Ob-Gyn Coding Alert

Question: My ob-gyn sees a patient who has breast implants or breast augmentation and orders a mammogram. Should I count the mammography as a screening or a diagnostic test? Louisiana Subscriber Answer: Implants and augmentation don't equate to a diagnostic mammogram every time. The ordering physician decides whether the patient requires a diagnostic mammogram. Diagnostic: To be a diagnostic mammogram (such as 77056, Mammography, bilateral), the ob-gyn must order the diagnostic service for a patient who has one of two requirements, states Medicare Claims Processing Manual, chapter 18, section 20.B (www.cms.hhs.gov/Manuals/IOM/list.asp). The patient must either have: signs or symptoms supporting medical necessity, or a personal history or other factors the physician decides merit a diagnostic service. Watch for: If the screening reveals a potential problem, Medicare allows the radiologist or ob-gyn to order or perform additional mammography views on the same date as the screening. When billing for these [...]