Wiki PETSCAN MODIFIERS

[Tazcheetarah]

We are billing for the professional component for PETSCANS with modifiers 26 and PI and PS. We have received several coding related denials to these claims across multiple carriers for incorrect modifiers. Any advice on getting these paid and why they are being denied would be greatly appreciated. Most of the research I've done so far seems to show we are coding the modifiers correctly.

 

[csperoni]

No experience with billing PETCT, only ordering and authorizing. A lot...
I think the first possible issue is that the patient has already received an initial PETCT with -PI, or 3 subsequent PETCTs with -PS for the specific cancer diagnosis. Or this is a different cancer diagnosis than prior, and the first PETCT with that diagnosis and billed -PS. For example, I know providers will often just pick C56.9 ovarian cancer unspecified, when it should really be C56.1 for right or C56.2 for left (or both). If the patient has had all scans at your facility, this should be fairly easy to determine.
The other item I would look at is whether or not the carriers have created their own separate policy outside CMS which would require you to follow that guidance.
Other than that, it seems these are valid modifiers. Hopefully someone with specific radiology experience can provide further assistance!

 

[Bluteam]

Hello I would like to know since you do the ordering and authorizing is the PET scan and CT done in the same machine? I also work for a radiologist group and are getting denials from the Blues for no authorization on CT scans that we bill for the reading on Thank You.