Wiki PET Scans in office

[jlb102780]

Hi everyone and happy Monday

I was wondering if anyone does PET Scans in their offices and if its worth
the reimbursement? The administrator here is asking me about them. So far,
when we've billed these, they were done at the hospital, so we were just reading them. Any info regarding office billing of these would be awesome

Thanks

 

[lhallstrom]

Office Based PET Scans

A cardiology practice with which I am involved is exploring the same option. The PET scan produce images far superior to SPECT scans. Some of the considerations we identified are: 1) equipment expense, 2) staff training and physician certification, 3) space renovation and 4) reimbursement issues (including precertification, etc.).

There are three CPT codes for cardiology: 78459 (PET myocardiac imaging, metabolic eval), 78491 (PET myocardial imaging, single study) and 78492 (PET myocardial imaging, multiple studies). If the study is performed while the patient is stressed (either via exercise or pharmacologically), you also report 93015 (or 93016, 93017 or 93018 as appropriate). We checked with some of our major payers regarding medical necessity diagnoses and pre-certification or notification requirements.

Cardiology reimbursement seems to be on CMS' radar screen, so it is hard to tell if the reimbursement will continue at the current level and, if so, for how long.