We are currently evaluating PEM (positron emission mammography) equipment for our imaging center. Using CPT 78811 PET, Tumor, Limited what ICD-9 codes would be acceptable?
A. As I understand it, the PEM equipment is used to perform a PET scan of the chest. Therefore CPT code 78811- PET, tumor, limited would be the correct code to report this procedure. But the coverage criteria of the payor is more important than which ICD-9 codes are accepted. The Medicare coverage of PET for breast cancer (as well as all other covered indications) can be found in the Medicare National Coverage Determinations Manual, link: http://www.cms.hhs.gov/manuals/downloads/ncd103c1_Part4.pdf Medicare does not cover PET for diagnosis of breast cancer. Furthermore if you look at the Medicare coverage of PET for breast cancer I do not think performing a limited scan is in compliance with the coverage. One would need to perform a PET, skull base to mid-thigh or whole body to be in compliance with the spirit of the coverage. In these instances, the ICD-9 codes that support medical necessity for the Medicare coverage of PET for breast cancer are the 174 and 175 series codes. Private pa
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