Radiology Coding Alert

Question: What codes should I report to Medicare for PET imaging used to restage Hodgkin's disease?

Massachusetts Subscriber

Answer: You should report the appropriate PET code, such as 78812 (Positron emission tomography [PET] imaging; skull base to mid-thigh), and the appropriate diagnosis code from the 201.x series (Hodgkin's disease).

Key: Medicare spells out coverage requirements for restaging -- which occurs after the patient completes a course of treatment -- in its National Coverage Determinations Manual, chapter 1, part 4, section 220.6 (http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part4.pdf).

For restaging, Medicare covers PET:

1. to detect residual disease after completing treatment

2. to detect suspected recurrence or metastasis

3. to determine the extent of a known recurrence or

4. to replace conventional imaging studies when the physician expects that conventional study information is insufficient for the patient's clinical management.