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J705
J705 – Lymphoma - assessment of response to treatment (PET)
OHIP Cardio-Thoracic Surgery Code — POSITRON EMISSION TOMOGRAPHY (PET) · Schedule of Benefits
For the assessment of response in early stage Hodgkin's lymphoma following 2 or 3 cycles of chemotherapy when chemotherapy is being considered as the definitive single modality therapy.
When to Use
- Use J705 specifically for interim PET/CT assessment in early-stage Hodgkin's lymphoma patients after completing exactly 2 or 3 cycles of chemotherapy.
- Select this code when the clinical intent is to determine if chemotherapy can serve as the definitive single modality therapy, distinguishing it from J703 which is reserved for staging or restaging.
Common Pitfalls
- Billing J705 for patients who have already completed more than 3 cycles of chemotherapy will result in automatic rejection, as it falls outside the specified treatment window.
- Submitting J705 for non-Hodgkin's lymphoma cases is a common audit trigger; ensure the diagnosis is strictly early-stage Hodgkin's lymphoma to avoid recovery of funds.
- Confusing J705 with J706, which is intended for post-treatment assessment, will lead to claim denials for incorrect timing of the scan.
Billing Tips
- Ensure the referring physician's requisition explicitly states the number of chemotherapy cycles completed to support the J705 criteria during a post-payment audit.
- Verify that the patient's treatment plan explicitly documents the intent for chemotherapy as the definitive single modality therapy, as this is a mandatory requirement for J705 eligibility.
Provider Fee$0.00
Specialist Fee$0.00
Surgical Assistant Fee$0.00
Anaesthetist Fee$0.00
Non-Anaesthetist Fee$200.00
Effective: October 1, 2009
Category
B. Nuclear Medicine - IN VIVO
Subcategory
POSITRON EMISSION TOMOGRAPHY (PET)
Service Type
Diagnostic
Code Classes
Positron Emission Tomography (PET)
Referral RequiredFrom: Physician
The medical record must document that the PET scan is for the assessment of response in early stage Hodgkin's lymphoma after 2 or 3 cycles of chemotherapy, and that chemotherapy is being considered as the definitive single modality therapy.
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