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Wiki Screening and diagnostic mammogram same session-coding?

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maclee

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What are your thoughts on billing a screening and diagnostic mammogram same session?
Bilateral diagnostic mammogram G0204 versus Unilateral screening G0202 and unilateral diagnostic G0206 GG. I am seeing CMS allowing G0202 and G0206 GG, but the radiology association says bill as bilateral diagnostic. Any assistance is greatly appreciated!
 
maclee said:
What are your thoughts on billing a screening and diagnostic mammogram same session?
Bilateral diagnostic mammogram G0204 versus Unilateral screening G0202 and unilateral diagnostic G0206 GG. I am seeing CMS allowing G0202 and G0206 GG, but the radiology association says bill as bilateral diagnostic. Any assistance is greatly appreciated!
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"New Modifier “-GG”: Performance and payment of a screening mammography and diagnostic mammography on same patient same day -
This is billed with the Diagnostic Mammography code to show the test changed from a screening test to a diagnostic test. A/B MACs (A) and (B) will pay both the screening and diagnostic mammography tests. This modifier is for tracking purposes only. This applies to claims with dates of service on or after January 1, 2002."

I believe the Radiology Association is coming from this point of view:
If the visit began as a bilateral screening (G0202) and turns into a diagnostic test, you would have to bill the equivalent bilateral diagnostic code (G0204). In other words, the [bilateral] encounter as a whole shifts from screening to diagnostic.
 
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