From the Research
For a full body PET scan in a patient with a history of thyroid cancer, the appropriate ICD-10 code would be Z85.850 (Personal history of malignant neoplasm of thyroid) as the primary diagnosis code. This code indicates the patient's history of thyroid cancer, which is the medical justification for performing the PET scan. The procedure code for the full body PET scan would be 78816 (Positron emission tomography with concurrently acquired computed tomography for attenuation correction and anatomical localization; whole body). When billing for this procedure, it's essential to document that the scan is being performed for cancer surveillance in a patient with a history of thyroid cancer. If the patient has any current symptoms or findings suspicious for recurrence, those should be coded as additional diagnoses. Insurance coverage for PET scans typically requires documentation of medical necessity, and a history of cancer with appropriate follow-up intervals is generally considered medically necessary for surveillance imaging, as supported by studies such as 1. Key points to consider include:
- The patient's history of thyroid cancer is the primary reason for the PET scan.
- The PET scan is used for cancer surveillance and to detect any potential recurrence.
- Documentation of medical necessity is crucial for insurance coverage.
- The ICD-10 code Z85.850 is used to indicate the patient's history of thyroid cancer.
- The procedure code 78816 is used for the full body PET scan. It's also important to note that the use of PET scans in thyroid cancer management has been evaluated in various studies, including 2, 3, and 4, which provide insight into the role of PET scans in detecting recurrence and guiding treatment decisions. However, the most recent and relevant study, 1, provides the strongest evidence for the use of PET scans in this context.