How should we code a unilateral screening on one breast and a diagnostic on the other?
You can’t. The definition of screening mammogram is a radiologic procedure provided to an asymptomatic woman for the purpose of early detection of breast cancer. If a patient has symptoms prompting a diagnostic mammogram, she does not qualify for a screening. Whether the problem is in one breast or both doesn’t matter. If you have orders for one breast diagnostic and one screening, you must clarify with the ordering physician prior to performing the exam. It can’t be both; it must be one or the other. Screening can resume once the problem is resolved.
For a question and answer regarding this situation, see the May/June 2013 issue of the ACR Radiology Coding Source at http://www.acr.org/Advocacy/Economics-Health-Policy/Billing-Coding/Coding-Source-List/2013/May-Jun-2013/QA.