J703 – Colorectal cancer - PET scan
OHIP Cardio-Thoracic Surgery Code — POSITRON EMISSION TOMOGRAPHY (PET) · Schedule of Benefits
Positron Emission Tomography (PET) for colorectal cancer. This service is insured only under specific conditions: standard imaging studies must be negative or equivocal, and recurrent disease after surgical resection must be suspected on the basis of an elevated and/or rising carcinoembryonic antigen (CEA) level(s).
When to Use
- Use J703 when a patient has a rising CEA level post-resection, but standard CT or MRI imaging fails to localize the site of recurrence.
- Use J703 for patients with equivocal findings on conventional imaging where PET is required to distinguish between post-surgical scarring and true malignant recurrence.
Common Pitfalls
- Billing J703 for initial staging of colorectal cancer, which is not an insured indication under the Schedule of Benefits.
- Submitting J703 without clear documentation of both the rising CEA trend and the negative/equivocal results of preceding standard imaging studies, leading to automatic audit flags.
Billing Tips
- Ensure the referring physician's notes explicitly state the CEA values and the specific dates of the negative/equivocal standard imaging to satisfy the B15 criteria for medical necessity.
Effective: October 1, 2009
B. Nuclear Medicine - IN VIVO
POSITRON EMISSION TOMOGRAPHY (PET)
Diagnostic
Positron Emission Tomography (PET)
As per , all insured services must be documented in the medical record to establish that the service was provided, the service claimed is the service rendered, and the service was medically necessary.
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