PET/CT
3 conventional imaging modalities used in Oncology
What are CT, MRI and Bone Scan
Recent contact is indicated
ONC - 1.1
Name pelvic LNs
What are iliac, inguinal and femoral LNs?
3 HPs that follow AETNA CPB 0071
Commercial AETNA, ABH or MCP Health Plans
T/F: Medicare PET/CT may be performed for a lung nodule < 8mm if the MD is concerned about CA
False: Cite 32.1. Use ONC-1.4 knowledge, but DO NOT place in Nurse Comment
Medicare Framework date for "counting" PET/CTs
What is June 11, 2013?
PET/CT is not indicated for surveillance
ONC - 1.4
Peritoneum, peritoneal disease or implants, peritoneal carcinomatosis, omental mass, omental caking
What are Indications for pelvic imaging?
T/F: If dz on Experimental Indications on CPB, the CR must review for medical necessity
False - Cite CPB 0071 and DR and move on
T/F: For PENDING Medicare PET/CT, cite (example) ONC - 32.1; ONC - 19.2; ONC - 1.1
ONC - 32 is the exclusive GL used for Medicare PET review
True/False: The CR is responsible for knowing the PET/CT radiotracer
True. Although, we do not review for the radiotracer, the CR must know it and document if it is a non-FDG radiotracer
Treatment response/ current treatment
ONC - 1.2
S&S that buy pelvic imaging
S&S: pain, pelvic, RLQ or LLQ, abdominal pain, lumbar, lower back; diarrhea/constipation related to CA (not treatment)
WILD CARD: Imaging of supraclavicular LNs. Two (2) answers required
What is Imaging of the Neck?
What is Imaging of the Chest?
T/F: For Initial Staging for MC FDG PET/CT, the client must have bx proven cancer
False: bx proven or cancers that is strongly suspected
CPT code reflects ___
What is anatomy or anatomic location?
WILD CARD: Imaging of cervical, occipital and pre-auricular LNs
What is Imaging of the Neck?
Name Five (5) Bones that buy Pelvic Imaging
Bones: lumbar vertebrae, sacrum, ileum, proximal femur, pelvis
Approve or Send: PET/CT request. Completed 2/6 planned cycles
Send: Not a covered benefit d/t tx monitoring request
Approve or Send: MC PET 78816 requested for uterine. No PET CPT code in GL ONC-22
Send: The CR would send to MD to determine code.
Approve or Send: PET/CT Request: Initial Staging completed. FOLFOX started. Initial Staging PET/CT requested
Send: Once initial staging completed and initial treatment commenced, an initial staging PET is not indicated, even if the former occurred prior to 6/11/2013 or while covered by another HP
Once PET is (-) or avid tumor resected, use conventional imaging
ONC - 1.4
Name Three (3) Previous areas of involvement of what anatomy
Primary CA of the uterus, prostate or ovary
For PET/CT, what AETNA HP is excluded from the CPB?
What is AETNA Medicare Advantage plans
Approve or Send: MC PET 78815 for Initial Staging HCC. No PET CPT code in GL ONC 14-14.5
Approve