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PET Scan billing

Linda Posted Tue 22nd of October, 2013 15:38:29 PM

If a patient has a PET/CT Scan done but it is not diagnostic and the scan has to be repeated, can we bill the patient for the non-diagnostic PET scan and then for the diagnostic scan also?

SuperCoder Answered Wed 23rd of October, 2013 09:16:47 AM

In either case, documentation will need to support proper orders and medical necessity. For instance, if the the 1st PET/CT was non-diagnostic, what was the reason for the test? For the second, again what was the reason? Was it repeated because of a change in patient medical circumstances necessitating another exam? Or was it repeated because of (unreimbursable) provider error during the first exam?

Linda Posted Mon 28th of October, 2013 09:21:46 AM

If the reason for the first PET not being diagnostic is because the patient did not follow instructions, and ate before the scheduled PET, what portion can be billed on this non diagnostic PET? And the second PET that is preformed would be able to be billed as normal?.

SuperCoder Answered Mon 28th of October, 2013 20:48:34 PM

We are working on this.


SuperCoder Answered Mon 28th of October, 2013 20:48:34 PM
With me
SuperCoder Answered Wed 30th of October, 2013 17:53:49 PM

Interesting question. The first question in my mind is -- why did they do the "non diagnostic" PET scan if the patient ate beforehand, which would goof up the test? Or did they not know until starting the test that the patient had eaten?

If they did everything they normally could, it seems like the first test would also be billable but you'd need to include notes explaining the situation. If the physician realized the test would be void and didn't read the results, I would think you might need to append modifier 52 for reduced services (or maybe modifier 53 if they got partway through the procedure and then stopped because they realized it wasn't valid). Either way, you'll need good documentation of the encounter to help your chances of getting any payment.

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