Digital mammo
Screening and diagnostic mammograms are solely determined by the ordering provider's script. The reason for study is what drives the exam and CPT/HCPCS and
diagnosis code assignment. The exception to this would be mammograms of male patients. Male patient mammograms may only be submitted as diagnostic regardless if there is a history of breast cancer. The old policies of a "2year rule" or history of breast cancer are obsolete.
If a digital screening is ordered and performed, then use G0202 - this applies to both a bilateral or unilateral screening. If a unilateral screening is performed, then use G0202-52 to show reduced services (I also add the anatomical modifiers -LT or -RT as applicable). The first listed
diagnosis code should be the V76.12 or V76.11 (for high-risk screenings); then you can code any findings or implant status code of V43.82 (which would be incidental).
If a diagnostic mammogram (G0204/G0206) is ordered to evaluate implants, code first the signs/symptoms/complaint or known diagnosis, and use the V43.82 implant status code as secondary or tertiary. V43.82 is NOT a first-listed
diagnosis code.
If you are coding any digital mammogram with V43.82 as a first-listed
diagnosis code, that may be the reason for your denials. V43.82 is in the group of Vcodes that may only be coded as additional-only.
You may reference Coding Clinics's V Code Table to learn which V code is First-Listed, First or Additional, and Additional Only.
I hope this helps.
Leigh