PHYSICIANS: Feds Sound New PET Edits

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Note:  The following article synopsis was NOT provided by AAPC. It was created by Find-A-Code/innoviHealth.

Article Overview

This article explains a set of upcoming Correct Coding Initiative (CCI) edits that affect PET tumor imaging services and related nuclear medicine, computed tomography, and orthopedic procedure coding. It is aimed at physicians, coders, and billing staff who need to understand which service combinations are being reclassified, what broad types of claims may be affected, and how CMS guidance and professional society commentary relate to the edits.

Why This Topic Matters

The article matters because it highlights coding changes that can affect how PET imaging and certain surgical procedures are billed under CCI, which may influence claim submission, modifier use, and medical necessity documentation.

Article Sections

  1. PET imaging and nuclear medicine edits

    Introduces the new CCI changes affecting PET tumor imaging and associated nuclear medicine services. Discusses the general scope of the edits and the timing of the update.

  2. CT-related components and CMS guidance

    Summarizes the categories of CT services and related imaging components included in the PET edit changes. Includes CMS commentary on when separate diagnostic imaging may be considered in relation to the PET service.

  3. Additional PET bundling edits

    Describes a second group of PET-related edits that bundle certain PET tumor imaging services together. Focuses on the broader structure of the edits rather than individual billing outcomes.

  4. External fixation code edits

    Covers orthopedic coding changes involving an external fixation procedure code and additional surgical codes. Notes the involvement of professional society commentary and the general areas of surgery affected.

What You Will Learn

  • The general categories of PET imaging services affected by the CCI update
  • How the article frames CT and reconstruction services in relation to PET tumor imaging
  • What broad types of PET service combinations are addressed by the bundling edits
  • How the article discusses orthopedic external fixation coding changes and related surgical areas

Who Should Read This

  • Physicians
  • Medical coders
  • Billing staff
  • Compliance staff
  • Radiology practices
  • Orthopedic practices

Codes Discussed

  • CPT: 78811
  • CPT: 78812
  • CPT: 78813
  • CPT: 78814
  • CPT: 78815
  • CPT: 78816
  • CPT: 70450
  • CPT: 70480
  • CPT: 70486
  • CPT: 70490
  • CPT: 71250
  • CPT: 72125
  • CPT: 72128
  • CPT: 72131
  • CPT: 72192
  • CPT: 73200
  • CPT: 73700
  • CPT: 74150
  • CPT: 76375
  • CPT: 20690

Code Ranges Discussed

  • CPT: 78811-78816

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