Oncology & Hematology Coding Alert

77055 should not be reported with localization clip placement, either.

The Correct Coding Initiative (CCI) manual has made it easy to spot revisions to the latest version, effective Jan. 1, 2013. Just look for the red, italicized text to pinpoint the changes. One section in particular will interest practices that perform breast biopsies with accompanying imaging services.

Scenario: The physician performs a breast biopsy and places a metallic localization clip, using radiologic guidance. The patient then has a mammogram at the same encounter to confirm placement. Should you report the mammogram for payers who apply Medicare rules?

Solution: No, you should not report the mammogram in this case. According to the updated manual, "The radiologic guidance codes include all imaging required to perform the procedure."

More specifically, "If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with radiologic guidance (e.g., 76942, 77012, 77021, 77031, 77032), the physician should not separately report a post procedure mammography code (e.g., 77051, 77052, 77055-77057, G0202-G0206) for the same patient encounter," states Chapter IX, Section D.11, of the manual.

Resource: To review the revised manual, head to www.cms.gov/Medicare/Coding/NationalCorrectCodInitEd/index.html. The CCI policy manual is available from the Downloads section.