Oncology & Hematology Coding Alert

Question: What documentation should the oncologist provide for tumor imaging codes 78811-78816?


Pennsylvania Subscriber

Answer: You need to check off a number of factors before reporting PET or PET/CT--physician review alone isn't enough.

For 78811-78816 (Tumor imaging, positron emission tomography [PET] ...), your report should include documentation of the following:

- radiopharmaceutical injected

- physician interpretation of the images and comparison to prior imaging studies 

- abnormality quantification through calculation of standardized uptake value when clinically indicated.

For 78811-78813, you should also see these additional tasks:

- PET data acquisition and reconstruction performed in multiple planes

- physician review of the study, determining adequacy and whether he needs additional acquisitions.

Codes 78814-78816 require a little more:

- CT data acquisition and PET data reconstruction in multiple planes

- physician overlay of PET and CT images-- at a computer workstation--to create images for anatomic correlation

- physician review of three sets of images--PET scans; CT anatomical localization data; and the combined, superimposed images.