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CAD with call-back????

  1. #1
    Default CAD with call-back????
    Medical Coding Books
    Please Help!!

    My RAD's are questioning if we can bill a CAD with a call-back diagnostic Mammo? I did find an article on the web (page 3, Guidelines for Screening and Diagnostic Mammography”)…

    Unfortunately I do not know how reliable this information is. I did call CMS (NJ) and their answer was, “It will be based on medical necessity.” I understand everything is based on medical necessity.

    Would anyone have any proof that it is allowable to bill for CAD with a call-back Mammo?

    Thank you all so much,
    Jessica O'Donnell CPC

  2. #2
    Fayetteville, NC
    What does the physician say in his/her dictation?
    If the physician called them back to get further views of a lesion or potential lesion and they stated that as their reason for the call back AND they obtained at least one full standard mammographic view of one breast (like the guide you found details) I would try to bill the CAD as well.
    If they deny the CAD send the physician's notes detailing why they felt the need to perform the CAD. If they still deny it then you know they will not pay the two together at all.
    This is obviously not my area of expertise but if thet reimbursement guide is current it would be worth a try to see if it truly is payable in s csll back scenario.
    A. McCormick, CPC, CGSC
    Walters Surgical Associates

  3. #3
    Thanks for the input Grintwig.. but again I was asking, "Would anyone have any proof that it is allowable to bill for CAD with a call-back Mammo?" Opinions are one thing, but as they say.."The proof is in the pudding."

    Any other comments anyone?

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