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Question:
How do you code for a screening mammogram when additional magnification views are required for a suspected abnormality? May I code both a diagnostic mammogram and a screening mammogram?
Answer:
If a screening mammogram is performed and, after film review, pathology is suspected and additional views are taken, it would be appropriate to charge for both a screening mammogram and a diagnostic mammogram.
When the additional diagnostic views are done on the same day as a screening mammogram, Medicare requires that providers append modifier GG to the diagnostic mammography CPT code used to designate that a screening procedure was performed in conjunction with a diagnostic procedure. Modifier 59 should be added to the screening mammogram code.
This question was answered in an edition of our Radiology Compliance Manager. For more hot topics relating to radiology services, please visit our store or call us at 1.800.252.1578, ext. 2.
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
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