Mammography Claims Require More than Correct Coding

Mammography Claims Require More than Correct Coding

Screening mammography is a radiologic procedure used for early detection of breast cancer. Medicare has provided Part B coverage of screening mammography for women since 1991.

Mammography Code Changes

For 2017, CPT® codes 77051, 77052, 77055, 77056, and 77057 are deleted. New codes for these radiology services bundled with CAD are:

77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral

77066            ; bilateral

77067 Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed

CMS is maintaining the current coding structure for digital tomosynthesis, with the technical change that G0279 Diagnostic digital breast tomosynthesis be reported with 77066 or 77065 as the replacement codes for G0204 and G0206, respectively.

CPT® code 77063 Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure) remains an add-on code for HCPCS Level II code G0202 Screening mammography, producing direct 2-D digital image, bilateral, all views.

Other Considerations

Correctly coded claims may still be denied. Medicare claims for film, digital, or 3-D mammography services will either deny or reject if:

  1. There is no FDA certification number reported on the claim
  2. The facility is not certified for the type of mammogram submitted on the claim (film, digital, or 3-D)
  3. A facility’s certificate is suspended or revoked
  4. The HCPCS/CPT® code billed does not match the certification on file for the facility, or
  5. There is no FDA certification number on the MQSA file for the facility listed on the claim.

Remember to append modifier GC Performance and payment of a screening mammography and diagnostic mammography on same patient same day to the diagnostic code when a test changes from a screening test to a diagnostic test. Medicare will pay for both tests.


Resources

Medicare Internet Only Manual (IOM) Publication 100-04, Chapter 18, Section 20

https://med.noridianmedicare.com/web/jeb/article-detail/-/view/10542/mammography-services-reminder

MPFS Final Rule, 2017

Renee Dustman
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Renee Dustman

Executive Editor at AAPC
Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.
Renee Dustman
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Renee Dustman, BS, AAPC MACRA Proficient, is an executive editor at AAPC. She holds a Bachelor of Science degree in Media Communications - Journalism. Renee has more than 20 years experience in print production and content management. Follow her on Twitter @dustman_aapc.

3 Responses to “Mammography Claims Require More than Correct Coding”

  1. Lisa says:

    Modifier -GC is incorrect. The correct modifier is -GG. It should be appended if a patient has had a screening and diagnostic mammogram on the same date of service.

  2. L. Lott says:

    Having a debate with unilateral Tom screening 77063 and modifier 52. Use it or not because of it just being unilateral?

  3. s w says:

    77063 is bilateral so mod 52 is appropriate

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