Radiology Coding Alert

Question: We received an order for mammography from a primary-care physician who indicated that the patient has fibrocystic breast disease. The report dictated by our radiologist noted that a screening bilateral mammography was performed. Shouldnt this be a diagnostic service, since the referring physician included the diagnosis of fibrocystic breast disease? Also, we often receive orders for bilateral diagnostic mammograms, but no diagnosis is provided. How should we handle this?

Missouri Subscriber  
Answer: For the patient with fibrocystic breast disease (610.1), the radiology practice should conduct and subsequently code the mammography service indicated in the referring physicians order. If the order did not specify which study was needed, the practice should call the referring physician for clarification and note the discussion in the medical record. Generally speaking, the determination whether a diagnostic or screening mammogram is indicated in women with a history of benign breast disease depends on their current clinical status. If a patient is symptomatic, a diagnostic mammogram (76090, mammograph; unilateral, or 76091, ... bilateral) should be ordered and reported if performed. If the patient was previously diagnosed but is now free from symptoms, a screening study (76092, screening mammography, bilateral [two view film study of each breast]) is usually more appropriate.
 
The same principle also governs the second part of this question. If the physician has specifically ordered diagnostic mammography but offers no diagnosis, the radiology practice should call the doctor for more information. If, indeed, no symptoms are present, the physician would most likely indicate that a screening mammogram should be performed.
 
Coders should note that, on occasion, primary care physicians may not completely understand the nuances distinguishing screening and diagnostic mammography since this is not their area of specialty. Good communication may provide the opportunity to educate these practices about issues like this.
 
If a screening mammogram is ordered and performed, and the radiologist detects an abnormality that makes it necessary to perform additional views, the study may be converted to a diagnostic mammogram. With Medicare patients, modifier -GH is appended to the CPT diagnostic code to indicate that the study was converted from a screening service.