J701 – Thyroid cancer PET scan
OHIP Cardio-Thoracic Surgery Code — POSITRON EMISSION TOMOGRAPHY (PET) · Schedule of Benefits
PET scan for thyroid cancer for which standard imaging studies, including I-131 scan and/or neck ultrasound, are negative or equivocal, and recurrent or persistent disease is suspected on the basis of an elevated and/or rising thyroglobulin level(s).
When to Use
- Use J701 when a patient has a rising thyroglobulin level but standard I-131 whole-body scans and neck ultrasounds have failed to localize the recurrence.
- Use J701 for suspected persistent thyroid cancer where previous imaging is equivocal and clinical suspicion remains high based on biochemical markers.
Common Pitfalls
- Billing for the CT component of the PET/CT scan separately is strictly prohibited; the CT is considered part of the PET service and is not separately compensable.
- Submitting J701 without documented evidence of negative or equivocal I-131/ultrasound results will lead to audit recovery, as these are mandatory prerequisites for the code's clinical criteria.
Billing Tips
- Ensure the referral documentation explicitly references the elevated thyroglobulin levels and the failure of prior imaging to justify the medical necessity of the PET/CT.
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).
PET scanning is an insured service only for the investigation of the indications listed below.
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.
Interpretation of a CT scan performed to identify the anatomical location of a PET scan abnormality or for attenuation correction is not eligible for payment.
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