Reimbursement News
FDG PET changed the management for one-third of NOPR patients
Preliminary results from more than 20,000 patients in the National Oncologic PET Registry (NOPR) found that referring physicians changed the intended clinical management for more than one-third of cancer patients based on the findings from FDG-PET.
The NOPR was devised to confirm that FDG-PET is as efficacious in clinical practice as it appeared to be from clinical trials that preceded the decision of the Centers for Medicare and Medicaid Services in 2005 to conditionally grant reimbursement for most applications for cancer diagnosis, staging, and treatment monitoring. The requirement for a registry, managed by the American College of Radiology Imaging Network, was written in Medicare's coverage determination to measure FDG-PET's influence on clinical decision-making.
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SNM Coding and Reimbursement Committee responds to 18F Sodium Fluoride questions
Members of the SNM Coding and Reimbursement Committee provide useful advice for coding 18F sodium fluoride in response to concerns brought forth by changes to the 2008 AMA CPT codes. One PET provider asks:
"We have been asked to perform whole-body PET bone scans for some of our oncology patients using F-18 fluoride. What codes should we use to bill: 78306, 78320 or both with modifier 59? Also, is A4641 the proper code to bill for the F-18 fluoride?"
Read the SNM Coding And Reimbursement Committee's answer
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Patient Advocacy
March is National Colorectal Cancer Awareness Month
Colorectal cancer is equally common in both men and women – 148,810 new cases are estimated to be diagnosed in 2008, and 49,960 people projected to die of the illness. It is also one of the most easily prevented cancers because it can develop from polyps that can be removed before they become cancerous.
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Health Update
HHS Secretary invites communities to apply for an innovative Electronic Health Record demonstration project; use of EHRs can improve the quality of health care and reduce errors
HHS Secretary Mike Leavitt recently called on community leaders across the country to apply for a new demonstration project that provides Medicare incentive payments to physicians for the use of certified electronic health records (EHRs) to improve patient care.
The project, which will be open to small- and medium-sized primary care physician practices, is expected to reduce medical errors and improve the quality of care for an estimated 3.6 million Americans.
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