Wiki Stereotactic Breast Biopsy with Post-Procedure Mammogram

[mbh1967]

Following stereotactic breast biopsy with clip/marker placement, our group of surgeons always perform a post-procedure mammogram to confirm marker location. Radiologists DO NOT perform or read the mammogram. It appears that the mammogram interp (77055-26) can be billed in 2014 with the new image-guided breast biopsy codes (ie, 19081 in this case). There are no CCI edits on this code combo. Wondering if other groups also do confirmatory mammography and also bill for this?

 

[tlivengo]

post-op mammograms

There are two reasons post-op mammograms should not be billed:

1. since they are doing it only to check their work it's not billable

and

2. Since 19083, 19084, 19085 all use radiologic guidance it should not be billed. The below paragraph is from the NCCI narrative.

11. If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with mammographic guidance (e.g., 19281,19282), the physician should not separately report a post procedure mammography code (e.g., 77051, 77052, 77055-77057, G0202-G0206) for the same patient encounter. The radiologic guidance codes include all imaging by the defined modality required to perform the procedure.

 

[kmschwarz]

confused on post-procedure mammogram

The question and answer below is from the ACR Jan-Feb. 2014. What my coworkers and I do not understand is why the wording keeps changing on this. Our question is do they need medical necessity to be able to bill post-procedure mammogram?

Q: Please provide advice regarding the reporting of post-biopsy mammogram, if a biopsy is performed under ultrasound guidance (19083). Following the biopsy, a post-procedure unilateral mammogram is performed in a digital room (G0206). Can I now bill separately for both the ultrasound-guided biopsy and the digital post-procedure mammogram?

A: When a breast biopsy is performed under ultrasound guidance (19083), and the post-procedure mammogram is done in a digital room (G0206), it is appropriate to bill separately for both, the ultrasound-guided biopsy and the digital post-procedure mammogram as different modalities were used for the biopsy guidance and the post-procedural film.

The wording in the 2014 National Correct Coding Initiative (NCCI) narrative now allows the coding of the post-procedure mammogram when a different modality is used for the breast biopsy.as noted in the following:

If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with mammographic guidance (e.g., 19281, 19282), the physician should not separately report a post procedure mammography code (e.g., 77051, 77052, 77055-77057, G0202-G0206) for the same patient encounter. The radiologic guidance codes include all imaging by the defined modality required to perform the procedure.