Draft Model Policy for PET
The American College of Radiology (ACR) and the Society of Nuclear Medicine (SNM) are currently drafting a model policy for positron emission tomography (PET) that Medicare contractors will be encouraged to adopt. A number of International Classification of Disease, 9th Revision (ICD-9) codes related to the evaluation of patients with solitary or multiple pulmonary nodules, such as 518.89 (Other disease of lung, not elsewhere classified) and 793.1 (Nonspecific (abnormal) findings on radiological and other examination of body structure, lung field) have been removed recently from several Medicare Local Coverage Determinations (LCDs). Hence, a number of radiology practices are beginning to receive denials citing a lack of medical necessity. If you are aware of this issue in your state, please contact Stephanie Le at 1-800-227-5463, ext 4584.
In the meantime, the ACR and the SNM encourage their members to continue to follow ICD-9 coding guidelines and to appeal denied claims, when appropriate.
