Radiology Coding Alert

Question: Our radiologist performed a PET/CT scan on a patient which did not aid in the diagnosis. The scan was repeated to confirm the findings and help in diagnosis. Can we bill for the non-diagnostic PET scan and then for the diagnostic scan also? The first PET scan proved to be non-diagnostic, as the patient was non-compliant with instructions for the procedure and consumed food before the scan. Can we bill for part of the non-diagnostic PET? Can we bill for the second PET as a usual procedure?

North Carolina Subscriber

Answer: For the two sequential PETs, you need documentation to support proper orders and medical necessity. You should gather the medical necessity for the two scans. Also keep reference documents for the reason to repeat the test. You need to know why the patient was taken in for the first scan after consuming food.

If the first scan was done as a usual normal procedure, it seems like the first test would also be billable but you’d need to include notes explaining the situation. If the physician realized the test would be void and didn’t read the results, you might need to append modifier 52 (Reduced services) for the services. An alternative can be to append modifier 53 (Discontinued procedure) if your physician initiated the procedure and then stopped when it was deemed to be invalid. Either way, you’ll need good documentation of the encounter to increase your chances of getting any payment.