Question:

Can a radiologist bill for the reading of a post breast biopsy/clip/wire-placement mammogram? It is usually a two-view mammogram that indicates the clip/wire placement. Prior to 2016, the National Correct Coding Initiative (NCCI) edits didn’t allow, but I believe this policy was revised.  If the radiologist can bill for the reading of the post breast biopsy/clip/wire placement mammogram, would it be a unilateral, diagnostic mammogram?

Answer:

Basically, the post-procedure mammogram may be billed for a biopsy or after a localization procedure unless mammographic guidance was used for the biopsy/localization. It is usually a unilateral mammogram (unless lesions on both breasts were biopsied).

According to the American College of Radiology’s Committee on Coding and Nomenclature, it is appropriate to code for a unilateral diagnostic mammogram, including computer-aided detection (CAD) when performed (77065) for verification of clip placement after biopsy when it is performed on separate pieces of equipment, if it is a different modality from the primary procedure, or if separate physicians are involved.

As shown below, the 2018 National Correct Coding Initiative Policy Manual for Medicare Services, Chapters 3 and 9, indicate that a post-procedure mammogram may be separately reported when the biopsy, localization, clip placement or other procedure was performed under a modality other than mammographic guidance. It says the following:

“If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with mammographic guidance (e.g., 19281,19282), the physician should not separately report a post-procedure mammography code (e.g., 77065–77067, G0202–G0206) for the same patient encounter. The radiologic guidance codes include all imaging by the defined modality required to perform the procedure. (HCPCS codes G0202-G0206 were deleted January 1, 2018.)”

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