Practice Management
Coding Corner
| TWO Oncology PET Procedures on SDOS |
| Revised: June 22, 2009 |
| Question |
| Can I code and bill for two oncology PET procedures on the same date of service (SDOS)? |
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| Answer |
The answer is both no and yes. CPT guidance is clear in the parenthetical following the PET tumor codes: "report 78811-78816 only once per imaging session". Therefore, providers may use only one CPT code in the series 78811-78816 when billing PET tumor imaging.
" NO ": - As an example, it would not be appropriate to code and bill for both a limited PET scan (CPT 78811) and a whole-body PET study (CPT 78813). The limited study is considered part of the whole body study. In general, when the AMA/Specialty Society Relative Value Scale Update Committee (RUC) values CPT codes, it does so based on a typical study (including additional views). Providers should choose the appropriate code to reflect the body area imaged. Even if the brain is included in an extended "skull base to mid thigh" study, the code for brain imaging should not be used in addition to CPT 78812 or 78815.
"YES" - If a separate brain PET is indicated and requested in addition to a PET or PET/CT body study (CPT 78811-78816), then it may be appropriate to submit two CPT codes. An example would be a patient with breast cancer that is metastatic to the brain with a residual enhancing lesion on MRI after stereotactic radiosurgery, in whom a dedicated brain PET procedure is requested for evaluation of "viable tumor versus radiation necrosis", and in whom a PET/CT of the skull base to mid thigh is requested for restaging to assess for evidence of progression at other sites. This would be coded as CPT 78608 with modifier-59 for the brain study and 78815 for the torso study. (If this is a Medicare patient and the site participates in NOPR, use the Q0 (zero) modifier to the brain study, because brain tumor studies are only covered nationally under NOPR . If this is a Medicare patient and your imaging facility does NOT participate in NOPR, use code G0235 (PET imaging, any site, not otherwise specified) for Medicare non-covered PET services. If this is a patient covered by a third-party payer other than Medicare, check with the payer; the correct coding could be either CPT 78608- 59 or G0235.) |
| Disclaimer
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| The opinions referenced are those of the members of the SNM Coding and Reimbursement Committee and their consultants based on their coding experience. They are based on the commonly used codes in Nuclear Medicine, which are not all inclusive. Always check with your local insurance carriers as policies vary by region. The final decision for the coding of a procedure must be made by the physician considering regulations of insurance carriers and any local, state or federal laws that apply to the physicians practice. The SNM and its representatives disclaim any liability arising from the use of these opinions.
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