# Modifier 52 for G0202/G0206



## pennylpalmer (Jan 27, 2015)

We have been billing G0202 52 , with G0206 LT.  Medicare is denying payment of the G0202 for bundling.  I cannot find any information stating that you can no longer use the modifier 52 for a reduced service on a screening mammogram nor can I find any information that states you cannot bill G0202 with G0206. Does anyone have any information?


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## greatbiller (Jan 27, 2015)

Under what circumstances are you billing G0202 and G0206 together?  G0202 is for a screening mammogram, and if you add a 52 modifier, it is implying that only one breast was imaged.  G0206 is a diagnostic unilateral mammogram.  If they are performed the same day, there is a separate modifier which indicates that it was a screening mammogram converted to a diagnostic mammogram. 

Patricia Murrin, CPC, RCC


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## pennylpalmer (Jan 28, 2015)

Patient is due for yearly screening and a follow up on the other breast.  In the past we would bill G0202 52, G0206 611.72 V67.59. We would be paid 50% of the G0202 and full contract price for the G0206. This year the G0202 is being denied for bundling.  No help when contacting Medicare. I cannot find any rules that show a change.


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## rachana (Mar 2, 2015)

In 2015, there is a CCI edit between CPT G0202 & G0206 so if you have proper documentation, then modifier 59 can be added to column 2 code. also check GG modifier as you are billing G0202 and G0206 on same day.


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## luhre (Mar 20, 2015)

*Coding Data Analyst CPC*

It would be inappropriate to do a screening on one breast and a diagnostic on the other.  If a patient presents with symptoms/problems in one breast, she would not qualify for a screening.  
If a bilateral screening and a diagnostic mammogram are done on the same day, modifier GG would be appended to the diagnostic, with V76.12 or V76.11 and a secondary code, the reason for converting to a diagnostic, 611.72, 793.89 etc.
 If a screening mammogram is done the first diagnosis code has to be V76.12 or V76.11.


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## luhre (Mar 20, 2015)

*Coding Data Analyst CPC*

Since January because of the new CCI edit, you must add modifier 59 the the screening exam and GG to the diagnostic.


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