Radiology Coding Alert

Question: If a patient has breast implants or breast augmentation, should I consider this to be a screening or a diagnostic mammogram? Louisiana Subscriber Answer: Implants and augmentation don’t equate to a diagnostic mammogram every time. The ordering physician is the one who decides whether the patient requires a diagnostic mammogram. Diagnostic: To be a diagnostic mammogram (such as 77056, Mammography, bilateral), a physician must order the diagnostic service for a patient either with signs and symptoms supporting medical necessity, or a personal history or other factors the physician decides merit a diagnostic service, states the Medicare Claims Processing Manual, Chapter 18, Section 20.B (www.cms.hhs.gov/Manuals/IOM/list.asp). Watch for: If the screening reveals a potential problem, Medicare does allow radiologists to order additional mammography views on the same date as the screening. You should code these additional views with the appropriate diagnostic mammogram code and append modifier GG (Performance and [...]