Hope this helps, THIS IS ALL PER THE ACR
First here is the website:
The following Q&As address Medicare guidelines on the reporting of breast imaging procedures. Private payer guidelines may vary from Medicare guidelines and from payer to payer; therefore, please be sure to check with your private payers on their specific breast imaging guidelines.
Q: How do you code for a unilateral screening mammogram in a patient who has had one of her breasts removed? The code descriptor for a screening mammogram specifies that it is a bilateral study.
When a screening mammography study is ordered and performed on a patient who has only one breast, it is appropriate to report 77057 (Screening Mammography, bilateral [2-view] film study of each breast) or G0202 (Screening mammography, producing direct digital image, bilateral, all views). Because the CPT code descriptors for 77057 and G0202 state â€śbilateral,â€ť it would be appropriate to use a 52 modifier (reduced level of service) to designate a screening procedure of only one breast. However, radiology practices should check with their local carrier and other third-party payers regarding the use of the 52 modifier in this situation, because some payers have stated that a 52 modifier is not necessary for reporting a unilateral screening mammogram.
Jessica O'Donnell CPC
- ICD-10 Trainings
- Comprehensive Courses
- CPC (Certified Professional Coder)
- COC (Certified Outpatient Coder)
- CIC (Certified Inpatient Coder) NEW!
- CRC (Certified Risk Adjustment Coder) NEW!
- CPB (Certified Professional Biller)
- CPMA (Certified Professional Medical Auditor)
- CDEO (Certified Documentation Expert – Outpatient) NEW!
- CPPM (Certified Physician Practice Manager)
- CPCO (Certified Professional Compliance Officer)
- VIEW ALL CERTIFICATIONS
Coding / Billing Solutions
- Audit / Compliance Solutions
Job Experience / Apprentice Removal
News / Discussion
- Other Resources
- Book Store
- Log In / Join