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Mammograms - Thank you in advance for everyone's

JGGBALLEN

Networker
Messages
26
Best answers
0
Thank you in advance for everyone's assistance in clarifying thses CPT/HCPCS codes

How do 77055 - 77057 differ from G0202 -G0206?

I read once that 77055-77057 are analog films. Is that correct?
There are no CPT codes for digital screening mammograms. Is that correct?

Provider is submitting G0202 - G0206, (various patients and ages) and documents the digital mamo screening to support.

My question is...when would you or under what circumstance would you select the HCPS code over the relevant CPT code?
It does not seem to be Medicare/age related.

What needs to documented to support 77051 vs 77052?
With 77051 would "benign appearing nodular density" support?
I say no, because CPT descripton specifically says "lesion detection"
i am not a clinician, but they don't seem to be the same (nodual/lesion).
 

donnajrichmond

True Blue
Messages
518
Location
Alexandria, LA
Best answers
0
Thank you in advance for everyone's assistance in clarifying thses CPT/HCPCS codes

How do 77055 - 77057 differ from G0202 -G0206?

I read once that 77055-77057 are analog films. Is that correct?
There are no CPT codes for digital screening mammograms. Is that correct?

Provider is submitting G0202 - G0206, (various patients and ages) and documents the digital mamo screening to support.

My question is...when would you or under what circumstance would you select the HCPS code over the relevant CPT code?
It does not seem to be Medicare/age related.

What needs to documented to support 77051 vs 77052?
With 77051 would "benign appearing nodular density" support?
I say no, because CPT descripton specifically says "lesion detection"
i am not a clinician, but they don't seem to be the same (nodual/lesion).

G0202 - G0206 are digital mammograms. These codes were initially added for Medicare to distinguish between film and digital, because CMS pays more for digital mammograms. Most other payers also now accept the G codes for digital mammograms.
Medicare and most payers use 77055 to 77057 for film mammograms.

So you use the G code if you do / interpret a digital mammogram, the 7705x codes if film.
For a unilateral screening mammogram, code the appropriate mammogram code with modifier -52 (G0202-52 or 77057-52)

If CAD is used with diagnostic mammogram, code 77051, if used with screening mammogram, code 77052. You don't code them based on finding, but on the type of mammogram that was done.
 
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