J707 – Cardiac PET
OHIP Cardio-Thoracic Surgery Code — POSITRON EMISSION TOMOGRAPHY (PET) · Schedule of Benefits
Cardiac PET using fluorodeoxyglucose (FDG) for myocardial viability assessment in a patient that: - has moderate to severe ischemic left ventricular dysfunction (left ejection less than or equal to 40%) despite maximal medical therapy; and - is a suitable candidate for a cardiac revascularization procedure or cardiac transplantation.
When to Use
- Use J707 when a patient with LVEF <= 40% has an equivocal result from a prior SPECT or dobutamine stress echocardiogram and requires definitive viability assessment.
- Use J707 for urgent viability assessment in patients with LVEF < 35% and documented multi-vessel coronary disease confirmed by angiography.
Common Pitfalls
- Billing J707 in conjunction with any other PET code from the J700-J710 series (excluding J708) will result in an automatic rejection.
- Failure to append the 'C' suffix to the claim will cause the professional component to be rejected or processed incorrectly.
Billing Tips
- Always append J708 to the J707 claim if quantitative analysis was performed to ensure appropriate reimbursement for the additional technical effort.
- Ensure the clinical record explicitly references the prior equivocal imaging modality (e.g., SPECT or stress echo) to satisfy the audit requirements for J707.
Effective: October 1, 2009
B. Nuclear Medicine - IN VIVO
POSITRON EMISSION TOMOGRAPHY (PET)
Diagnostic
Positron Emission Tomography (PET)
PET is an insured service for the clarification of myocardial viability when: - a previous myocardial imaging assessment has been rendered, using another modality (e.g. SPECT using thallium, MIBI or dobutamine stress echocardiography) and the result of the previous imaging assessment was equivocal or demonstrated insufficient viable myocardium; or - a patient with a left ventricular ejection fraction less than 35% and known multi-vessel coronary disease determined by coronary angiography urgently needs an assessment of myocardial viability.
Submit claims for the professional component of a PET scan using the 'C' suffix.
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