Radiology Question for the Week of October 19, 2015

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.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.