Radiology Coding Alert

A Florida radiology group agreed to pay $2.53 million after being charged with billing Medicare falsely, including reporting screening mammograms as diagnostic procedures. Learn one way to avoid this costly mistake.

Remembering modifiers and knowing when documentation is necessary for Medicare reimbursement can be a tricky business with dangerous consequences. Here's how to use modifier -GG to code same-day screening and diagnostic mammograms performed in a single patient encounter. Use Modifier -GG in the Proper Situation
 
Problem: A female patient covered by Medicare comes in for her annual screening mammogram. The radiologist detects an abnormality and determines that a diagnostic mammogram is necessary. He completes this procedure on the same day. How do you code this? What documentation is necessary for reimbursement for these services?
 
Solution: Modifier -GG (Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day) addresses this problem for all services performed after Jan. 1, 2002. CMS intends for you to report modifier -GG when a diagnostic exam is ordered and performed for a patient who has undergone a screening and is still at the facility, says Jackie Miller, RHIA, CPC, senior consultant for Coding Strategies Inc. in Powder Springs, Ga. You should never append -GG if a physician sends a patient home after a screening exam and then calls her back for diagnostic services on a different date.
 
Modifier -GG tells the insurance carrier "that you really thought you found something, and you wanted to investigate further," says Cheryl Schad, BA, CPCM, CPC, owner of Schad Medical Management, a medical reimbursement consulting firm in New Jersey. Modifier -GG also tells the carrier that the choice to do the diagnostic was legitimate and not just an attempt to get more money. 
 
Medicare musts: For Medicare to reimburse you for each mammogram, you should report both the screening (76092, Screening mammography, bilateral [two view film study of each breast]) and diagnostic mammogram (either 76090, Mammography; unilateral or 76091, ... bilateral). You append modifier -GG to the diagnostic code. The same is true if the radiologist uses digital imaging. You report the screening code (G0202, Screening mammography, producing direct digital image, bilateral, all views) and append -GG to the diagnostic code (G0204, Diagnostic mammography, producing direct digital image, bilateral, all views or G0206, ... unilateral ...).
 
Medicare Transmittal 1724 announced the addition of modifier -GG and states that the modifier should be used for tracking.
 
Remember: Medicare requires HCPCS Level II codes when you report digital mammograms, and non-Medicare insurers may not accept these codes. Consult with private payers [...]