Radiology Coding Alert

Question: A patient presents for a screening mammogram and interpretation is done while the patient is still at the facility. Upon review, the radiologist decides additional films of one breast are required. Would this be coded 76091, because the screening mammogram (76092, screening mammography, bilateral [two view film study of each breast]) has been converted to diagnostic? Also, can 76090 be billed because more films are required?

California Subscriber

Answer: This scenario describes a classic example of the conversion of a screening mammogram to a diagnostic study. It would be appropriate for both Medicare and non-Medicare payers to use 76091 (mammography; bilateral).

For Medicare beneficiaries, you would append the -GH modifier to 76091. This modifier is used to inform Medicare that a screening mammogram was converted to a diagnostic study on the same day. When the radiologist interprets a screening mammogram and orders additional films, Medicare no longer considers the mammogram to be screening for application of age and frequency standards or for payment purposes.

It would not be appropriate to code 76090 (mammography; unilateral) in addition to 76091.