Neurology & Pain Management Coding Alert

You Be the Coder:

PET Scans

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.

Question: How can I bill Medicare for positron emission tomography (PET) scans?

Oregon Subscriber

 
 

Answer: Positron emission tomography scans are billed using temporary HCPCS codes G0125 and G0210-G0234, as appropriate to the type of imaging and the portion of the body scanned. For neurologists, the most commonly used PET scan by far is G0229 (PET imaging; metabolic brain imaging for pre-surgical evaluation of refractory seizures; full and partial-ring PET scanners only).

PET is a diagnostic examination that uses subatomic particles to create biologic images. The particles are emitted from a radioactive substance (such as 2-[F-18] fluoro-d-glucose [FDG]) administered to the patient intravenously. A positron camera (tomograph) produces cross-sectional tomographic images, which are used to assess biological function.

For example, PET scans of the brain are used to evaluate patients who have memory disorders of an undetermined cause, who have suspected or proved brain tumors, or who have seizure disorders that are not responsive to therapy and are candidates for surgery.

According to CMS guidelines, Medicare covers PET scans under the following circumstances:

  • The PET scan must be performed using a camera that the FDA has either approved or cleared for marketing to image radionuclides in the body.
  • Submission of claims for payment must include any information Medicare requires to assure that the PET scan performed was medically necessary, did not unnecessarily duplicate other covered diagnostic tests and did not involve investigational drugs, or procedures using investigational drugs, as determined by the FDA.
  • The entity submitting claims for payment must keep such patient records as Medicare requires on file for each patient for whom a PET scan claim is made.