Ob-Gyn Coding Alert

Question: Medicare is denying our claims that contain 76092 and 76092-76. Is there a better way to bill for this procedure?

Minnesota Subscriber

Answer: Code 76092 is for a bilateral screening mammography. And modifier -76 (Repeat procedure by same physician) indicates that the ob-gyn performed a second screening mammography on the same date. A better option may be modifier -59 (Distinct procedural service) for the second mammography to distinguish it more clearly from the first.

Normally, however, if the screening mammography shows something, the physician would likely order a diagnostic mammogram (76090, Mammography; unilateral; or 76091, bilateral) instead of a second screening.