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need some radiology guidance

  1. #1
    Default need some radiology guidance
    Medical Coding Books
    we do digital mammograms in our facility but our doctor also uses the icad machine. (why i don't understand) the 77052 description says bill with primary procedure 77056 which is a standard analog mammo. but doesn't mention anything about g0202 digital mammo. well isn't g0202 digital mammogram incidental to 77052? and can we legally bill the two procedure codes together? i say no but my boss says yes. any suggestions would help.
    Amber Gary, CPC

  2. Default
    G0202 is reported together, unless your payor doesn't want it done that way. I do have one state that does report both, and another that doesn't and only the G code. 77057 or G0202 and 77052.

  3. #3
    Highmark MC, TriCare, and Pennsylvania BS are now denying the CAD with the G0202. I'm seeing this on other forums. Has anyone had success with submitting these for reviews? If so, can you provide what types of info you submitted?

    Which state no longer bills both? Have you gotten any official documentation as to why they now take the position they cannot be billed together? We are awaiting responses to reviews...

    Thank you very much.

  4. #4
    Default G0202
    In Florida for the radiology billing co I used to work for, we used the G0202 in conjunction with 77057 for Medicare Screening Mammo's, digital. They were getting paid. If it is a bilateral diagnostic, G0204 is used and G0206 if it was unilateral diag with the 77055 0r 77056

  5. #5
    G0202 w/ 77052
    G0204 w/ 77051
    G0206 w/ 77051

  6. #6
    I too am having problems with Tricare denying these claims, and no luck with getting appeals approved, they are all denied. I have tried to contact a provider rep because our Medicare (WPS) pays these as do all our other payers. Does anyone have any recent information on this?

    Regional Director, Audit Services

    2015-2018 AAPC National Advisory Board Member

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