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Ob-Gyn Coding Alert

Reader Question:

Modifier -59 May Be Better Option

Question: Medicare is denying our claims that contain 76092 and 76092-76. Is there a better way to bill for this procedure? Minnesota Subscriber Answer: Code 76092 is for a bilateral screening mammography. And modifier -76 (Repeat procedure by same physician) indicates that the ob-gyn performed a second screening mammography on the same date. A better option may be modifier -59 (Distinct procedural service) for the second mammography to distinguish it more clearly from the first. Normally, however, if the screening mammography shows something, the physician would likely order a diagnostic mammogram (76090, Mammography; unilateral; or 76091, bilateral) instead of a second screening.  

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