Spotlight on Screening-to- Diagnostic Mammograms
Published on Sat Dec 01, 2001
CMS has announced several Medicare policy changes affecting reimbursement for mammography in 2002 including the welcome news that it will pay for both services when a screening mammogram is converted to a diagnostic study.
Late last month, CMS revealed the addition of new HCPCS modifier -GG to indicate the performance of a screening mammography and diagnostic mammography on the same patient on the same day, according to Thomas Greeson, a partner with Reed Smith, LLP in Falls Church, Va., whose client base is composed of diagnostic radiology groups, and formerly the general counsel for the American College of Radiology (ACR). Published in Transmittal 1724 and modifying Section 4601.2 of the Medicare Carriers Manual (MCM), the announcement identifies the -GG modifier as used for tracking purposes to identify when screening studies convert to diagnostic exams.
However, it notes that new billing instructions will apply for dates of service on or after Jan. 1, 2002, stating, "Both the screening mammography and the diagnostic mammography will be reimbursed by Medicare."
"This signals a change for CMS," Greeson says. "In the past, Medicare would pay only for the diagnostic mammogram." When reporting these combined services, coders will report 76092 (screening mammography, bilateral [two view film study of each breast]) and the appropriate diagnostic mammogram code (either 76090, mammogram; unilateral or 76091, bilateral). The -GG modifier will be appended to the diagnostic mammogram code.
Through the end of 2001, radiology practices will continue to report a screening study converted to a diagnostic study with either 76090 or 76091, as appropriate, and the currently recognized -GH modifier, which tracks conversions.
Digital Mammography
CMS also added 76085 (digitization of film radiographic images with computer analysis for lesion detection and further physician review for interpretation, screening mammography [list separately in addition to code for primary procedure]). This add-on code is reported with 76092 to describe computer-assisted detection of tissue abnormalities using special digitization software.
Similarly, radiology coders will use new HCPCS Code G0236 (digitization of film radiographic images with computer analysis for lesion detection and further physician review for interpretation, diagnostic mammography [list in addition to code for primary procedure]), a computer-aided detection add-on code for diagnostic mammography. This code will be reported with 76090 or 76091.
With the introduction of 76085 and G0236, CMS will eliminate G0203, G0205 and G0207. These three old codes described mammography film processed to produce digital images, with G0203 used for screening studies, G0205 for bilateral diagnostic studies and G0207 for unilateral diagnostic studies.
Three additional HCPCS Codes that were implemented in April 2001 will remain [...]
