2nd Qtr 2016 Oncology IRR Case Study #2
17yoM TX MEDICAID-FFS PA REQ
Requesting Provider: Pediatric Hematology and Oncology
Request Initiated: 5/31/16
CPT: 78815- PET imaging with concurrently acquired CT for attenuation correction and anatomical localization; skull base to mid-thigh
ICD-10: 171.5- Malignant neoplasm of connective and other soft tissue of abdomen
Oncology Member History Details:
Date of Diagnosis: 5/1/15
Cell Type and Location: GIST
Current Stage: not noted
Type of Treatment: Partial gastrectomy and omentectomy; Gleevec
Treatment Dates: Approx 5/19/15; 5/2015-6/2015
Nurse Reviewer Note:
Betty/MDO and ACDS note/peds req. PET 78815 for 17 yoM
LOV: 05/29/2016
reason; surveillance.
Onc member hx reviewed.
Prior imaging: PET 01/25/2016: Interval resection of the large perigastric mass with postsurgical changes at the gastric antrum. Mild wall thickening and hypermetabolism in this region is likely postsurgical. Close observation of this region recommended to exclude residual disease. Moderately hypermetabolic right level II cervical lymph node. Given that this would be an unusual location for metastasis, a reactive lymph node is suspected. Clinical monitoring and attention on followup recommended. Additional findings for which continued monitoring is recommended include stable 6mm non-FDG avid hepatic hypodensity (suspected to represent cyst or hemangioma), stable mildly metabolic small pericecal lymph nodes (suspected to represent reactive lymph nodes), and scattered PET negative pulmonary micronodules. Note that 2 peripherally hazy right upper lobe nodules are new and are suspected to be inflammatory. 3 month followup chest CT recommended to ensure resolution of these. Hypermetabolic anterior mediastinal soft tissue which most likely represents residual or rebound thymus.
PE; no worrisome findings
Sx: no new sx
labs; no recent tumor markers noted
ACDS note verified.
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