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Two diagnostic mammograms

  1. #1
    Default Two diagnostic mammograms
    Medical Coding Books
    I wanted to see if anyone else charges for two diagnostic mammograms on the same day. We have patients who come into our breast center for a diagnostic mammogram (either uni or bil) and then end up having a breast biopsy with US guidance done the same day. After the biopsy another uni diagnostic mammo is done to verify clip placement. So we are charging for the G0206 x 2. Or we have the G0204 x1 and G0206 x 1. We are unable to modify these when they hit our CCI edits, but was wondering if we are charging incorrectly to start with?

  2. #2
    Alexandria, LA
    I would not code 2 diagnostic mammograms on the same day. I would roll all the views into one exam.

  3. #3
    Salt Lake City
    The follow up mammo is included in the biopsy
    Jenifer McPolin CPC, CPMA, RCC

  4. #4
    The ACR has guidance on the mammo for clip placement:

    "The American College of Radiology's (ACR) Committee on Coding & Nomenclature has issued an opinion stating “that it is not appropriate to code for a unilateral diagnostic mammogram for verification of clip placement post-stereotactic breast biopsy since these images are included in the placement of the clip localization code 19295.”

    There is additional guidacne on whether it is appropriate to bill a full diagnostic mammo after biopsy is performed, based on the guidance used. However, cannot be billed only for clip confirmation.

  5. Default
    I disagree that you can not bill for post biopsy clip placement dx mammogram. It is not included in the breast biopsy and is medically necessary to perform the DX mammogram to make sure the surgical clip is in the correct place. I bill the post biopsy dx mammogram all the time and never get denied.

  6. Default
    According to the quarter fourth IVR webinar 2012,now the post mammo should not be billed irrespective of any guidance provided,but the pre mammo can be billed.Hence I would not code for post biopsy mammogram.

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