jlynnhowe
Networker
I don't actually have any experience in radiology coding or billing (I'm in home health), so I'm out of my depth with this question, which was posed to me by a colleague.
A patient has been diagnosed with two pulmonary nodules. The pulmonologist feels they are probably cancerous esp. since the patient is a lifelong smoker, but due to the location on the lungs and the patient's comorbidities (COPD, history of TIA), he is concerned that even a needle biopsy might be risky. What he wants is to have a PET scan done, whole body, to check for other sites, and proceed from there.
The radiology office is concerned that Medicare won't cover the PET scan, but after some research into NCDs my understanding is that it would not be covered as a screening, but may be billable as a diagnostic procedure given the risk posed by more invasive biopsy procedures.
Am I off base, or should the PET scan be a covered service? If covered, is there a specific way it should be coded?
A patient has been diagnosed with two pulmonary nodules. The pulmonologist feels they are probably cancerous esp. since the patient is a lifelong smoker, but due to the location on the lungs and the patient's comorbidities (COPD, history of TIA), he is concerned that even a needle biopsy might be risky. What he wants is to have a PET scan done, whole body, to check for other sites, and proceed from there.
The radiology office is concerned that Medicare won't cover the PET scan, but after some research into NCDs my understanding is that it would not be covered as a screening, but may be billable as a diagnostic procedure given the risk posed by more invasive biopsy procedures.
Am I off base, or should the PET scan be a covered service? If covered, is there a specific way it should be coded?