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PET - Positron Emission Tomography 78815

B

bearps@comcast.net

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12
Location
Nashville, TN
Is anyone having issue with Novitas paying 78815? Since they did the LCD revision back in September they haven't paid any of our PET Scans that are used for diagnosis a patient with suspicion of cancer.
 
pet

Has anyone figured this out yet? We are having an awful time with PET scan payments thru Novitas. Ever since a revision of the LCD we get denials.
Our PET company wants us to use R91.8 as the diagnosis to diagnose NSCLC. It is not covered per the LCD. R91.1 is covered but that is for a solitary pulmonary nodule and sometimes the patients have 2 or more so we cannot change to R91.1, correct? I am very frustrated by this !!!
 
R91.8 is for a "nonspecific finding of the lungs". I wouldn't code that way if you are coding for a type of cancer because "cancer" in itself is a pretty specific finding. I would consider using something like C80.1 if it is a known malignancy but not specified as to what type or where. Just a suggestion, either way I would definitely not be comfortable using the R91.8 code, especially given that it is not covered. And you're right now to use the R91.1 because if you know it's cancer then it's not just a nodule.
 
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