Scenario;
Pt diagnosed with brest ca, has been in remission for 5 years now; she has been coded V10.3 History/Remission Breast ca. being she has not shown any symptoms and was off therapy. Now presents with bone pain and breast pain, a CT abdomen/pelvis was done and showed abnormal findings (possible liver cysts), tumor markers are within normal limits. Physician wants to do a Pet Scan for "breast cancer" which has not yet been confirmed as recurrent.
CMS states Pet can be done for staging and re-staging if the stage of the cancer remains in doubt after completion of standard diagnostic workup, including conventional imaging. By which I understand this referring to cancer still being present not as in patient went in remission and now is showing symptoms of "possible or suspected recurrence".
How the heck do we code this, there is limitations as to what diagnosis is covered for a Pet Scan. I don't feel confortable coding this patient as breast cancer being there is no other documentaion to back diagnosis, and an abnormal CT as mentioned above recurrence does not make... Please help!!!