# PET CT modifier with dx 518.89



## shegun4 (Sep 26, 2011)

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.)


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## donnajrichmond (Sep 27, 2011)

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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