Radiology Question for the Week of April 18, 2016

Question:

We did a bilateral diagnostic mammogram on a patient and because of the findings decided to perform an ultrasound-guided breast biopsy on the same day. A unilateral mammogram was done after the biopsy to verify clip placement. Can we code both of the mammograms?   

Answer

There is a national correct coding initiative (CCI) edit that precludes billing both a bilateral and a unilateral mammogram on the same day. The edit has a “0” indicator, so it cannot be bypassed with a modifier.  Since there is no limit to the number of views required for a bilateral diagnostic mammogram, all diagnostic images taken on the same day are considered to be included.

Answer: