |
| Over 30 Years Old | |
| Review Order for Documentation | Order to include location by o’clock position and distance from nipple Address any documented lump or patient detected lump If patient does not feel and no documentation, contact ordering clinician’s office and attempt to obtain notes (or review Epic notes). If information is not obtainable, document attempt to obtain information |
| If Baseline | Bilateral Diagnostic Mammogram with lump marked Standard views (If 2D only, add Spot Mag CC/ML) Targeted Ultrasound |
| If Patient Has Had a Prior Baseline and Under 40 Years Old | Unilateral Diagnosistic / Bilateral Diagnostic (bilateral if prior not in system) Targeted Ultrasound |
| If Last Mammogram Was Less than 6 Months Ago | Targeted Ultrasound Mammogram if needed |
| Over 40 Years Old | |
| If Close to One Year or More Since Prior | Bilateral Diagnostic Mammogram with lump marked Standard views (If 2D only, add Spot Mag CC/ML) Targeted Ultrasound |
| If Last Mammogram was Less than 6 Months Ago | Targeted Ultrasound Mammogram if needed |
| If Last Mammogram was Greater than 6 Months but Less than 12 Months | Unilateral Diagnostic Mammogram with lump marked Standard views (If 2D only, add Spot Mag CC/ML) Targeted Ultrasound |
Screening Breast MRI
Who:
- BRCA gene carrier or untested first degree relative
- Lifetime risk ≥20%
- Chest radiation between 10-30 years of age
- Genetic syndrome that increases risk (i.e. Li Fraumeni syndrome)
Intermediate Risk Women – Still Controversial:
- Lifetime risk 15-20%
- Personal history of breast cancer
- History of lobular neoplasia or atypical ductal hyperplasia ADH
Screening Breast Ultrasound
- Indicated in high-risk patients who cannot tolerate MRI
- Supplemental screening for intermediate risk women and women with dense breasts (controversial)
- Increase in cancer detection
- High false positive rates and time consuming
- According to American College of Radiology (ACR): .“the balance between cancer detection and the risk of a false positive result should be considered by women and their health care providers when considering the use of screening US or other ancillary screening examinations”
- Currently not offered by Quantum Radiology
- Defer service to breast surgeons in our market if appropriate
Tomosynthesis (3D Mammography)
Tomosynthesis is now available:
- Digital Breast Tomosynthesis (DBT) is the “New 3D Mammogram”
- Better evaluation of dense tissue
- Fewer false positives/callbacks
- Detection of more early invasive breast cancers
- Beneficial in most women
Notes:
- Not all patients are candidates for tomosynthesis
- May be subject to an additional charge