Download PET CT Ref Phy Brochure.indd

REFERRING PHYSICIAN
Positron Emission Tomography/
Computed Tomography Imaging
(PET/CT)
What is the patient preparation?
•
•
Oak Street
NPO 6 hours prior to exam time.
For patients with diabetes mellitus, meal
times and medication may need to
be altered.
Radiologist must receive copies of recent
radiographic films and reports.
Have patient wear warm, comfortable
clothing.
The Cancer Center
AT BLESSING HOSPITAL
PATIENT
PARKING
BLESSING
HOSPITAL
Broadway
one way
1. Decide which study to perform.
Assess patient history to determine if
study should be for diagnosis, staging or
restaging.
2. Contact Quincy Medical Group your
PET/CT provider.
To schedule the patient, please have the
following information available:
• Patient history;
• Diagnostic exams performed; and
• Information about biopsies, surgery
and therapy.
3. Inform the patient (IMPORTANT).
Provide patient with information about the
exam (i.e. a copy of the brochure entitled
"Your PET/CT Exam," which includes
date, time, and instructions for exam
preparation).
11th Street
Vermont Street
10th Street
How do I order a
PET/CT scan for my patient?
one way
PATIENT
PARKING
12th Street
•
•
Hampshire Street
PATIENT
PARKING
PATIENT
PARKING
1118 HAMPSHIRE
SUPPORT
SERVICES
1025 MAINE ST
Maine Street
The Cancer Center,
Entrance at Broadway &11th street
Quincy, IL 62301
Phone: 217-277-3500, ext. 7749
Fax: 217-277-5938
www.quincymedgroup.com
Shared Medical Services
“D ISCOVER
THE
SMS D IFFERENCE !”
www.sharedmed.com
Does insurance cover PET/CT?
Nationally Covered Indications
Cancer Type
Bladder
Positron Emission
Tomography/Computed
Tomography Imaging
(PET/CT)
What is PET/CT?
PET/CT combines the functional information
from a Positron Emission Tomography (PET) exam
with anatomical information from a Computed
Tomography (CT) exam in one single exam.
A PET scan detects changes in cellular function - how
cells are utilizing nutrients like
sugar and oxygen. Since these
functional changes take place
before physical changes occur,
PET can provide information that
enables physicians to make an
early diagnosis.
The advantage of CT is its ability
to take cross sectional images of
the body. These are combined
with the information from the PET
scan to provide more anatomic
details of the metabolic changes
in the body.
The PET exam pinpoints metabolic activity in cells
and the CT exam provides an anatomical reference.
When these two scans are fused together, the
physician can view metabolic changes in the proper
anatomical context of the body.
Initial Treatment
Strategy
Subsequent
Treatment
Strategy
X
Brain
X
Breast (Female and Male)
X1
X
2
Yes, PET/CT imaging is covered by both Medicare
and private insurance companies. Private insurance
companies usually follow Medicare guidelines.
However, many private insurance companies will
cover indications not covered by Medicare.
Cervical
X
X
What are the Medicare guidelines?
Colorectal
X
X
For Initial Treatment Strategy
Gallbladder
X
Esophageal
X
X
Head & Neck (Non-Thyroid or CNS)
X
X
Kidney
X
Liver
X
Lymphoma
X
3
X
Melanoma
X
X
Myeloma
X
X
Non-Small Cell Lung
X
X
Ovarian
X
X
Pancreatic
X
Small Cell Lung
X
Soft Tissue Sarcoma
X
Stomach
X
Testicular
X
Thyroid
X
Unknown Primary
X
Uterus
X
All other solid tumors
X4
•
•
•
5
X
Refractory Seizures
Pre-surgical evaluation
Myocardial Viability
Initial diagnosis following inconclusive SPECT
Dementia
One FDG-PET/CT study is reimbursable for
beneficiaries who have solid tumors that are biopsy
proven or strongly suspected based on other
diagnostic testing when the beneficiary’s treating
physician determines that the FDG-PET/CT study is
needed to determine the location and/or extent of
the tumor for the following therapeutic purposes
related to the initial treatment strategy:
Differential diagnosis between Alzheimer's
Disease and fronto-temporal dementia.
1 Breast: Noncovered for diagnosis and/or initial staging of axillary lymph nodes.
Covered for initial staging of metastatic disease.
2 Cervical: Covered for the detection of pre-treatment metastases (i.e. staging) in
newly diagnosed cervical cancer subsequent to conventional imagin that is negative for
extra-pelvic metastasis. All other uses are CED.
3 Melanoma: Noncovered for initial staging of regional lymph nodes. All other uses for
initial staging are covered.
4 Prostate: Initial treatment strategy in Medicare beneficiaries with adenocarcinoma of
the prostate is not a covered indication.
5 Thyroid: Covered for subsequent treatment strategy of recurrent or residual thyroid
cancer of follicular cell origin previously treated by thyroidectomy and radioiodine
ablation and have a serum thyroglobulin >10ng/ml and have a negative I-131 whole
body scan. All other uses for subsequent treatment strategy are CED.
To determine whether or not the beneficiary
is an appropriate candidate for an invasive
diagnostic or therapeutic procedure; or
To determine the optimal anatomic location for
an invasive procedure; or
To determine the anatomic extent of tumor
when the recommended anti-tumor treatment
reasonably depends on the extent of the tumor.
For Subsequent
Treatment Strategy
FDG-PET/CT is reimbursable
when results improve physician
decision making in the
determination of subsequent
antitumor treatment strategy
or improves health outcomes in
Medicare beneficiaries with the
following tumor types; breast,
cervix, colorectal, esophagus,
head & neck (non-CNS/thyroid), lymphoma,
melanoma, myeloma, non-small cell lung, ovary, and
thyroid.