Neurology & Pain Management Coding Alert

Question: Recently, I submitted a claim for positron emission tomography (PET) using G0229. Medicare rejected the claim. Is this code no longer correct?


Colorado Subscriber

Answer: Retroactive to Jan. 30, CMS will no longer accept HCPCS PET scan codes (G0210-G0234). Instead, you should turn to CPT codes 78608-78609 (brain) and 78811-78816 (tumor), according to Transmittal 475, issued Feb. 11, 2005. Non-Medicare payers have been accepting CPT codes for PET scans for years.

You should re-file your claim using the appropriate CPT code. In this case, the best replacement for G0229 (PET imaging; metabolic brain imaging pre-surgical evaluation of refractory seizures) is 78608 (Brain imaging, positron emission tomography [PET]; metabolic evaluation).

Remember also that if your neurologist provides interpretation for a diagnostic scan only, you should append modifier 26 (Professional component) to the appropriate CPT code.