Wiki pet scan Q

[metzger130]

I am trying to get a PET scan paid by Blue Cross and they are calling it "experimental." the patient has a history of breast cancer, bilateral mastectomies. previous pet 9/9/11 was negative. had one done 10-30-12 and it is negative again. I coded the v71.1, v10.3 and v45.71 and they are saying experimental. Is there any other codes I can use to get this paid?

Thanks,
Rob

 

[mbgg]

The physician should of had some evidence of the disease returning. Pets are not normally paid unless the pt is restaging after treatment or there is evidence of reoccurence such as elevated tumor marker on lab or abnormal radiological findings. It should not be done as screening in asymptomatic patients, it's considered investigational.