Part B Insider (Multispecialty) Coding Alert

Published on Tue Oct 14, 2003 PDF

When screening mammograms turn diagnostic, it's important to be agnostic

Good news can sometimes become confusing, especially when it lets you bill for two things on the same day.
 
Since the start of 2002, Medicare has paid for both 76092 (Screening mammogram) and 76090 or 76091 (Diagnostic mammogram) on the same day. But many providers still find the rules confusing, judging from carrier Arkansas Medicare Services' latest frequently asked questions list. Providers aren't sure how to code both mammograms and what diagnosis codes to use.
 
In the past, providers who performed both screening and diagnostic mammograms on the same day could bill only for the diagnostic one, says coding expert Melanie Witt in Fredricksburg, Va. If you bill for both types of mammograms on the same day, you would use modifier -GG (... screening mammogram and diagnostic mammogram on the same patient, same day).
 
Providers usually do a diagnostic mammogram if they see something "a little bit unusual" in a screening mammogram and they want to make or confirm a diagnosis, says Philip Eskew, medical director of Women & Infant Services at St. Vincent Hospital in Indianapolis. This will usually involve taking several pictures and magnifying them, and maybe performing an ultrasound as well.
 
A screening mammogram usually involves two "views" of the breast, says Carolyn M. Davis, billing supervisor for Oncology Hematology West in Papillion, Neb. If you're billing for both kinds of mammograms, you should show that you really performed both. That means that the diagnostic mammogram should consist of more than just one additional view. If the physician only performed three views total, Davis says that would count as "converting" the mammogram from screening to diagnostic, and you should only bill for a diagnostic mammogram and use modifier -GH to indicate a conversion.
 
It's important to use different diagnosis codes for the different mammograms, says Donna Richmond, radiology coding specialist with Acadiana Computer Systems Inc. in Lafayette, La. You'd generally use V76.12 as the diagnosis for the screening mammogram, but you should change the diagnostic mammogram to a "diagnostic problem" diagnosis like 611.72 (Breast lump or mass), 793.80 (Abnormal mammogram) or 793.81 (Mammo-graphic microcalcification).