Oncology & Hematology Coding Alert

Question: My oncologist performed a routine screening mammogram on a 66-year-old Medicare patient, and it revealed a mass. She then ordered a diagnostic mammogram. Can we get paid for both mammographies?

Michigan Subscriber

Answer: You can't bill separately for a screening mammogram and a diagnostic mammogram for the same patient during the same visit. In fact, the two services can even be represented with just one code.

When a screening mammogram is converted to a diagnostic mammogram, use either code 76090 (Mammography; unilateral) or code 76091 ( bilateral) and append the alpha modifier -GH (Diagnostic mammogram converted from screening mammogram on same day).

If the diagnostic mammogram produces digital imagery, you can also use one of Medicare's temporary G codes: G0204 (Diagnostic mammography, producing direct digital image, bilateral, all views), G0206 ( unilateral, all views) and G0236 (Digitization of film radiographic images with computer analysis for lesion detection, or computer analysis of digital mammogram for lesion detection, and further physician review for interpretation, diagnostic mammography [list separately in addition to code for primary procedure]) with modifier -GH.