Wiki R91.8 FOR PETSCAN

Create Wiki
B

bgallahar@omipetct.com

New
Messages
3
Best answers
0
I am new to AAPC as in today new. We are an IDTF PET/CT facility. I am having terrible issues with referring drs using the diagnosis code of R91.8 for 78815/A9552. In the past, I have been instructed not to accept this code. However, in just the past 3 weeks, I have had an increase of PETscans being approved with this diagnosis code. Can anyone offer any guidance on what your practice does in this case? I have some referring drs upset that I have requested them to change the auth, which is what our billing center advised me to do. Thanks
 
Bgallahar
Please look up each dx code and the Z dx code as last dx. Also with PET add if repeat(PS) or initial (PI) scans by certain modifiers and if use A9552 if contrast used. And add referring doctor s name to claim. Also if pathologist results list a definitive ds. he notices, put this on claim. This info below was received from web site by Whawold listed above. I hope this data helps you Lady T

.Disease Possible Dx Codes from Provider
Colorectal K62.89, K63.89 D01, C18, D12 or D22 see area if polyp removed from or K63.5 and Z12.11 or Z13.811
Esophagus KCover
Head and Neck (not thyroid, CNS) R90Cover
LymphomaCover
Lungs R94.2 but results must state abnormal J98.9 Unspec. DO of Respiratory J98.4 Disorder of LungsCover
OvaryCover
BrainCover
CervixCover with exceptions *
Breasts C44, C50, N63 and N64 R92Cover
Soft tissue sarcomaCover
 
bgallahar@omipetct.com said:
I am new to AAPC as in today new. We are an IDTF PET/CT facility. I am having terrible issues with referring drs using the diagnosis code of R91.8 for 78815/A9552. In the past, I have been instructed not to accept this code. However, in just the past 3 weeks, I have had an increase of PETscans being approved with this diagnosis code. Can anyone offer any guidance on what your practice does in this case? I have some referring drs upset that I have requested them to change the auth, which is what our billing center advised me to do. Thanks
Click to expand...
Also try dx J98.9 or J98.4 if pt has no lung cancer or growths and dx Z13.83 or dx Z12.2 as last dx.
Hope this helps you
Lady T
 
TThivierge said:
Bgallahar
Please look up each dx code and the Z dx code as last dx. Also with PET add if repeat(PS) or initial (PI) scans by certain modifiers and if use A9552 if contrast used. And add referring doctor s name to claim. Also if pathologist results list a definitive ds. he notices, put this on claim. This info below was received from web site by Whawold listed above. I hope this data helps you Lady T

.Disease Possible Dx Codes from Provider
Colorectal K62.89, K63.89 D01, C18, D12 or D22 see area if polyp removed from or K63.5 and Z12.11 or Z13.811
Esophagus KCover
Head and Neck (not thyroid, CNS) R90Cover
LymphomaCover
Lungs R94.2 but results must state abnormal J98.9 Unspec. DO of Respiratory J98.4 Disorder of LungsCover
OvaryCover
BrainCover
CervixCover with exceptions *
Breasts C44, C50, N63 and N64 R92Cover
Soft tissue sarcomaCover
Click to expand...
So these are diagnosis codes that you actually would use for 78815-a9552 restaging PET/CT? I am blown away, I have been working in this field for 13 years and I have never heard this. This is great information to hold on to. Thank you all for your input.
 
bgallahar@omipetct.com said:
So these are diagnosis codes that you actually would use for 78815-a9552 restaging PET/CT? I am blown away, I have been working in this field for 13 years and I have never heard this. This is great information to hold on to. Thank you all for your input.
Click to expand...
Hi B Gallaghar
Please let me add if the patient has cancer metastasis we add new area where cancer has spread or grown,then dx C78 and C79 of secondary Cancer growth see dx block .Also add past HO of Cancer see dx block Z85 on whatever type/location cancer it is too. Natural the results show this and providers doumentation
I hope this helps too
Lady T
 
bgallahar@omipetct.com said:
I am new to AAPC as in today new. We are an IDTF PET/CT facility. I am having terrible issues with referring drs using the diagnosis code of R91.8 for 78815/A9552. In the past, I have been instructed not to accept this code. However, in just the past 3 weeks, I have had an increase of PETscans being approved with this diagnosis code. Can anyone offer any guidance on what your practice does in this case? I have some referring drs upset that I have requested them to change the auth, which is what our billing center advised me to do. Thanks
Click to expand...
I think you will find the following links to be very helpful. Especially the second one! You will be able to download a spreadsheet with covered icd10 for PET Scans for oncologic conditions which is a lot easier to navigate and search through (Ctrl+F) than the long list included in the PDF. It's a LOT of info. But it's straight from CMS and it's very important to understand the NCD.
https://lcd.optum.com/pdf/253984.pdf
https://www.cms.gov/Medicare/Coverage/DeterminationProcess/downloads/CR13828.zip
 
You must log in or register to reply here.
Top