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Radiology Coding Alert

You Be The Coder:

How Should I Report a Non-Medicare PET?

Question: I can't find an appropriate code for a PET scan for staging of neuroblastoma in a 20-year-old non-Medicare patient. Should I report one of the PET HCPCS codes?

Kansas Subscriber

Answer: The PET scan HCPCS Codes (G0125, G0210-G0234) are essential when reporting these services to Medicare carriers, but for non-Medicare patients, it's another story.
You should report 78810 (Tumor imaging, positron emission tomography [PET], metabolic evaluation) when your physician administers a PET scan for staging of neuroblastoma in a non-Medicare patient.
Remember that this code should be submitted to private insurers only. Blue Cross/Blue Shield of Kansas' local medical review policy (LMRP) states, "Payment for procedure code 78810 will be denied when claims are submitted to Medicare."

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