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Radiology Coding Alert

You Be the Coder:

G0202 Screening When Patient Had Breast Cancer?

Published on Thu Jan 06, 2011

Question: My understanding is that a routine mammogram is only for bilateral services. I also believe we cannot use a modifier for a routine mammogram (such as G0202-RT). So how should I code this case? The patient is status post left breast mastectomy. She presents herself to our office for a yearly mammogram on her right breast. Do we code this as a unilateral diagnostic, or do we code this as a routine screening?Answer: The general advice is that you should (a) code based on whether the ordering doctor called it screening or diagnostic (keeping in mind that Medicare doesn't require an order for screening) and (b) make sure the ordering doctor's understanding of screening/diagnostic matches the payer's.If you're coding for someone under NGS Medicare, New York's carrier, there are a couple of resources you can look to for information. They show that for NGS Medicare patients, your case could [...]
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