Part B Insider (Multispecialty) Coding Alert

Published on Fri Aug 06, 2010 PDF

Question:

You should report both the screening and diagnostic exams. Append modifier GG (Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day) to the diagnostic mammogram code. You will not need an order for the diagnostic exam in this case.

Example: A patient presents for a screening mammogram. The radiologist detects a suspicious abnormality requiring further imaging and performs a separate unilateral diagnostic mammogram on the same date. On the claim, report the following:

Or if the mammograms are digital, use the following codes:

Payer preference: G codes are appropriate for CMS claims. Other payers may prefer that you use CPT mammography codes 77054-77057 for digital services; be sure to get that policy in writing.

Order requirements: According to Medicare Claims Processing Manual (MCPM), chapter 18, section 20.A, Medicare will cover screening mammograms even without a physician order for women who meet age and frequency requirements:

Medicare allows radiologists who interpret a screening mammogram to order and interpret additional mammography films "while a beneficiary is still at the facility for the screening exam" if the screening reveals a potential problem, according to MCPM, chapter 18, section 20.B. And Medicare will pay for both the screening and diagnostic exams.