Radiology Coding Alert

Question: Can you report a bilateral screening tomosynthesis on the same day as a bilateral diagnostic tomosynthesis? Our screening tomosynthesis codes are being denied.

California Subscriber

Answer: You should be aware that proper reporting of a screening and diagnostic mammogram performed on the same day requires modifier GG (Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day) appended to 77066 (Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral) and modifier 59 (Distinct Procedural Service) appended to 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed).

National Correct Coding Initiative (NCCI, or CCI) policy does not offer specific guidelines on the reporting of screening and diagnostic tomosynthesis on the same day. However, you’ll find that no NCCI edits exist between codes +77063 (Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure)) and G0279 (Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to 77065 or 77066)).

However, you will find the following parenthetical note under +77063:

• (Do not report +77063 in conjunction with 76376, 76377, 77065, 77066)

Additionally, you’ll find an NCCI edit when reporting +77063 with 77065 and 77066 with a modifier indicator of “1.” This is clearly the reason that you are receiving denials on your screening tomosynthesis claims. Based on the fact that no edit exists between +77063 and G0279, you could make the assumption that the edit is probably meant as a way of catching coders who report screening tomosynthesis procedures with diagnostic mammogram claims accidentally.

However, your best course of action is to contact the payer. From a simply practical perspective, performing a screening and diagnostic tomosynthesis on the same day might be considered redundant.