Radiology Coding Alert

Question: We reported G0202-TC for a patient who presented for a screening mammogram. The patient later returned for a diagnostic mammogram of both breasts. Should we report G0206 twice (once for left and once for right) or G0204?

Indiana Subscriber

Answer: You should report G0204 (Diagnostic mammography, producing direct digital image, bilateral, all views). Bilateral code G0204 is the appropriate code when you image both breasts.

You should not report unilateral code G0206 (Diagnostic mammography, producing direct digital image, unilateral, all views) twice for a bilateral exam because you have the more accurate bilateral coding option, G0204.

You should also append modifier TC (Technical component) if you only provided the technical service as you did when you reported G0202 (Screening mammography, producing direct digital image, bilateral, all views).

If you performed the screening and diagnostic mammograms on the same day, you should also append modifier GG (Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day) to G0204.

Note: You typically use G0202-G0206 for Medicare. Other payers may prefer that you use CPT mammography codes 77054-77057.