Typically PET CT are for oncologic purposes-the documentation I have regarding FDG Pet for Infection and Inflammation from Med Learn are as follows:
" CMS is continuing its national non-coverage of FDG PET for the requested indications. It has determined that the evidence is inadequate to conclude that FDG PET for chronic osteomyelitis, infection of hip arthroplasty, and fever of unknown origin improves health outcomes in the Medicare population and, therefore, has determined that FDG PET for chronic osteomyelitis, infection of hip arthroplasty, and fever of unknown origin is not reasonable and necessary under section 1862(a)(1)(A) of the Social Security Act. CMS had also determined that request for coverage is not appropriate for the CED paradigm. (This NCD was last reviewed March of 2008).
Since encephalitis falls into this category, while the information does not specifically state encephalitis, I would follow the logic above.
Since commercial insurance generally follows CMS guidelines, I would apply the same logic when coding/billing for commercials.
You may want to request a peer to peer between your Nuclear Medicine radiologists and the Medical directors of commercial insurance to see if they may cover the study.
I hope this provides some insight for your billing.
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Monica Witt
Patient Records Abstractor
University of California - Irvine
Orange CA
(714) 456-3952
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Original Message:
Sent: 07-17-2018 14:38
From: Dawn Krueckeberg
Subject: PET CT FOR ENCEPHALITIS
Has any practice done or read a PET CT for encephalitis? There is very little information out on the web regarding use of a PET CT for this type of diagnosis.
Any information would be useful. Thank You.