J706 – Non-small cell lung cancer PET scan
OHIP Cardio-Thoracic Surgery Code — POSITRON EMISSION TOMOGRAPHY (PET) · Schedule of Benefits
Payable for a Positron Emission Tomography (PET) scan for Non-small cell lung cancer (NSCLC) in the following circumstances: - a. For which curative surgical resection is being considered based on negative standard imaging tests; or - b. For clinical stage III NSCLC which is being considered for potentially curative combined modality therapy with radical radiotherapy and chemotherapy.
When to Use
- Use J706 when a patient with suspected or confirmed NSCLC requires a PET scan to rule out distant metastases before proceeding with curative-intent surgical resection, provided standard imaging (CT/MRI) is negative.
- Use J706 for patients with confirmed clinical stage III NSCLC who are being evaluated for combined modality therapy (radical radiotherapy and chemotherapy) where PET staging is required to define the treatment field.
Common Pitfalls
- Billing J706 for routine surveillance or follow-up scans in patients with known metastatic disease will result in rejection, as it is strictly limited to curative-intent staging.
- Failure to document the specific clinical intent (curative surgery vs. curative combined modality therapy) in the patient chart is a frequent cause of audit recovery.
- Do not bill J706 for staging of small cell lung cancer (SCLC) or other thoracic malignancies; those indications require different diagnostic pathways.
Billing Tips
- Ensure the referring physician's documentation explicitly states the intent for curative treatment, as this is the primary criterion for J706 eligibility.
- If the PET scan is performed in an urgent hospital setting, ensure you are not attempting to bill J706 with special visit premiums (e.g., C108, C110) unless the specific criteria for those premiums are met, as they are often flagged for manual review.
Effective: October 1, 2009
B. Nuclear Medicine - IN VIVO
POSITRON EMISSION TOMOGRAPHY (PET)
Diagnostic
Positron Emission Tomography (PET)
The medical record must substantiate the clinical scenario, either: - a. Consideration of curative surgical resection for NSCLC based on negative standard imaging tests; or - b. A diagnosis of clinical stage III NSCLC with consideration for potentially curative combined modality therapy with radical radiotherapy and chemotherapy.
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