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INFORMATION FOR PHYSICIANS

PET statistics  |  Diagnostic Codes

Positron Emission Tomography (PET) and Computed Tomography (CT) have been in existence for years; however, with financing available, it is now party of most Physician's daily practice in diagnosing, staging and restaging malignancies.

By combining PET with CT, Fusion Diagnostic Group now offers the next generation in diagnostic imaging power. This sophisticated diagnostic scanner provides highly accurate tumor detection for oncologists as well as enhanced imaging options for cardiology and neurology applications. PET/CT provides form, with CT, and function, with PET. As a physician your examinations now can provide information on metabolic activity and anatomical form, as the most advanced tool on which to base clinical decisions and treatment plans.

CHANGES IN PATIENT MANAGEMENT WITH PET

  • Breast Cancer (184,200 cases)
    • a. Diagnosis - 100% change in patient management
    • b. Staging - 28% change in patient management

  • Colorectal Cancer (130,200 cases)
    • a. Staging - 37% change in patient management
    • b. Recurrence - 33% change in patient management

  • Esophageal Cancers (12,300 cases)
    • a. Diagnosis - 14% change in patient management
    • b. Staging - 23% change in patient management

  • Head and Neck Cancers (32,400 cases)
    • a. Diagnosis/Staging - 33% change in patient management
    • b. Recurrence - 33% change in patient management

  • Lung Cancers (164,100 cases)
    • Staging - 37% change in patient management

  • Lymphoma (63,200 cases)
    • a. Staging - 23% change in patient management
    • b. Diagnosis/Staging - 5% change in patient management
    • c. Recurrence - 5% change in patient management
    • d. Monitoring response to treatment - 12% change in patient management

  • Melanoma (47,700 cases)
    • a. Staging - 20% change in patient management

  • Testicular Cancers (6,900 cases)
    • a. Staging - 22% change in patient management
    • b. Recurrence - 51% change in patient management

  • Cancers of Unknown Primary (34,000 cases)
    • a. Staging - 35% change in patient management

717,700 lives affected by potential life-saving change in disease management prompted by PET.


DEFINITIONS:

Diagnosis:  PET is covered in clinical situations in which the PET results may assist in avoiding an invasive diagnostic procedure, or in which the PET results may assist in determining the optimal location to perform an invasive diagnostic procedure. PET is not covered for other diagnostic uses, and is not covered for screening (testing of patients without specific symptoms).

Staging and restaging:  coverage for PET is subject to 2 conditions: 1) the stage of the cancer remains in doubt after completion of a standard diagnostic work-up, including conventional imaging, and 2) clinical management of the patient would differ depending on the stage of the cancer identified. Use of PET would also be considered reasonable and necessary if it could potential replace one or more conventional imaging studies.

Restaging includes both restaging in the setting of recurrence and restaging following completion of a therapeutic regimen or to asses whether a complete response has been achieved. Use of PET to monitor tumor response during the planned course of therapy (i.e. when no change in therapy is being contemplated) is not covered.

DIAGNOSTIC CT CODES:

  • 71250 CT Chest w/o Contrast
  • 71260 CT Chest w Contrast
  • 71270 CT Chest w/o and w Contrast
  • 72192 CT Pelvis w/o Contrast
  • 72193 CT Pelvis w Contrast
  • 72194 CT Pelvis w/o and w Contrast
  • 74150 CT Abdomen w/o Contrast
  • 74160 CT Abdomen w Contrast
  • 74170 CT Abdomen w/o and w Contrast
  • 70450 CT Brain w/o Contrast
  • 70460 CT Brain w Contrast
  • 70470 CT Brain w and w/o Contrast
  • 70490 CT Neck w/o Contrast
  • 70491 CT Neck w Contrast
  • 70492 CT Neck w and w/o Contrast
  • 72125 CT Cervical spine w/o Contrast
  • 72126 CT Cervical Spine w Contrast
  • 72127 CT Cervical Spine w and w/o Contrast

PET & PET/CT CODES:

  • 70460 Brain/head
  • 78459 PET Myocardial Viability, Metabolic Evaluation
  • 78608 PET Brain, Metabolic Evaluation, Seizures
  • 78609 PET Brain, Perfusion Evaluation
  • 78812 PET Skull base to mid-thigh
  • 78815 PET/CT
  • - Breast-staging, restaging, response/therapy
  • - Cervical-diagnosis, stage, restage
  • - Esophageal-diagnosis, stage, restage
  • - Head and Neck-diagnosis, diagnosis, stage, restage
  • - Lymphoma-diagnosis, stage, restage
  • - Pulmonary/Lung SPN, NSCL-diagnosis, stage, restage
  • - Thyroid (Follicular)-restage (neg I-131 scan, Thyroglobulin >10ng/ml)
  • 78813 PET
  • 78816 PET/CT Melanoma

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