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screening and diagnostic mammograms on the same day

  1. Default screening and diagnostic mammograms on the same day
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    I understand that we bill for both diagnostic and screening mammograms on the same day.

    77067 - screening mammogram
    77063 - 3d tomo

    77066 - diagnostic mammogram
    g0279 - 3d tomo

    Here is what I am coding for - 77067 & 77063 for the screening mammograms (59 modifier on each) and 77066 and g0279 for the diagnostic mammogram (GG on each for Medicare claims only)

    We are getting denials for the g0279.

    Can we bill tomo twice per day if its used for a screening mammogram and a diagnostic mammogram?



  2. Smile Maybe this will help?
    "A/B MAC (A) Claims

    A/B MACs (A) require the diagnostic claim be prepared reflecting the diagnostic revenue code (0401) along
    with HCPCS code 77065*(G0206*), 77066*(G0204*), or G0279 and modifier “-GG” “Performance and
    payment of a screening mammogram and diagnostic mammogram on the same patient, same day.”
    Reporting of this modifier is needed for data collection purposes. Regular billing instructions remain in
    place for a screening mammography that does not fit this situation.

    Both A/B MACs (A) and (B) systems must accept the GH and GG modifiers where appropriate.
    * For claims with dates of service prior to January 1, 2017 thru December 31, 2017, providers report CPT
    codes G0206 and G0204. For claims with dates of service January 1, 2018 and later, providers report CPT
    codes 77065 and 77066 respectively."

  3. #3
    Syracuse, NY
    Default Coding Data Analyst
    I would not add GG modifier to 77061, 77062, or G0279. There are edits on 77061 and 77062 with 77067. I would use modifier 59.

  4. #4
    Default 77063
    Is it appropriate to bill 77063 w/77066 and add mod 59 to 77063? Per the AMA CPT manual "do not report 77063 in conjunction w/76376, 76377, 77065, 77066". Applying modifier 59 to 77063 does remove the edit, but wouldn't these guidelines override adding the modifier to 77063?

    Thank you.

  5. #5
    Syracuse, NY
    Default Coding Data Analyst, CPC
    What that means is that you can't code 77065 or 77066 and 77063 without also coding 77067. You can't code a screening tomosynthesis and a diagnostic mammogram, those two codes alone. You are coding two separate exams.

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