You Be the Coder:
Same-Day Screening, Diagnostic Mammograms
Published on Fri Mar 01, 2002
Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: Under what circumstances would our Radiology Practice assign Medicare's new -GG modifier? When a screening mammogram and a diagnostic mammogram are performed on the same date, would both codes be reported? If so, would the modifier be attached to the screening code?
Pennsylvania Subscriber
Answer: Radiology practices welcomed the news last fall when CMS announced the creation of modifier -GG (Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day). It indicates the performance of a screening mammography (76092, Screening mammography, bilateral [two view film study of each breast]) and diagnostic mammography (either 76090, Mammography; unilateral; or 76091, bilateral) on the same patient on the same day.
Published in Transmittal 1724 and modifying Section 4601.2 of the Medicare Carriers Manual (MCM), the announcement identifies the -GG modifier as being used for tracking purposes to identify when screening studies convert to diagnostic. In addition, the -GG modifier signals a significant policy change, because Medicare will now pay for both the screening and diagnostic mammogram. According to CMS' billing instructions for 2002, both services will be reimbursed for dates of service on or after Jan. 1, 2002. In the past, Medicare would pay only for the diagnostic mammogram and tracked screening studies converted to diagnostic exams with the -GH modifier (Diagnostic mammogram converted from screening mammogram on same day), which should no longer be appended to these services. When reporting these combined services, coders will report 76092 and the appropriate diagnostic mammogram code (i.e., 76090 or 76091). The -GG modifier will be appended to the diagnostic mammogram code.
Most local Medicare carriers advise radiology coders to submit the screening code in the primary position on the claim form, mapped to the screening diagnosis code (V76.12, Special screening for malignant neoplasms, breast, other screening mammogram). The diagnostic mammogram with the -GG modifier would be reported secondarily, accompanied by the diagnosis from the diagnostic study exam (e.g., 611.72, Signs and symptoms in breast, lump or mass in breast; 793.8x, Nonspecific abnormal findings on radiological and other examination of body structure, breast; or 793.81, ... mammographic microcalcification).
The -GG modifier is used only to report these combined services to Medicare. It does not apply to other payers. It is used for Medicare Part B claims, not for hospital services.
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