Wiki Digital mammo help please

[TLC]

Can someone help me. We get denials on how we are billing our Digital mammos, when a patient has implants. We bill G0402/V43.82 as per past guidelines for Medicare this is ok to bill as diagnostic for implants. Or is this only true if the patients implants are due to breast cancer? Any help on coding this would be appreciated. Thank you

 

[lastle]

Digital mammo

Screening and diagnostic mammograms are solely determined by the ordering provider's script. The reason for study is what drives the exam and CPT/HCPCS and diagnosis code assignment. The exception to this would be mammograms of male patients. Male patient mammograms may only be submitted as diagnostic regardless if there is a history of breast cancer. The old policies of a "2year rule" or history of breast cancer are obsolete.

If a digital screening is ordered and performed, then use G0202 - this applies to both a bilateral or unilateral screening. If a unilateral screening is performed, then use G0202-52 to show reduced services (I also add the anatomical modifiers -LT or -RT as applicable). The first listed diagnosis code should be the V76.12 or V76.11 (for high-risk screenings); then you can code any findings or implant status code of V43.82 (which would be incidental).

If a diagnostic mammogram (G0204/G0206) is ordered to evaluate implants, code first the signs/symptoms/complaint or known diagnosis, and use the V43.82 implant status code as secondary or tertiary. V43.82 is NOT a first-listed diagnosis code.

If you are coding any digital mammogram with V43.82 as a first-listed diagnosis code, that may be the reason for your denials. V43.82 is in the group of Vcodes that may only be coded as additional-only.

You may reference Coding Clinics's V Code Table to learn which V code is First-Listed, First or Additional, and Additional Only.

I hope this helps.
Leigh