Help!!! 77052 denials

[jdd111168]

I am working some denials and, being new to radiology, there are a few things I am seriously confused about. We have claims billed with G0202 and 77052 that are being paid and then others where only the G0202 is being paid and the 77052 is being denied as incidental. Can anyone tell me why this is happening because I can't seem to get an answer that makes sense. Help! Please!



Jayme D. CPC

[feliciathomas]

From what I can tell G0202 is for a screening mammogram - bilateral - all views. 77052 is an add on code for 77057 a screening mammogram 2 views - each breast with computer adied detection.

Why would the practice use these two codes together. 77052 can only be used with 77057.

[Lisa Bledsoe]

You should be able to code G0202 (screening mammo producing direct digital images) with 77052 (computer aided detection). I realize 77052 states to use with 77057, but with the new G codes for the digital films, 77052 should be acceptable. My interpretation of "all views" does not include the CAD. Appeal the carriers that are denying 77052 and point out to them that it is in an add-on code.

[cobin]

Hello, I have a follow-up question regarding mammo billing. I know you cannot bill cad charges alone without the appropriate mammo code, but can you bill mammo codes (i.e. g0204, g0206..) without cad cpt's?

Thanks for any insight.

[Lisa Bledsoe]

Originally Posted by cobin

Hello, I have a follow-up question regarding mammo billing. I know you cannot bill cad charges alone without the appropriate mammo code, but can you bill mammo codes (i.e. g0204, g0206..) without cad cpt's?

Thanks for any insight.

Yes, these do not have to be accompanied by CAD codes.

[jdd111168]

Thanks for the help! I did rebill all of the claims to the carrier with a letter explaining that this is an add-on code and should be paid accordingly! Wish me luck!