Wiki Billing mammogram before and after breast biopsy

[Kimberley]

When pt has a unilateral diagnostic mammogram before an ultrasonic guided bx and then has another unilateral diagnostic mammogram to verify clip placement are we to bill for both mammos? If so, what modifier should be added to the post bx mammo? I do know that you cannot bill for the post bx mammo if performed under stereotactic or mammo guidance.

Thank you in advance

Kimberley Tober, CPC

 

[Kimberley]

Any help on this question would be great appreciated

 

[kmschwarz]

We are having the same question - did you ever find any authoritative guidance on whether you can bill both?

Thanks!

 

[danskangel313]

I don't know if this helps, but here's what I found:

"Postprocedure mammograms

Medicare's policy on post-procedure mammography has changed yearly since 2013 -- from not allowing it at all, to allowing it with stereotactic, ultrasound, and MR-guided procedures; and then to allowing it only with ultrasound and procedures guided by MRI. The 2016 NCCI Policy Manual has reverted back to the 2014 policy statement that allows separate coding of a postprocedure mammogram with all but the mammogram-guided localization.

Chapter 9 of the policy manual includes the following statement:

11. If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with mammographic guidance (e.g., 19281, 19282), the physician should not separately report a postprocedure mammography code (e.g., 77051, 77052, 77055-77057, G0202-G0206) for the same patient encounter. The radiologic guidance codes include all imaging by the defined modality required to perform the procedure."

 

[Rmjohann]

billing mammo before and after breast biopsy

Did anyone find out whether or not the mammo before the biopsy can be coded in addition to the post biopsy mammo?