Victoria Posted Fri 20th of January, 2017 11:17:26 AM
We bill for the professional component which is modifier 26, We are billing the new Mammo codes 77067, 77066,& 77065 and our payors are denying that we are billing with the incorrect modifier and there is a more appropriate modifier. Is there any special modifier we should be using? I can't find anything online to support this.
SuperCoder Answered Mon 23rd of January, 2017 08:55:59 AM
Our team is working on it and will get back soon.
SuperCoder Answered Tue 24th of January, 2017 08:21:59 AM
We would like to know some more details related to your report as well as place of service. As sometimes under certain circumstances, a charge may be made for the technical component alone, where instead of 26 modifier we will go for TC alone. Also we may have to bill these codes with multiple modifier. But to reach to conclusion and reason for denial we must know the situation, POC, person performing, payer policy and more…
Victoria Posted Tue 24th of January, 2017 11:23:17 AM
We bill for the interpretation of radiological exams, in this case we billed for the interpretation of the mammogram. This make us the professional component (mod 26). This exam was performed in the out patient setting. The facility performed the mammo and my radiologist read the exam. I hope this helps.
SuperCoder Answered Wed 25th of January, 2017 08:18:06 AM
If you are billing CPT codes 77067, 77066 & 77065 individually on different patient or on different date of service, then billing with 26 modifier is correct. If you are billing these codes together on same patient and on same date of service then, it can lead to denial of 1 or all CPT codes.
CPT code 77065 is considered included in CPT code 77066, if performed on same patient and on same date of service, as unilateral breast diagnostic mammogram is an integral part of bilateral diagnostic mammogram, so CPT code 77065 will be denied.
Furthermore, NCCI states “Screening and diagnostic mammography are normally not performed on the same date of service. However when the two procedures are performed on the same date of service, Medicare requires that the diagnostic mammography CPT code to be reported with modifier GG (performance and payment of a screening and diagnostic mammogram on the same patient, same day) and the screening mammography CPT code be reported with modifier 59”.
So if diagnostic and screening mammography performed on same date of service, then you can bill this scenario as “77065/77066 -GG and 77067 -59”.