J702 – Germ cell tumour - PET scan
OHIP Cardio-Thoracic Surgery Code — POSITRON EMISSION TOMOGRAPHY (PET) · Schedule of Benefits
A PET scan for germ cell tumour for which recurrent or persistent disease is suspected on the basis of: - a. elevated tumour marker(s) (beta human chorionic gonadotrophin (HCG) and/or alpha fetoprotein) in the presence of negative or equivocal standard imaging studies; or - b. the presence of a residual mass after primary treatment for seminoma when curative surgical resection is being considered. As per the note on page , this service must be performed using a combined positron emission tomography-computed tomography scanner (PET/CT).
When to Use
- Use J702 when a patient with a history of seminoma presents with a residual mass post-treatment and surgical resection is being actively considered.
- Use J702 when a patient shows rising HCG or alpha-fetoprotein levels, but standard imaging like CT or MRI is negative or inconclusive for recurrence.
Common Pitfalls
- Billing a separate diagnostic CT scan code on the same day as J702 is a common audit trigger, as the CT component of the PET/CT is considered inclusive.
- Attempting to use J702 for non-seminomatous germ cell tumours with residual masses is incorrect, as the criteria specifically limit residual mass assessment to seminoma cases.
Billing Tips
- Ensure the clinical record explicitly documents the negative or equivocal results of prior standard imaging to satisfy the specific criteria for marker-driven PET requests.
Effective: October 1, 2009
B. Nuclear Medicine - IN VIVO
POSITRON EMISSION TOMOGRAPHY (PET)
Diagnostic
Positron Emission Tomography (PET), Diagnostic and Therapeutic Procedures
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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