rachelb117
Contributor
I have been coding for about a year now, and am employed by a Hematology/Oncology Office. I need some major clarification regarding PET scan modifiers and have found the CMS website and guidelines to be about as clear as mud!
I am having some confusion understanding the PI and PS modifier. Can there be more than 1 initial staging PET scan? My understanding of this is that One initial PET scan may be covered (based on diagnosis, etc) for initial staging. I have encounted a doc who has ordered a second PET scan on a patient with unknown primary cancer (199.1). Per the NCD, this is covered for the initial scan. Now the patient had a scan with this dx in February and now doc wants one in March. When I advised that subsequent (PS) scan would not be covered, the nurse stated "this would not be subsequent PET, the first one was for the bones, this is his first PET for staging"
PLEASE PLEASE if you have any advice, opinions, or thoughts, please reply!
Thanks,
Rachel B.
I am having some confusion understanding the PI and PS modifier. Can there be more than 1 initial staging PET scan? My understanding of this is that One initial PET scan may be covered (based on diagnosis, etc) for initial staging. I have encounted a doc who has ordered a second PET scan on a patient with unknown primary cancer (199.1). Per the NCD, this is covered for the initial scan. Now the patient had a scan with this dx in February and now doc wants one in March. When I advised that subsequent (PS) scan would not be covered, the nurse stated "this would not be subsequent PET, the first one was for the bones, this is his first PET for staging"
PLEASE PLEASE if you have any advice, opinions, or thoughts, please reply!
Thanks,
Rachel B.