Radiology Coding Alert

Responding quickly to legislation raising reimbursement for digital mammography and conversion of standard images to digital format, HCFA unveiled six new codes, effective April 1, 2001, to report these services.

Late last year, Congress increased Medicare reimbursement for full-field digital diagnostic mammography services to 150 percent of the rate paid for standard diagnostic mammography, according to Stacey Hall, RHIT, CPC, CCS-P, director of corporate coding for Medical Management Professionals Inc., a national billing and management firm for hospital-based practices in Chattanooga, Tenn. Under the new legislation, the average reimbursement for full-field digital mammography will be about $120. In addition, the bill provides an extra payment of $15 for practices converting standard mammography film to digital images when accompanied by analysis with appropriate software (i.e., computer-aided detection devices).

The new Level II urology Coders provide a reporting mechanism that allows radiology coders to take advantage of the new reimbursement rates, Hall explains. Each of the codes is a G code, indicating its temporary status

Each code describes a specific digital mammography service:

G0202 and G0203 will be used to report bilateral screening mammography; G0202 applies to direct digital images, while G0203 will be assigned when standard films are made but later processed to produce digital images subsequently analyzed for potential abnormalities. Both of these codes include all views obtained to complete the study. (The applicable revenue code for hospital billers is 403.)

G0204 and G0205 will be assigned for bilateral diagnostic mammography services; G0204 describes direct digital images, while G0205 will be reported when standard films are converted to digital images to be interpreted for potential abnormalities. Both codes include all views obtained to complete the study. (The applicable revenue code for hospital billers is 401.)

G0206 and G0207 describe unilateral diagnostic mammography; as with the previous sets of codes, G0206 will be used when direct digital images are taken, while G0207 will be assigned when standard films are converted to digital. (The applicable revenue code for hospital billers is 401.)

When it announced the new temporary codes, HCFA noted that all coinsurance, deductible and payment policy rules that apply to current conventional diagnostic and screening mammographies also apply to the new digital mammography codes. For instance, Medicare covers conventional film screening in asymptomatic women 40 years and older once a year. The same frequency convention will apply to digital screening mammography and to standard screening films converted to digital images.

Whats the Reimbursement Impact?

While few radiology practices will argue with enhanced reimbursement rates, this particular piece of news is a double-edged sword, according to Cindy Parman, CPC, CPC-H, co-owner of Coding Strategies Inc., an Atlanta-based firm that supports 1,000 radiologists and 350 physicians from other specialty areas. Professional organizations like the American College of Radiology (ACR), as well as radiologists, mammographers and coders throughout the country, have expressed significant concerns about how policy governing digital mammography is being crafted.

Among the issues raised are:

The increased reimbursement applies only to digital mammography, not to standard bilateral diagnostic mammography. Payment for standard mammography is much lower, averaging only about $80 (payment will vary from region to region), a figure some experts estimate covers only about one-third of the cost of providing the service.

The reimbursement windfall may prompt radiologists and mammographers to favor digital technologies, even though these have not yet been proven to be as accurate a diagnostic tool as standard mammography. Experts note that conventional film mammography continues to be the benchmark for the industry, while digital mammography has not been scientifically proven to be an improved benefit.