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My Doctor Submitted An Order For A Skull To Mid
Question: My doctor submitted an order for a skull to mid thigh PET/CT scan to detect brain lesions in my cerebellum caused by neurotoxins from Legionella bacteria. I have neurological deficits since contracting Legionaries disease on 1/6/2019 including problems with balance, walking and talking. This is the only test that can detect such lesions. MRI and CT cannot detect them. Medicare denied the order because they said the diagnosis was not medically necessary. I called Medicare and they would not tell me what what conditions are covered for this procedure. They said the doctor would have to call Medicare Part B Provider Line and ask. I am trying to help my doctor find a covered diagnosis because I desperately need this test and my doctor is very busy. Can you provide a list of conditions that are covered for a PET/CT scan of skull to mid thigh?
The cot code for the procedure is 78815
I meant the cpt code is 78815
Brief Answer:
A more localized examination with PET/CT could be ordered.
Detailed Answer:
Hello and welcome to "Ask a Doctor" service.
I have read your query and here is my advice.
That PET/CT code corresponds to:(tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; skull base to mid-thigh).
Since your Doctor thinks that is a necessary evaluation of your cerebellum with PET/CT, I think he can ask for a more localized examination with PET/CT likely provided by Medicare.
The examination with PET/CT may be restricted on the brain and its code is 78608 (Brain imaging, positron emission tomography (PET); metabolic evaluation).
Hope you found the answer helpful.
Let me know if I can assist you further.
A more localized examination with PET/CT could be ordered.
Detailed Answer:
Hello and welcome to "Ask a Doctor" service.
I have read your query and here is my advice.
That PET/CT code corresponds to:(tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; skull base to mid-thigh).
Since your Doctor thinks that is a necessary evaluation of your cerebellum with PET/CT, I think he can ask for a more localized examination with PET/CT likely provided by Medicare.
The examination with PET/CT may be restricted on the brain and its code is 78608 (Brain imaging, positron emission tomography (PET); metabolic evaluation).
Hope you found the answer helpful.
Let me know if I can assist you further.
Above answer was peer-reviewed by :
Dr. Kampana
Thank you for the more specific cpt code. What diagnosis would usually prompt this type of procedure? I do not have cancer. I have dizziness, balance problems and unsteady walking, along with volatile blood pressure.
Brief Answer:
Codes for orientation about the part to be examined.
Detailed Answer:
Welcome back.
These cpt codes are for orientation about the part of the body that needs to be examined.
I think that your Doctor is assessing any abnormalities in the cerebellum or vestibular system with the pET/CT scan.
Hope I helped you.
Feel free to discuss with me if you have further questions.
Codes for orientation about the part to be examined.
Detailed Answer:
Welcome back.
These cpt codes are for orientation about the part of the body that needs to be examined.
I think that your Doctor is assessing any abnormalities in the cerebellum or vestibular system with the pET/CT scan.
Hope I helped you.
Feel free to discuss with me if you have further questions.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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