Wiki G0202 with 77052 and 77056-GG billed on the same day

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sudip.rai

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Hi,

I have a question for people coding mammograms, can we bill use G0202 and 77052 (for CAD) and have a diagnostic mammogram 77056 (with GG) billed on the same day. I am facing denials from some commercial carriers when we bill G0202 (digital screening) 77052 (CAD) and 77056-GG (bilateral diagnostic) on the same day, could not find any reference on the net, need help on this urgently.
 
Coding for screening and diagnostic mammos same day

We will often bill for screening and diagnostic on the same visit, and as
far as I know, it's never been a problem. Often a problem is seen with the
screening, so they do the diagnostic, and I just code it that way, with the screening code, and the abnormal mammo code.
 
This is how I have been coding the screening and diagnostic mammogram with GG modifier appended to the diagnostic mammography code, we are getting denials infrequently from Medicare or some commercial insurances.
 
additional Question re: G0202

We recently added the equipment to perform Digital Mammograms to our office. We have noticed higher reimbursment from all payers with the exception of one. We contacted that payer and we were advised that there is an addtional code that we should be submitting to receive full reimbursement but she would not tell us what that is.

After reading many of the posts on this site I wonder if she is refering to the CAD code. We no longer have the equipment for the CAD but I just want to be sure that we aren't missing out on something.

Any help is greatly appreciated.

:eek:
 
sudip.rai said:
Hi,

I have a question for people coding mammograms, can we bill use G0202 and 77052 (for CAD) and have a diagnostic mammogram 77056 (with GG) billed on the same day. I am facing denials from some commercial carriers when we bill G0202 (digital screening) 77052 (CAD) and 77056-GG (bilateral diagnostic) on the same day, could not find any reference on the net, need help on this urgently.
Click to expand...

You are doing digital screening, but film diagnostic?
Which is getting denied, and what denial reason?
For Medicare at least, your facility must be certified for digital and/or film. If you are only certified for digital, you won't get paid for film and vice versa.
What diagnosis codes are you using on each?
 
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