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Oncology & Hematology Coding Alert

Reader Questions:

Prepare to Code Oncologic PET Trial Claims

Published on Tue May 25, 2010

Question: Medicare covers NaF-18 PET to identify bone metastasis only for patients in a clinical study. How can I prove trial participation on the claim?Florida SubscriberAnswer: Append modifier Q0 (Investigational clinical service provided in a clinical research study that is in an approved clinical research study) to indicate that patient is in an approved study. Wait, there's more: To stand up to scrutiny and make it through the system, your claim for NaF-18 PET or NaF-18 PET/CT to inform initial or subsequent treatment strategy "for suspected or biopsy proven bone metastasis" must meet several requirements, according to MLN Matters article MM6861 (www.cms.hhs.gov/MLNMattersArticles/downloads/MM6861.pdf), effective Feb. 26, 2010.The claim must include all of the following:1. A PET or PET/CT code:78608 -- Brain imaging, positron emission tomography (PET); metabolic evaluation78811-78813 -- Positron emission tomography (PET) imaging ...78814-78816 -- Positron emission tomography (PET) with concurrently acquired computed tomography (CT) ...2. Modifier Q03. Either modifier PI (Positron [...]
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