Wiki Dementia Code PET Scan

Albany, OR
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Hello, Could I please get some advise on this? Our radiology group performs PET scans and the following was coded with the DX of 294.8. I was wondering if the more appropriate code would be 331.19? If yes/no please explain why. Thanks!

Procedure: PET/CT FUSION

Indication: Frontal Lobe Deficiency

Technique: PET-CT fusion study was obtained of the brain utilizing a GE Discovery ST scanner. 11.92 mCi of 18-FDG was administered IV for the study. Limited unenhanced CT performed for anatomic registration purposes only. This is not a diagnostic CT.

Comparison: Head CT 2/2/12

Findings: There is symmetric reletive hypometabolism in the frontal lobes as well as the anterior medial temporal lobes. Perfusion is otherwise symmetric with no focal defects noted. Basal ganglia and cerbellar activity is relatively unremarkable.

Conclusion: Symmetric frontal and anterior temporal hypometabolism, most consistent with frontal temporal dementia.
Not sure if I can do this justice, but will try. :) The ICD-9 documentation guidelines state, "There must be a cause-and-effect relationship between the care provided and the condition, and an indication in the documentation that it is a complication. Query the provider for clarification, if the complication is not clearly documented." The report detail only gives the findings, so I would code this as 294.8, if the physician does not specify otherwise. These must be combined with the physician's note(s) to get a more complete picture of "cause-and-effect." If the physician says it is frontotemporal dementia, then I would code it as 331.19. My understanding is that it is better determined by combining the testing AND the signs/symptoms/habitus of the patient. The physician is equipped to determine this by combining the two. In my opinnion, the only findings on this report is frontal lobe degeneration. I would code that to 294.8. Tried to keep this short. Hope it helps! :)
Indication for the study is Frontal Lobe Deficiency and the Radiologist not evidently found dementia but he found hypometabolism of brain. So I guess it can be coded as other specified disorder of brain (348.89).

You may also want to check the coverage policy for the insurance that it was billed to. Most commercial payors don't cover PET for dementia/Alzheimer's disease, they will only cover for seizure localization for epilepsy. Medicare doesn't cover 294.8 but will cover 780.93 memory loss. Look at the NCD for Non-oncologic PET to see the covered codes for Medicare. I code and get pre-authorizations for PET/CT's all day. If you have any questions, I will be happy to answer!