Radiology Coding Alert

Reader Questions:

MCPM Answers Modifier GG Questions

Question:

What is the proper way to use modifier GG? Do I append it to a diagnostic mammogram code? Do we need a separate order for the diagnostic exam?

Illinois Subscriber

Answer:

You should report both the screening and diagnostic exams. Append modifier GG (Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day) to the diagnostic mammogram code. You will not need an order for the diagnostic exam in this case.

Example: A patient presents for a screening mammogram. The radiologist detects a suspicious abnormality requiring further imaging and performs a separate unilateral diagnostic mammogram on the same date. On the claim, report the following:

77057 -- Screening mammography, bilateral (2-view film study of each breast)

77055-GG -- Mammography; unilateral.

Or if the mammograms are digital, use the following codes:

G0202 -- Screening mammography, producing direct digital image, bilateral, all views

G0206-GG -- Diagnostic mammography, producing direct digital image, unilateral, all views.

Payer preference: G codes are appropriate for CMS claims. Other payers may prefer that you use CPT mammography codes 77054-77057 for digital services; be sure to get that policy in writing.

Order requirements: According to Medicare Claims Processing Manual (MCPM), chapter 18, section 20.A, Medicare will cover screening mammograms even without a physician order for women who meet age and frequency requirements:

Under age 35: No payment allowed for screening mammography.

35-39: Baseline (pay for only one screening mammography performed on a woman between her 35th and 40th birthday).

Over age 39: Annual (11 full months have elapsed following the month of last screening).

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. And Medicare will pay for both the screening and diagnostic exams.

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