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Screening/Diagnostic Mammo Same Day

  1. #1
    Location
    Overland Park, KS
    Posts
    1,166
    Question Screening/Diagnostic Mammo Same Day
    Medical Coding Books
    This may come across as a dumb questin to some of you and please excuse my ignorance.

    If a patient (non-Medicare) presents to the office for a screening mammo and then we also perform a diagnostic mammo later that day, would you report modifier 59 on the diagnostic mammo code? I have checked the NCCI Edits and I don't see an edit in place for the screening and diagnostic mammo codes, so would modifier 59 be necessary?

    I am aware of CMS modifier GG for this instance, but would this modifier work for non-Medicare?
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  2. Talking
    You would use the GG modifier and NOT the 59 modifier

    I do not know about the other forum users but no question is dumb when it comes to coding and billing. If ever anyone is the slightes unsure it is way better to clarify than bill and get a denial

  3. #3
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thank you so very much!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  4. #4
    Default
    I wouldn't use a GG modifier for Non-Medicare patients / Insurance may not recognize it/
    I would bill first without any modifier- if denied as "not payable separatly " than I would resubmit as corrected claim with 59 on diagnostic mammo

  5. #5
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks.
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

  6. #6
    Default
    We bring patients back the same day and do a daignostic one side and add the LT or RT and a 52 modifier as in the guidelines for Radiology.

  7. #7
    Location
    Overland Park, KS
    Posts
    1,166
    Default
    Thanks!
    Dawson Ballard, Jr., CPC, CEMC, CPMA, CCS-P, CPC-P, CRHC, AAPC Fellow
    Coder

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