PET scan for tx planning? Billing question for the practicing docs...

[OTN]

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Quick question:

If a pt already has a PET scan which was done for staging purposes, can you do a limited PET for treatment planning purposes?

I think I remember something coming across ASTROgram mentioning that it had been approved for cervical cancer, but I can't seem to find anything on it.

Anybody had any luck with this?

Thanks!

t

 

[Gfunk6]

Why not just fuse the existing PET with your planning CT?

 

[Brim]

Why not just fuse the existing PET with your planning CT?

In certain situations that works. But when the patient isn't in the same position (think: h&N), the fusion is poor.

 

[Gfunk6]

(think: h&N), the fusion is poor.

Duh, I should've remembered that!

At our institution if the pt already had a PET/CT it is a very hard sell to get insurance auth for a re-PET in the treatment position. I guess in the community, if you own a PET/CT scanner, the key is to make sure your referring practices know so that you can do the PET yourself.

BTW, I think I found the ASTROgram the original poster was referring to (dated 4/9/09)

CMS expands PET coverage
The Centers for Medicare and Medicaid Services expanded its coverage of PET scans for Medicare cancer patients. Previously, PET scans for many cancers would be reimbursed only if the PET facility submitted data to the National Oncologic PET Registry (NOPR). Now, all Medicare beneficiaries with certain cancers can receive Medicare coverage for at least one PET scan. The nine currently covered cancers — breast, cervix, colorectal, esophageal, head and neck, lymphoma, melanoma, non-small cell lung and thyroid — have all been expanded to cover the subsequent treatment strategy, in addition to initial diagnosis. Medicare is also expanding coverage to include ovarian cancer and myeloma, making a total of 11 indications now covered for both the initial diagnosis and subsequent treatment strategy. For all other cancers, PET coverage for subsequent treatment strategy evaluation requires participation in an approved Coverage with Evidence Development (CED) program, such as a modified N OPR. For more information, visit the CMS Web site at www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=218&.

 

[OTN]

My billing office seems to think if the patient only has a limited PET study, and it isn't read by a radiologist, it can be done for tx planning purposes and billed appropriately. We'll see how this shakes out.

The fusion is the issue, as mentioned. Seems most significant to me with H+N and cervical/vulvar/anal cancers, but it could help for lung as well.

As much as I'd like to see every patient before a PET was ordered, which would fix the issue, it would be nice to have another option.

T