icd 10 code for choline pet scan

Full Answer

What is the ICD 10 code for a PET scan?

NOTE: For institutional claims, continue to include ICD-9 diagnosis code V70.7 or ICD-10 diagnosis code Z00.6 and condition code 30 to denote a clinical study. PET claims billed to inform initial treatment strategy with the following Procedure codes AND modifier –PI: 78608, 78811, 78812, 78813, 78814, 78815, 78816.

How do you code a PET scan in a clinical trial?

When used in a clinical trial, the Q0 modifier should be added in addition to the TC or -26 modifier accordingly. For Part A claims for all PET scans, use an additional ICD-10-CM code when coding involves a Z code. PET with concurrently acquired CT is reported with procedure codes 78814-78816 as appropriate.

What is the NCD code for PET scan for non-oncologic conditions?

Please refer to A53134, NCD Coding Article for PET Scans Used for Non-Oncologic Conditions. Note: This table is not a comprehensive listing of covered indications.

What is the CPT code for PET scan with PS modifier?

• PI or PS modifier AND • PET or PET/CT Procedure code (78811, 78812, 78813, 78814, 78815, 78816) AND • Cancer diagnosis code AND

What diagnosis will cover a PET scan?

Some of the reasons your doctor might order a PET scan include: characterization of pulmonary nodules. diagnosis and staging of small cell lung cancer. diagnosis and staging of esophageal cancer.

How do you code a PET scan?

When a diagnostic CT scan is performed on the PET/CT scanner, the provider must report the PET scan using a code from series 78811–78813. These codes represent PET without concurrently acquired CT.

What is diagnosis code R93 89?

ICD-10 code R93. 89 for Abnormal findings on diagnostic imaging of other specified body structures is a medical classification as listed by WHO under the range - Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified .

Is FDG PET the same as PET CT?

However, in the majority of cases, FDG PET is a sensitive imaging modality for the detection, staging, re-staging as well as for assessment of therapy response in oncology [6, 17–25]. In contrast to PET, computed tomography (CT) uses an x-ray beam to generate tomographic images.

What is code A9597?

HCPCS Code A9597 A9597 is a valid 2022 HCPCS code for Positron emission tomography radiopharmaceutical, diagnostic, for tumor identification, not otherwise classified or just “Pet, dx, for tumor id, noc” for short, used in Diagnostic radiology.

What is the CPT code for FDG PET scan?

For FDG tumor brain imaging use CPT 78608, not the more general PET tumor codes CPT 78811-78816. As with any nuclear medicine coding, always use organ-specific coding if available.

What does code Z12 31 mean?

For example, Z12. 31 (Encounter for screening mammogram for malignant neoplasm of breast) is the correct code to use when you are ordering a routine mammogram for a patient.

What is DX R05?

R05.1 Acute cough.

What is the ICD-10 code for CT scan?

Computerized Tomography (CT Scan) of Chest, Abdomen and Pelvis using Other Contrast BW25YZZ. ICD-10-PCS code BW25YZZ for Computerized Tomography (CT Scan) of Chest, Abdomen and Pelvis using Other Contrast is a medical classification as listed by CMS under Anatomical Regions range.

What is difference between PET scan and PET-CT?

They use different materials: CT scans pass x-rays through the body to create images. A PET scan uses a radioactive material which emits energy. The energy is then detected by a special camera to produce images. A PET scan is more time-consuming: A CT scan is performed in minutes.

Whats the difference between PET and PET-CT?

A CT scan shows detailed pictures of the organs and tissues inside your body. A PET scan can find abnormal activity and it can be more sensitive than other imaging tests. It may also show changes to your body sooner. Doctors use PET-CT scans to provide more information about the cancer.

What is FDG avid on PET scan?

An FDG PET scan is one of the most powerful tools we have to detect and monitor disease. Most often used in conjunction with CT or MRI, it helps radiologists distinguish between healthy tissue and diseased tissue so that cancer can be accurately diagnosed, correctly staged, and appropriately treated.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

CMS IOM Publication 100-03, Medicare National Coverage Determinations Manual , Chapter 1, Part 4, Section 220.6.17 - Positron Emission Tomography (FDG PET) for Oncologic Conditions

Article Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire NCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

ICD-10-CM Codes that Support Medical Necessity

It is the provider's responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

General Information

CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

CMS National Coverage Policy

CMS IOM, Publication 100-03, Medicare National Coverage Determinations (NCD) Manual , Chapter 1, Part 4, Section 220.6.9 FDG PET for Refractory Seizures, Section 220.6.13 FDG PET for Dementia and Neurodegenerative Diseases, Section 220.6.20 for Beta Amyloid Positron Tomography in Dementia and Neurodegenerative Disease

Article Guidance

The CMS National Coverage Determinations (NCD) Manual, Internet-Only Manual (IOM) Publication 100-03, Section 220.6, discusses Positron Emission Tomography (PET) Scans coverage.

ICD-10-CM Codes that Support Medical Necessity

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.

ICD-10-CM Codes that DO NOT Support Medical Necessity

All those not listed under the “ICD-10 Codes that Support Medical Necessity” section of this article.

Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.

Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.

What is PET in medical terms?

Positron Emission Tomography (PET) is a minimally invasive diagnostic imaging procedure used to evaluate metabolism in normal tissue as well as in diseased tissues in conditions such as cancer, ischemic heart disease, and some neurologic disorders. A radiopharmaceutical is injected into the patient that gives off sub-atomic particles, known as positrons, as it decays. PET uses a positron camera (tomography) to measure the decay of the radiopharmaceutical. The rate of decay provides biochemical information on the metabolism of the tissue being studied.

Is PET scan covered by Medicare?

Note: Manual section 220.6 lists all Medicare-covered uses of PET scans. Except as set forth below in cancer indications listed as “Coverage with Evidence Development,” a particular use of PET scans is not covered unless this manual specifically provides that such use is covered. Although PET scan sections may have some non-covered uses, it does not constitute an exhaustive list of all non-covered uses.

What is PET in medical terms?

Positron Emission Tomography (PET) is a minimally invasive diagnostic imaging procedure used to evaluate metabolism in normal tissue as well as in diseased tissues in conditions such as cancer, ischemic heart disease, and some neurologic disorders. A radiopharmaceutical is injected into the patient that gives off sub-atomic particles, known as positrons, as it decays. PET uses a positron camera (tomography) to measure the decay of the radiopharmaceutical. The rate of decay provides biochemical information on the metabolism of the tissue being studied.

What is the ASC X12 837?

Claims for PET scan services must be billed using the ASC X12 837 professional claim format or on Form-CMS 1500 with the appropriate HCPCS or CPT code and diagnosis codes to the A/B MAC (B). Effective for claims received on or after July 1, 2001, PET modifiers were discontinued and are no longer a claims processing requirement for PET scan claims. Therefore, July 1, 2001, and after the MSN messages regarding the use of PET modifiers can be discontinued. The type of service (TOS) for the new PET scan procedure codes is TOS 4, Diagnostic Radiology. Payment is based on the Medicare Physician Fee Schedule.

What are the requirements for FDG PET?

1. FDG PET Requirements for Coverage in the Differential Diagnosis of AD and FTD An FDG PET scan is considered reasonable and necessary in patients with a recent diagnosis of dementia and documented cognitive decline of at least 6 months , who meet diagnostic criteria for both AD and FTD. These patients have been evaluated for specific alternate neurodegenerative diseases or other causative factors, but the cause of the clinical symptoms remains uncertain. The following additional conditions must be met before an FDG PET scan will be covered:

What is the purpose of a PET positron?

PET uses a positron camera (tomography) to measure the decay of the radiopharmaceutical. The rate of decay provides biochemical information on the metabolism of the tissue being studied.

Can you use 78811-78816 for PET?

The answer is both no and yes. Procedure guidance is clear in the Procedure parenthetical following the PET tumor codes: “report 78811-78816 only once per imaging session”. Therefore, providers may use one Procedure code in the series 78811-78816 when billing PET tumor imaging.

What is PET scan?

The PET scan is used following an inconclusive SPECT scan (i.e., the results of the SPECT are equivocal, technically uninterpretable, or discordant with a member's other clinical data); or. For use in assessment of coronary artery disease after cardiac transplant.

Why do we need a FDG PET scan?

Fluorodeoxy-D-glucose (FDG)-PET scans are considered medically necessary for the determination of myocardial viability prior to re-vascularization , either as a primary or initial diagnostic study or following an inconclusive SPECT. The greater specificity of PET makes a SPECT following an inconclusive PET not medically necessary.

What is a Schwannoma?

Schwannoma (also known as an acoustic neuromas) are benign nerve sheath tumors composed of Schwann cells, which normally produce the insulating myelin sheath covering peripheral nerves. They are mostly benign and less than 1 % become malignant, degenerating into a form of cancer known as neurofibrosarcoma. Schwannomas can arise from a genetic disorder called neurofibromatosis. Schwannomas can be removed surgically, but can then recur. The imaging procedure of choice for schwannomas is magnetic resonance imaging, with or without gadolinium contrast, which can detect tumors as small as 1 to 2 mm in diameter. There are studies reporting FDG uptake in schwannomas, but no studies demonstrating better accuracy or improvements in clinical outcomes with PET over MRI.

What imaging is used for splenic cysts?

An UpToDate review on "Approach to the adult patient with splenomegaly and other splenic disorders" (Landaw and Schrier, 2014) states that "A variety of imaging techniques are available for assessment of splenic lesions (e.g., splenic cysts, other space-occupying lesions), including CT scanning, magnetic resonance imaging, ultrasound, Tc-99m sulfur colloid scintigraphy, and 18F-FDG PET. Although the age of the patient, clinical symptomatology, and imaging characteristics might help the radiologist arrive at the correct diagnosis, one study has concluded that PET scanning offered no additional information over that obtained using CT scanning alone, and that a history of prior malignancy was the only independent predictor for a splenic lesion being malignant (odds ratio 6.3; 95 % CI 2.3-17)".

What is PET guided surgery?

PET-probe guided (assisted) surgery is used for intraoperative localization of PET-positive recurrent/metastatic lesions. The surgery utilizes a hand-held PET probe, essentially is a high energy gamma probe designed to process the 511 keV photons of PET tracers, to localize areas of uptake and guide excision. There is no clinical evidence to support the use of PET-probe guided surgical resection for recurrent ovarian cancer.

What is the false negative rate for lymph node biopsy?

Dengel et al (2011) stated that the false-negative rate for sentinel lymph node biopsy (SLNB) for melanoma is approximately 17 % , for which failure to identify the sentinel lymph node (SLN) is a major cause. Intra-operative imaging may aid in detection of SLN near the primary site, in ambiguous locations, and after excision of each SLN. In a pilot study, these researchers (2011) evaluated the sensitivity and clinical utility of intra-operative mobile gamma camera (MGC) imaging in SLNB in melanoma. From April to September 2008, 20 patients underwent Tc99 sulfur colloid lymphoscintigraphy, and SLNB was performed with use of a conventional fixed gamma camera (FGC), and gamma probe followed by intra-operative MGC imaging. Sensitivity was calculated for each detection method. Intra-operative logistical challenges were scored. Cases in which MGC provided clinical benefit were recorded. Sensitivity for detecting SLN basins was 97 % for the FGC and 90 % for the MGC. A total of 46 SLN were identified: 32 (70 %) were identified as distinct hot spots by pre-operative FGC imaging, 31 (67 %) by pre-operative MGC imaging, and 43 (93 %) by MGC imaging pre- or intra-operatively. The gamma probe identified 44 (96 %) independent of MGC imaging. The MGC provided defined clinical benefit as an addition to standard practice in 5 (25 %) of 20 patients. Mean score for MGC logistic feasibility was 2 on a scale of 1 to 9 (1 = best). The authors concluded that intra-operative MGC imaging provides additional information when standard techniques fail or are ambiguous. Sensitivity is 90 % and can be increased. This pilot study has identified ways to improve the usefulness of an MGC for intra-operative imaging, which holds promise for reducing false negatives of SLNB for melanoma.

What is 18F-FDG-PET?

Manthey and co-workers (2002) described 18F-FDG-PET findings in patients referred for evaluation of painful hip or knee prostheses. These investigators studied 23 patients with 28 prostheses, 14 hip and 14 knee prostheses, who had a complete operative or clinical follow-up. 18F-FDG-PET scans were obtained with an ECAT EXACT HR+ PET scanner. High glucose uptake in the bone prostheses interface was considered as positive for infection, an intermediate uptake as suspect for loosening, and uptake only in the synovia was considered as synovitis. The imaging results were compared with operative findings or clinical outcome. FDG-PET correctly identified 3 hip and 1 knee prostheses as infected, 2 hip and 2 knee prostheses as loosening, 4 hip and 9 knee prostheses as synovitis, and 2 hip and 1 knee prostheses as unsuspected for loosening or infection. In 3 patients covered with an expander after explantation of an infected prosthesis, FDG-PET revealed no further evidence of infection in concordance with the clinical follow-up. FDG-PET was false-negative for loosening in 1 case. The authors concluded that these preliminary findings suggested that FDG-PET could be a useful tool for differentiating between infected and loose orthopedic prostheses as well as for detecting only inflammatory tissue such as synovitis.

Neuro

Prep: A minimum fasting interval of 4 hours is recommended before the study.

Cardiac

Prep: Since these exams are specific to patient disease, prep information for these exams will need to be provided by the PET department case-by-case.

Tumor

Prep: A minimum fasting interval of 4 hours is recommended before the study. Consult the nuclear medicine physician if the patient is diabetic. The patient’s last meal prior to the PET study (which is typically the day before the study) should have a high protein and low carbohydrate content. Limit exercise the day before the PET scan appointment.

Musculoskeletal

Prep: Drink 2 or more 8-oz glasses of water within 1 hour before the examination.