J700 – Solitary pulmonary nodule (PET)
OHIP Cardio-Thoracic Surgery Code — POSITRON EMISSION TOMOGRAPHY (PET) · Schedule of Benefits
Positron Emission Tomography (PET) scan for a solitary pulmonary nodule (SPN) for which a diagnosis could not be established by a needle biopsy due to one of the following reasons: - An unsuccessful attempted needle biopsy. - The SPN is inaccessible to needle biopsy. - The existence of a contra-indication to the use of needle biopsy.
When to Use
- Use J700 when a patient has a solitary pulmonary nodule and a prior needle biopsy attempt failed to provide a definitive diagnosis.
- Use J700 when the nodule is anatomically inaccessible to biopsy, such as deep central lesions or those adjacent to major vascular structures.
- Use J700 when the patient has severe comorbidities, such as uncorrectable coagulopathy or severe emphysema, that make needle biopsy medically contraindicated.
Common Pitfalls
- Billing J700 for a pulmonary nodule that has not yet undergone a biopsy attempt or clinical assessment for biopsy feasibility will result in rejection.
- Submitting a claim for the associated CT scan interpretation is a common error; the payment rules explicitly state that CT attenuation correction or anatomical localization scans are not eligible for separate payment.
- Failing to document the specific reason for biopsy failure or contraindication in the patient record will lead to clawbacks during an audit.
Billing Tips
- Ensure the referral clearly states the specific reason for biopsy failure or contraindication to satisfy the mandatory documentation requirements for J700.
- Verify that the PET scan is performed using a combined PET/CT scanner, as this is a strict requirement for all oncologic PET claims in Ontario.
Effective: October 1, 2009
B. Nuclear Medicine - IN VIVO
POSITRON EMISSION TOMOGRAPHY (PET)
Diagnostic
Positron Emission Tomography (PET)
PET scanning for all oncologic or suspected oncologic indications must be performed using a combined positron emission tomography-computed tomography scanner (PET/CT) in order to localize anatomically any areas of abnormality on the PET image.
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