Radiology Coding Alert

Answer: No. The technologist cannot change the procedure ordered by the physician. If, upon review, the radiologist feels there are clinical findings warranting a diagnostic mammogram, he or she may order the diagnostic procedure.

As a courtesy, many radiologists will communicate with the attending physician to notify him or her about the order change. Nonetheless, the radiologist is permitted to make this decision based on medical necessity, and there is no requirement that the attending physician be consulted.

In the case of a Medicare patient, you would code 76091 (mammography; bilateral), with the -GH modifier (diagnostic mammogram converted from screening mammogram on same day) to notify the carrier of a screening mammogram converted to a diagnostic study. Coders should check with other insurers about their modifier policies under these circumstances. Some accept the -GH modifier, but its use is not universal.