Radiology Coding Alert
Mammography Codes Don't Belong on Breast Biopsy Claims, Says CCI
Post-procedure check shouldn’t be separately billed.
Reviewing changes to the latest Correct Coding Initiative manual will be pretty quick work. Although there are several revisions, they’re marked in red so you can spot them quickly. If your practice performs breast biopsies, be sure to check the following addition to the version effective Jan. 1, 2013.
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.
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.
Radiology Coding Alert
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