J713 – Staging of nasopharyngeal carcinoma - PET
OHIP Cardio-Thoracic Surgery Code — POSITRON EMISSION TOMOGRAPHY (PET) · Schedule of Benefits
A Positron Emission Tomography (PET) scan for the staging of nasopharyngeal carcinoma, as listed under the POSITRON EMISSION TOMOGRAPHY (PET) section of the Schedule.
When to Use
- Use J713 specifically for the initial staging of confirmed nasopharyngeal carcinoma to determine the extent of disease.
- Use this code when the PET scan is performed to evaluate for distant metastasis or nodal involvement in a patient with a biopsy-proven nasopharyngeal primary.
Common Pitfalls
- Do not use J713 for follow-up or surveillance scans; it is strictly designated for the staging of the primary diagnosis.
- Avoid billing J713 for PET scans related to other head and neck cancers, as these require their own specific codes within the PET section of the Schedule.
- Ensure the referral source is limited to a Physician, Nurse Practitioner, or Oral Maxillofacial Surgeon, as claims from other providers will be rejected.
Billing Tips
- Ensure the clinical indication for staging is clearly documented in the patient record to satisfy GP8 requirements in the event of an audit.
- If the PET scan is performed as a non-elective, urgent service in a hospital setting, verify eligibility for applicable Special Visit Premiums (e.g., C109, C108, C110) to supplement the diagnostic service.
Effective: October 1, 2013
B. Nuclear Medicine - IN VIVO
POSITRON EMISSION TOMOGRAPHY (PET)
Diagnostic
Positron Emission Tomography (PET)
In accordance with , all insured services must be documented in the patient's medical record 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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