Wiki Question regarding PET

[librak1]

Hello,
I have a question regarding a positron emission tomography. A patient is scheduled and comes in with the intent to have this done. They are injected with FDG but then eventually refuse to have the PET done due to claustrophobia. Does anyone know if any part of this procedure is billable? Is it possible to bill A9552 alone and get paid? Thanks for any suggestions!

 

[cblack712]

I would bill the PET code with the 53 modifier and report notes that indicate that the procedure was started (fdg administered) and then the patient freaked out and had to be stopped. Here is documentation showing the correct use of the 53 modifier on diagnostic studies.

http://www.wpsmedicare.com/part_b/resources/modifiers/modifier-53.shtml
http://www.trailblazerhealth.com/Publications/Job Aid/CorrectUseof52and53Modifiers.pdf

 

[donnajrichmond]

I agree, according to SNM, once the radiopharmaceutical is injected you have begun the procedure. Bill the PET with -52 for hospitals or -53 for physicians.