confused on post-procedure mammogram
The question and answer below is from the ACR Jan-Feb. 2014. What my coworkers and I do not understand is why the wording keeps changing on this. Our question is do they need medical necessity to be able to bill post-procedure mammogram?
Q: Please provide advice regarding the reporting of post-biopsy mammogram, if a biopsy is performed under ultrasound guidance (19083). Following the biopsy, a post-procedure unilateral mammogram is performed in a digital room (G0206). Can I now bill separately for both the ultrasound-guided biopsy and the digital post-procedure mammogram?
A: When a breast biopsy is performed under ultrasound guidance (19083), and the post-procedure mammogram is done in a digital room (G0206), it is appropriate to bill separately for both, the ultrasound-guided biopsy and the digital post-procedure mammogram as different modalities were used for the biopsy guidance and the post-procedural film.
The wording in the 2014 National Correct Coding Initiative (NCCI) narrative now allows the coding of the post-procedure mammogram when a different modality is used for the breast biopsy.as noted in the following:
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 post procedure 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.