Radiology Coding Alert

Check your answers to the quiz on page 83.

Once you've completed the quiz on page 83, take a look below to see if your answers line up with Medicare's rules.

Signature Requirements Satisfied?

Answer 1: Yes. An illegible signature over a typed or printedname does meet Medicare's signature requirements, as noted in Transmittal 327, CR 6698. You also may meet signature requirements with a legible full signature, a legible first initial and last name, an illegible signature with the signator's name circled on the letterhead of that page, or several other options included in a chart in the transmittal. Items that don't meet requirements include an unsigned typed note with a typed name, or an unsigned handwritten note that's the only entry on the page, among others.

The Medicare transmittal also includes a special warning for electronic signatures: "Providers using electronic systems need to recognize that there is a potential for misuse or abuse with alternate signature methods. For example, providers need a system and software products which are protected against modification, etc., and should apply administrative procedures which are adequate and correspond to recognized standards and laws. The individual whose name is on the alternate signature method and the provider bears the responsibility for the authenticity of the information being attested to. Physicians are encouraged to check with their attorneys and malpractice insurers in regard to the use of alternative signature methods."

Is This Exam Screening or Diagnostic?

Answer 2: You should report digital diagnostic mammogram code G0206 (Diagnostic mammography, producing direct digital image, unilateral, all views).

To be a diagnostic mammogram, a physician must order the diagnostic service and the patient must have either signs and symptoms supporting medical necessity, or a personal history or other factors the ordering physician decides merit a diagnostic service (Medicare Claims Processing Manual [MCPM], chapter 18, section 20.B, www.cms.hhs.gov/Manuals/IOM/list.asp).

Bonus: The diagnosis code will depend on the documented findings. If the radiologist doesn't offer anything more specific than the breast lump, consider 611.72 (Lump or mass in breast). Or if he notes the mammogram is inconclusive and the patient requires additional tests, remember to consider 793.82 (Inconclusive mammogram).

How Do You Handle Same Day Exams?

Answer 3: Report 77057 (Screening mammography, bilateral [2-view film study of each breast]) for the screening mammogram. For the same-day diagnostic exam, report 77055- GG (Mammography; unilateral; Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day). Note the addition of modifier GG to the diagnostic code.

Tip: Depending on your Medicare contractor's instructions, your claim may include 77057 linked to V76.12 (Special screening for malignant neoplasms; breast; other screening mammogram). Then report 77055-GG linked to either 611.72 or a more specific exam finding.

You won't require orders from outside physicians for either of these exams. Medicare doesn't require patients who meet age and frequency requirements to have an order to get a screening exam (MCPM, chapter 18, section 20.A). In addition, Medicare allows radiologists who interpret a screening mammogram to order and interpret additional mammography films "while a beneficiary is still at the facility for the screening exam" if the screening reveals a potential problem, according to MCPM, chapter 18, section 20.B. For more on screening and diagnostic mammography, see Medicare Benefit Policy Manual, chapter 15, section 280.3.