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PET for Brain Metabolism

CPT: 78608

1 Dementia to differentiate FrontoTemoral Dementia (FTD) from Alzheimer’s Disease (AD) [all]

1.1 Signs and Symptoms

  • 1.1.1 Apraxia (impaired ability to carry out motor activities despite intact motor function)
  • 1.1.2 Confusion
  • 1.1.3 Disorientation
  • 1.1.4 Language difficulties
  • 1.1.5 Memory loss
  • 1.1.6 Progressive cognitive decline
  • 1.1.7 Social disinhibition

1.2 Medical conditions to explain dementia have been eliminated by normal or nondiagnostic

  • 1.2.1 Thyroid-function tests
  • 1.2.2 Vitamin B12 level
  • 1.2.3 Blood urea nitrogen (BUN)
  • 1.2.4 Serum electrolyte
  • 1.2.5 Blood glucose levels, and
  • 1.2.6 Liver-function

1.3 Nondiagnostic SPECT, MRI or CT

1.4 Planned medical intervention if AD is diagnosed

2 Seizure [All of the following]

  • 2.1. Seizures not responsive to adequate dosage of medications
  • 2.2. Surgery is planned
  • 2.3. MRI does not define a “seizure focus”

3 Primary or metastatic brain tumor [One of the following]

  • 3.1. Pre-operative study tumor resection or radiosurgery with margins not defined on MRI or CT
  • 3.2. Post treatment determination of viable tumor versus radiation necrosis

4 Movement disorder [One of the following]

5 Suspected Huntington’s chorea with a non-diagnostic MRI and genetic testing is inconclusive [One of the following]

  • 5.1. Irregular lurching gait
  • 5.2. Speech disturbance
  • 5.3. Positive family history
  • 5.4. Progressive ataxia of undetermined etiology

References

  • ACR Appropriateness Criteria® Seizures and Epilepsy American College of Radiology Last review date: 2014
  • American College of Radiology Appropriateness Criteria – Dementia and Movement Disorders. Last review date: 2014
  • Procedure Guideline for FDG-PET Brain Imaging v1.0 1 Society of Nuclear Medicine Procedure Guideline for FDG PET Brain Imaging
  • National Coverage Determination (NCD) for FDG PET for Dementia and Neurodegenerative Diseases (220.6.13) Accessed 3/17/11 at http://www.cmms.hhs.gov/medicare-coverage-database/details/ncd-details.aspx?NCDId=288&ncdver=3&bc=AAAAgAAAAAAA&

I. Primary or metastatic brain tumor [One of the following]

  • A. Pre-operative study tumor resection or radiosurgery with margins not defined on MRI or CT
  • B. Post treatment determination of viable tumor versus radiation necrosis

II. Movement disorder [One of the following]

A. Suspected Huntington’s chorea with a non-diagnostic MRI and genetic testing is inconclusive

[One of the following]

    1. Irregular lurching gait
    1. Speech disturbance
    1. Positive family history

B. Progressive ataxia of undetermined etiology

III. Seizure [All of the following]

  • Seizures not responsive to adequate dosage of medications
  • Surgery is planned
  • MRI does not define a “seizure focus”

References

  • ACR Appropriateness Criteria® Seizures and Epilepsy American College of Radiology Last review date: 2014
  • American College of Radiology Appropriateness Criteria – Dementia and Movement Disorders. Last review date: 2014
  • Procedure Guideline for FDG-PET Brain Imaging v1.0 1 Society of Nuclear Medicine Procedure Guideline for FDG PET Brain Imaging