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J712
J712 – PET scan for liver metastasis from colorectal cancer
OHIP Cardio-Thoracic Surgery Code — POSITRON EMISSION TOMOGRAPHY (PET) · Schedule of Benefits
A Positron Emission Tomography (PET) scan for the assessment of liver metastasis originating from colorectal cancer.
When to Use
- Use J712 specifically for preoperative staging when a patient has confirmed colorectal cancer and is being evaluated for potential curative-intent resection of liver metastases.
- Use J712 when clinical or conventional imaging findings are equivocal regarding the extent of liver involvement, and the PET scan result will directly alter the surgical management plan.
Common Pitfalls
- Billing J712 for routine surveillance of colorectal cancer without specific suspicion of liver metastasis will result in rejection, as it is restricted to the assessment of liver-specific disease.
- Submitting J712 without clear documentation of the primary colorectal cancer diagnosis and the specific intent to evaluate liver metastases is a common audit trigger.
Billing Tips
- Ensure the referral explicitly states the clinical question regarding liver metastasis, as this documentation is required to support the medical necessity of J712.
- If the patient is under 16 years of age, remember to append the appropriate Age Premium code, as J712 is eligible for these diagnostic radiology-associated premiums.
Provider Fee$0.00
Specialist Fee$0.00
Surgical Assistant Fee$0.00
Anaesthetist Fee$0.00
Non-Anaesthetist Fee$237.50
Effective: October 1, 2013
Category
B. Nuclear Medicine - IN VIVO
Subcategory
POSITRON EMISSION TOMOGRAPHY (PET)
Service Type
Diagnostic
Code Classes
Positron Emission Tomography (PET), Diagnostic and Therapeutic Procedures
Referral RequiredFrom: Physician, NursePractitioner, OralMaxillofacialSurgeon
All insured services must be documented in appropriate records to establish that: 1. an insured service was provided; 2. the service for which the account is submitted is the service that was rendered; and 3. the service was medically necessary.
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