# Whole-body PET scan



## jlynnhowe (Apr 9, 2015)

I don't actually have any experience in radiology coding or billing (I'm in home health), so I'm out of my depth with this question, which was posed to me by a colleague.

A patient has been diagnosed with two pulmonary nodules.  The pulmonologist feels they are probably cancerous esp. since the patient is a lifelong smoker, but due to the location on the lungs and the patient's comorbidities (COPD, history of TIA), he is concerned that even a needle biopsy might be risky.  What he wants is to have a PET scan done, whole body, to check for other sites, and proceed from there.

The radiology office is concerned that Medicare won't cover the PET scan, but after some research into NCDs my understanding is that it would not be covered as a screening, but may be billable as a diagnostic procedure given the risk posed by more invasive biopsy procedures.

Am I off base, or should the PET scan be a covered service?  If covered, is there a specific way it should be coded?


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## amandamkcj (Jun 10, 2015)

Whole Body Pet Scan CPT Code could be either 78813 or 78816 depending on your equipment. I assume this is the patients first PET Scan so you would apply a PI (meaning initial) modifier and multiple pulmonary nodules 793.19. I am not able to assist you with confirming if this would be payable or not by the payer but those are the CPT/Mod/Dx codes. (If the patient already had a PET Scan then the modifier would be PS-Subsequent)
Thank you,
Amanda Patterson CIRCC, RCC


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## blondie525 (Jun 10, 2015)

A head to thigh PET would be more appropriate for a lung nodule. The only times I have seen whole body scans is for melanomas or prostate cancer.


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