Radiology Coding Alert

Question: A patient was referred to our radiology practice for her annual screening mammography. During the procedure, the radiologist noticed an abnormality in the patient’s left breast. After the screening mammogram, the radiologist interpreted the results and performed a diagnostic mammography on the patient’s left breast on the same day. The radiologist interpreted the results and submitted their report to the patient’s general practitioner (GP).

How do we report a screening mammogram and a diagnostic mammogram that occurred during a single encounter?

South Carolina Subscriber

Answer: You’ll assign 77067 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed) to report the screening mammogram on both of the patient’s breasts. A screening mammography is a procedure provided to a woman who doesn’t exhibit signs or symptoms of breast disease.

You’ll then assign 77065 (Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral) and append the code with modifier LT (Left side) to indicate the radiologist performed the diagnostic mammography on the left breast. According to the Centers for Medicare and Medicaid Services (CMS), a diagnostic mammography is a “radiologic procedure furnished to a man or woman with signs and symptoms of breast disease, a personal history of breast cancer, or a personal history of biopsy.”

According to Palmetto GBA, the local Medicare Administrative Contractor (MAC) for South Carolina, you’ll also append HCPCS Level II modifier GG (Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day) to 77065 to show the diagnostic mammography occurred on the same day as the screening mammography.

The guidelines for modifier GG also state the radiologist may perform additional mammograms without requiring a new order from the patient’s treating physician.