J704 – Lymphoma - evaluation of residual mass(es)
OHIP Cardio-Thoracic Surgery Code — POSITRON EMISSION TOMOGRAPHY (PET) · Schedule of Benefits
For the evaluation of a residual mass(es) following chemotherapy in a patient with Hodgkin's or Non-Hodgkin's lymphoma when further potentially curative therapy (such as radiation or stem cell transplantation) is being considered.
When to Use
- Use J704 when a patient with Hodgkin's or Non-Hodgkin's lymphoma has completed a planned chemotherapy regimen and a residual mass is identified on CT imaging that requires metabolic characterization to determine if further curative intervention like radiation or transplant is warranted.
- Select J704 over J703 when the scan is specifically triggered by the presence of a post-chemotherapy residual mass rather than for initial staging or restaging purposes.
Common Pitfalls
- Billing J704 for routine surveillance or follow-up scans in patients without a documented residual mass will result in rejection, as the code specifically requires the presence of a mass.
- Failing to explicitly document the intent for 'potentially curative therapy' in the referral or clinical notes is a frequent cause for audit recovery, as this is a mandatory clinical criterion for J704.
Billing Tips
- Ensure the referring physician explicitly states the presence of a residual mass and the intent to pursue curative treatment in the requisition to satisfy the specific criteria for J704.
Effective: October 1, 2009
B. Nuclear Medicine - IN VIVO
POSITRON EMISSION TOMOGRAPHY (PET)
Diagnostic
Positron Emission Tomography (PET)
The medical record must document the specific indications for the PET scan, including the diagnosis of Hodgkin's or Non-Hodgkin's lymphoma, the status post-chemotherapy, the presence of a residual mass, and the consideration of further potentially curative therapy.
As per general requirements on , the medical record must establish that an insured service was provided, the service claimed is the service rendered, and the service was medically necessary.
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