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76098

Heather Posted Thu 01st of November, 2012 16:28:20 PM

We use the Bioptic Digital Mammography. The use of such a device is extremely important in the management of women with an abnormal finding of calcifications during routine mammograms.

The presence of these calcifications requires a biopsy or complete removal of the area in question. After the patient undergoes the operative procedure the specimen that is obtained is sent to the laboratory. In the laboratory the specimen is radiographed again to confirm that indeed the calcifications were removed with the surgical procedure.

If calcifications are identified in the tissue, the pathologists can select this important spot for histologic evaluation. Identifying the calcifications in this way is much more accurate than analyzing blindly where multiple blocks need to be processed rather than to focus in one or more specific areas.

Finally, calcifications can be affected during the chemical preparation of the histologic slide and dissolve during the process. The specimen radiograph after receipt in the laboratory is the only proof that the calcifications were removed from the patient.

Our question is whether or not we can bill for a global 76098 as we are performing both the x-ray of the surgical specimen and its interpretation.

SuperCoder Answered Fri 02nd of November, 2012 03:24:55 AM

You should be able to bill the global code assuming you meet the requirements for both technical (you bear the cost of the equipment, staff taking the x-ray, etc.) and the professional component (written interpretation).

Also consider this article from CAP:

Q: We often receive mammography films in conjunction with a breast specimen as a part of our complete surgical pathology consultation. Can we bill CPT code 76098 for our evaluation of the specimen mammogram?
A: CPT code 76098, Radiological examination, surgical specimen, can be reported if the films are interpreted as an integral part of the evaluation. Medical record documentation should reflect the interpretation as well as the evaluation. Because you did not perform the mammography, the professional component modifier (-26) should be appended to the CPT code. It should also be noted that Medicare generally does not pay for two physicians to read and interpret a film, so you may not receive payment if the radiologist has submitted a claim for the same service.

Source: http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt{actionForm.contentReference}=cap_today%2Ffeature_stories%2FCPTqs_06_03.html&_state=maximized&_pageLabel=cntvwr

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