Radiology Coding Alert

Question: I have conflicting information on how to report a bilateral screening and diagnostic mammogram that have been performed and reported on the same day. Can you help?

New York Subscriber

Answer: For the most part, you are not going to encounter too many scenarios in which the provider performs a screening and diagnostic mammogram on the same day. Typically, the patient will present for an annual mammogram (if asymptomatic) and then return for a diagnostic mammogram if the results of the screening mammogram reveal any abnormalities. Another scenario is if a patient presents to their primary care physician (PCP) with signs or symptoms, in which case the PCP would order a diagnostic mammogram for the patient.

When you do come across an instance in which the provider performs both procedures on the same day, you've got to be aware of which modifiers to incorporate on each code. For a quick and definitive answer to your question, you can reference the National Correct Coding Initiative (NCCI) Policy Guide:

• Screening and diagnostic mammography are normally not performed on the same date of service. However, when the two procedures are performed on the same date of service, Medicare requires that the diagnostic mammography HCPCS/ CPT^® code be reported with modifier GG (Performance and payment of a screening mammography and diagnostic mammography on the same patient on the same patient, same day) and the screening mammography HCPCS/ CPT^® code be reported with modifier 59 (Distinct procedural service).

The coding for your example above is as follows:

• 77067-59 (Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed)
• 77065-GG (Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral)