Oncology & Hematology Coding Alert

Get the most out of initial and restaging scans When you're reporting positron emission tomography (PET) scans, the radiation oncologist's reason for the scan and the patient's cancer will determine the codes you assign.

A PET scan is a noninvasive imaging procedure that assesses perfusion and various organs'metabolic activity. Your radiation oncologist uses the scan to detect breast cancers (174.x) and metastatic cancers (198.x), says Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.

Medicare also covers PET scans for diagnosis, staging and restaging of various malignant neoplasms, including lung, esophageal, colorectal, lymphoma, head and neck and thyroid, she says. Learn These Important PET Requirements You should assign different oncology-related PET codes for private and Medicare insurers. Also, both sets of payers may have different coding and billing requirements. For private carriers, you should report 78810 (Tumor imaging, positron emission tomography [PET], metabolic evaluation) for whole-body scans to determine the cancer's stage after a biopsy has revealed the malignant neoplasm, says Anita Perdue, CPC, billing office manager at Texas Hematology/Oncology Center PAin Carrollton, Texas.

Check with your local private carrier to determine which cancers the payer covers. For instance, Blue Cross Blue Shield in Carrollton, Texas, doesn't accept breast cancer codes (174.0-174.9) but pays for lung cancer (162.0-162.9), Perdue says. Make Sure PET Scans Aren't Duplicates On the other hand, if you want Medicare to pay for PET codes G0210-G0234, you have to meet the following requirements, according to Medicare guidelines:   The PET scan cannot unnecessarily duplicate other covered diagnostic tests. For instance, your radiation oncologist will use a PET scan when he is unsure of a cancer's stage following a standard diagnostic test, such as a magnetic resonance imaging (MRI) scan of the patient's stomach (74181, Magnetic resonance [e.g., proton] imaging, abdomen; without contrast material[s]). If the MRI reveals the cancer's stage, you probably shouldn't report a PET scan code. Your practice should not bill for a PET scan that requires investigational drugs. Generally, your radiation oncologist will use 2-(fluorine-18)-fluoro-2-deoxy-d-glucose (FDG) for the scan. The appropriate code for FDG is A4641 (Supply of radiopharmaceutical diagnostic imaging agent, not otherwise classified). Most Medicare payers, however, won't pay for the code. The physician must use a full- or partial-ring PET scan that the FDAhas approved. Assign G Codes for Specific Cancers Medicare has 25 oncology-related PET codes (G0210-G0234), many with different documentation and coding requirements. You can keep track of these codes if you understand how to link the G codes to the appropriate cancer, Perdue says.

That's because many PET codes represent different [...]