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PET CT modifier with dx 518.89

  1. Question PET CT modifier with dx 518.89
    Medical Coding Books
    I understand that an initial PET CT with a diagnosis code 518.89, pulmonary nodule, would require modifier PI. I understand that if a subsequent PET CT with a diagnosis code 518.89, pulmonary nodule, would require modifier PI if it is a new nodule. If a subsequent PET CT with a diagnosis code 518.89 is NOT for a new nodule, but reexamining the previously studied nodules, would the required modifier be PI or PS? I am confused on this one, since I was told "if it has not been diagnosed cancer, then you wouldn't be restaging so it would be PI." (Medicare doesn't pay for 78815 PS with dx 518.89.)

  2. #2
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    Alexandria, LA
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    If this is a Medicare patient, then I hope you got an ABN signed, because otherwise you are probably out of luck.
    If this nodule has been determined to be non-cancerous (previous PET is negative, biopsy, etc.), then neither the PI or PS would be appropriate because these are only used for PET for oncologic indications.
    If the patient is Medicare and this PET is being performed for a non-covered indication, use code G0235 instead of 78811-78816.
    I would also suggest that you read the SNM Q & A on pulmonary nodules and PET at http://interactive.snm.org/index.cfm?PageID=8734

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