Wiki Screening mammo vs diagnostic mammo

[uhlerclarem]

AS I understand it, if a doctor orders a screening mammo, that is what our radiologist must do. We have had instances where, based on a questionnaire the patient fills out, the radiologists changes the screening to a diagnostic. I know with Medicare we can bill both on the same day with a modifier GG on the diagnostic. My question has more to do with PPO and fee for service insurances.

Our radiology department is insisting that according to radiology guidelines, since the patient answered on a questionnaire that they may at risk for breast ca (ie family hx of breast ca) they have the right to only do a diagnostic mammo even thought the order was for a screening!?!

Any help would be appreciated
Thanks
Clare

 

[mitchellde]

No the guidelines are clear on this, the visit is screening if that is what was ordered, diagnostic is for when the patient is symptomatic and we are looking for a definitive diagnosis as the causation. Even if the patient expresses family hx then it is still screening with family hx secondary. The guidelines that screening remains first listed regardless of the finding or any other procedure performed due to the findings(at the same session.)