3rd Qtr Physician 2016 Oncology Case Study #1
12 yom GWHCIGNA SI-PPO/OAP
Provider specialty: Physician Assistant
Request Initiated: 7/19/16
CPT: 78816 PET imaging with concurrently acquired CT for attenuation correction and anatomical localization; whole body
ICD-10: C74.90 Malignant neoplasm of unspecified part of unspecified adrenal gland
Nurse Reviewer Note:
Req 78816
LOV: 5/12/16
Member History: Stage IV High Risk NBL diagnosed at age 7 with Bone Marrow Met’s. Relapse 5/2015.
Chemo ongoing since 6/24/15
Reason : Restaging, Response to Treatment .
ONC Member Hx: Updated .
Prior Imaging: none recently
PE: Not provided .
Sxs: Not provided.
Labs: No LFt's nor tumor markers noted
Reviewed ACDS and web notes
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