Get the Lowdown on How to Justify PET Scan Charges
Published on Fri Jun 25, 2004
Reporting the appropriate cancer code makes all the difference
To ensure proper ICD-9 coding for PET scan procedures, make sure you know the eight kinds of cancers Medicare covers. These cancers often determine the diagnosis codes your physician will list.
But if your physician bills for a PET scan on a Medicare patient with a nonapproved cancer, you can expect a denial.
Here are some examples of ICD-9 codes most Medicare payers will accept for these cancers:
Esophageal -- 150.x, Malignant neoplasm of esophagus
Colorectal -- 153.x, Malignant neoplasm of colon
Non-small cell lung -- 162.x, Malignant neoplasm of trachea, bronchus, and lung
Melanoma -- 172.x, Malignant melanoma of skin
Breast -- 174.x, Malignant neoplasm of female breast
Thyroid -- 193, Malignant neoplasm of thyroid gland
Head and neck -- 195.0, Malignant neoplasm of other and ill-defined sites; head, face, and neck
Lymphoma -- 202.0x, Other malignant neoplasms of lymphoid and histiocytic tissue; nodular lymphoma.