Radiology Coding Alert

Question: How should I code a postmastectomy screening mammogram? I know the screening code is bilateral, but I am unsure whether that means I must use a modifier.

California Subscriber

Answer: Before you worry about appending a modifier to a screening mammography code, you may want to double-check the documentation for any recorded sign, symptoms, or history of breast cancer in the remaining breast, and the order from the attending physician if you choose the wrong code right off the bat, there's no way your claim is going to get past the carrier.

If you determine the screening mammogram code to be the procedure ordered and performed, append modifier -52 (Reduced services) to the 76092 (Screening mammography, bilateral [two-view film study of each breast]) to indicate that the procedure was unilateral, not bilateral as indicated by the descriptor of code 76092. You may want to report either V10.3 (Personal history of breast cancer) or V45.71 (Acquired absence of breast) as the reason for the unilateral screening mammogram.