Billing and Coding: Positron Emission Tomography (PET) Scan for Inflammation and Infection

PET scans for inflammation/infection evaluation are covered for fever of unknown origin when there is a documented fever curve, at least 21 days since onset, and fevers within the two weeks prior to the study. Coverage requires complete medical documentation (history, exam, tests), explicit rationale for PET over other imaging, PET results and clinical management plan, a formal written report with images and reconstruction data, and submission of appropriate ICD-10-CM codes; missing or insufficient documentation or missing ICD-10 codes may result in claim return or denial.

"PET scan is covered to evaluate fever of unknown origin when there is a documented fever curve with temperatures, at least 21 days since fever onset, and documented fevers within the two weeks prio..."

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