We had to do a lot of research before we got the answer" " says Diane Huston CPC RCC a quality-assurance auditor with Lexon Medical Las Vegas a billing service with offices located nationally and in Nevada. What Medicare Carriers Say Like many other carriers Upstate Medicare Division (UMD) the Medicare carrier in upstate New York does not have specific edits against billing clip placement with a stereotactic biopsy. However it still maintains that if the protocol for the stereotactic biopsy with a clip calls for a postoperative mammography to check placement then you shouldn't bill for the follow-up mammography.
Such a practice would likely fail in a postpayment audit on the grounds of lack of medical necessity. This postprocedure mammogram may be considered a quality-assurance function by this payer. The reason UMD has not put an edit in place is that it would eliminate legitimate preoperative diagnostic mammograms Huston says. ACR Has an Opinion The American College of Radiology's (ACR) Committee on Coding & Nomenclature has issued an opinion stating "that it is not appropriate to code for a unilateral diagnostic mammogram for verification of clip placement post-stereotactic breast biopsy since these images are included in the placement of the clip localization CPT 19295 (provided that the guidance and exam was done by the radiologist)."
The committee goes on to say that "if a stereotactic biopsy with clip placement is done by a surgeon who then requests a radiologist to interpret a two-view mammogram to confirm clip localization it would be appropriate for the radiologist to code a unilateral diagnostic mammogram (76090)."