You Be the Coder:
Focus on Follow-Up Mammogram Guidance
Published on Wed Apr 19, 2006
Question: Our radiologists perform breast biopsies and place a clip at the same time. They perform another unilateral mammogram to assess for breast nodule resolution or to assess whether they placed the clips correctly. May we bill for the follow-up unilateral mammogram?
California Subscriber
Answer: The answer depends on the imaging modality the physician used for biopsy guidance and clip placement.
Solid documentation may convince payers you're correct to separately code a diagnostic mammogram (76090, Mammography; unilateral) with clip placement confirmation code +19295 (Image-guided placement, metallic localization clip, percutaneous, during breast biopsy) if the documentation shows that the physician performed the biopsy under ultrasound or MRI guidance.
If the radiologist performs the breast biopsy using stereotactic or mammographic guidance, include the follow-up mammogram in the code for that procedure. Payers typically bundle the follow-up mammogram into 76095 (Stereotactic localization guidance for breast biopsy or needle placement [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation) and 76096 (Mammographic guidance for needle placement, breast [e.g., for wire localization or for injection], each lesion, radiological supervision and interpretation). As always, check your payer to be sure.
The report should document why the physician used either ultrasound or MRI to guide the intervention and then needed to use mammography to document the clip location.
Caution: If you do code a diagnostic mammogram for this scenario, the mammogram may be subject to all the typical MQSA requirements, such as communication with the patient concerning the results.
