Wiki -GG Mod with Medicare Mammograms

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SienTC1720

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I bill for the professional side of radiology, and we have only had one or two patients this year have a screen and diagnostic mammo on the same day. So far we have had a hard time getting these paid. We are putting the -GG on the diagnostic mammogram, for one patient in particular, this is what we have billed out:
77067-26
77063-26
77065-26-GG
76642-26
The only thing medicare paid on the claim was the 77065 and 76642, they completely denied the screening and tomo.

I'm thinking I have read too much now and I'm just thinking too hard, can someone spell it out simply for me? Or point me in the direction of valid info from CMS?
 
Coding Data Analyst

There are edits on 77067 and 77063 with 77065 and 77066. Also edits on 77061 and 77062 with 77067. You would need to add modifier 59 to the second column codes.

Example:
77067-26,59
77063-26,59
77065-26,GG,LT or RT
77061-26,59,LT or RT
 
Last edited:
77063

I have a question about coding 77063 and 77066. Can you correctly code these two together? The AMA CPT 2018 coding book says "Do not report 77063 in conjunction with 76376, 76377, 77065 and 77066". So I am confused as I would think that we would have to follow this guideline instead of adding mod 59 to 77063. Maybe I am over thinking, but just because you add a modifier and the edit clears, does not make it correct coding, right? Help.


Thank you.
 
Coding Data Analyst, CPC

What that really means is that you can't code 77065 or 77066 and 77063 without also coding 77067. In other words, you can't code a screening tomosynthesis and a diagnostic mammogram (those two codes alone). You are coding 2 separate exams. You aren't really coding 77063 with 77065/6. You are coding 77063 with 77067 and you are coding 77065/6 with 77061/2 (or G0279 for Medicare).
 
WE ARE SEEING OUR CLAIMS WITH BOTH THE SCREENING MAMMOGRAM AND TOMO AND DIAGNOSTIC MAMMO AND DIAGNOSTIC TOMO BUT ONE IS BEING DENIED USUALLY THE DIAGNOSTIC TOMO. EVEN THOUGH WE ARE USING BOTH THE 59 AND GG MODIFIERS. ANY ADVISE? FROM WHAT I HAVE READ THIS IS THE INSTRUCTION TO ADD THESE MODIFIERS WHEN A SCREENING MAMMO IS ABNORMAL AND THEY DO THE DIAGNOSTIC IN THE SAME DAY. WE ARE USING THE G CODE FOR MEDICARE BUT STILL HAVING DENIALS.
 
On the Diagnostic Tomo, I would add modifier 59 not GG. GG modifier on the Diagnostic Mammo only. If Medicare, G0279, no GG or 59.
 
Has anyone found a solution for this problem? I was sending out appeals for these claims, but the appeals have been coming back as a denial again. I believe the insurance companies have been taking the wording in the book too literally. TIA
 
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