Revenue Cycle Insider

Question: A Medicare patient with no history of breast cancer presented for their annual screening mammogram. They had no palpable findings and no breast complaints. The radiologist performed bilateral planar screening digital mammography with digital breast tomosynthesis (DBT) and computer-aided detection (CAD). The radiologist identified a 9 mm focal asymmetry in the right breast, upper outer quadrant, posterior depth. The radiologist documented the decision to proceed with diagnostic mammography on the same day. Later in the day, the radiologist performed a right diagnostic mammography with right breast DBT.

The report lists the impression as an 8 mm irregular mass in the right breast, 10 o’clock, BI-RADS 4.

How do we report the screening and diagnostic mammography exams on the same day?

Georgia Subscriber

Answer: Start by assigning 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed) to report the bilateral screening mammography with CAD, and use +77063 (Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)) to report the screening DBT.

Next, you’ll select 77065 (Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral) to report the diagnostic mammography of the right breast. You’ll also append modifier GG (Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day) to 77065 to indicate that the screening and diagnostic mammography exams occurred on the same day. Furthermore, you’ll also assign G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)) along with 77065, per the Medicare Claims Processing Manual, Chapter 18, Section 20.2.1.

Additionally, the Medicare National Correct Coding Initiative (NCCI) Policy Manual, Chapter IX.C.16, requires you to report the screening mammography CPT^® code with modifier 59 (Distinct procedural service) or XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service). Check with your Medicare Administrative Contractor (MAC) to confirm which modifier to use.

Mike Shaughnessy, BA, CPC, Production Editor, AAPC