Oncology & Hematology Coding Alert

If you're not sure whether to use 76092 or 76090 when a patient has a screeningturned-diagnostic mammogram, you're risking unnecessary denials. But a few simple pointers offered by coding experts should clear up any confusion and boost your reimbursement for these transitional studies. If a woman has a family history of breast cancer (V16.3), that alone doesn't mean you can classify the mammogram as "diagnostic." Although you may think mammogram screenings and diagnostic mammograms are quite similar, payers see them differently, says Carolyn M. Davis, CMA, CPC, CCP, CCS-P, CPHT, TMC, billing supervisor for Oncology Hematology West in Papillion, Neb., and a professional coding and continuing-education instructor at Iowa Western Community College.

Medicare and private carriers consider a screening mammogram, 76092 (Screening mammography, bilateral [two view film study of each breast]), a routine procedure performed for asymptomatic patients to detect breast cancer. For example, a 40-yea rold woman visits her primary-care physician for her annual exam. On the other hand, carriers recognize diagnostic mammograms, 76090 (Mammography; unilateral) and 76091 (... bilateral), when a woman presents to your oncologist with signs or symptoms that signify breast neoplasm, such as nipple discharge (611.79), mass (611.72) and mastodynia (611.71). And, Medicare carriers like AdminaStar Federal in Indianapolis don't require a year waiting period when reporting diagnostic mammograms, as long as you support your claim with the proper conditions, such as 611.72 and 611.79. Use G0202 for Digital Mammograms If your oncologist owns and operates digital mammogram imaging equipment, you should use the temporary HCPCS codes, not 76090-76092. But make sure your practice uses this technology, which allows the physician to magnify and optimize different parts of the breast tissue, before you submit these codes, or your carrier will deny your claim. Filing the HCPCS codes signifies that your practice owns the equipment. When Medicare patients have screening mammography performed with digital imaging, report G0202 (Screening mammography, producing direct digital image, bilateral, all views). For bilateral diagnostic mammograms performed with digital imaging, use G0204 (Diagnostic mammography, producing direct digital image, bilateral, all views). You should code unilateral diagnostic mammograms with digital imaging as G0206 (Diagnostic mammography, producing direct digital image, unilateral, all views).

Also, you may assign G0236 (Digitization of film radiographic images with computer analysis for lesion detection, or computer analysis of digital mammogram for lesion detection, and further physician review for interpretation, diagnostic mammography [list separately in addition to code for primary procedure]) along with G0204 or G0206, says Linda L. Lively, MHA, CCS-P, RCC, CHBME, founder and CEO of American Medical Accounting and Consulting in Marietta, Ga.
 
CPT includes add-on code +76085 (Digitization of film radiographic images with computer analysis for lesion detection and further physician review for interpretation, mammography [list separately in [...]