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Screening Mammogram

Pessie Posted Fri 15th of January, 2016 10:46:27 AM

Patient has only one breast, and is coming in for screening Mammogram. G0202 is a Bilateral code. what is the correct code to use?

SuperCoder Answered Sat 16th of January, 2016 01:32:37 AM

Hi,
When a screening mammography study is ordered and performed on a patient who has only one breast, it is appropriate to report G0202 (Screening mammography, producing direct digital image, bilateral, all views). Because the descriptors for HCPCS code G0202 state “bilateral,” it would be appropriate to use a 52 modifier (reduced level of service) to designate a screening procedure of only one breast.
The reporting of the 52 modifier in conjunction with the screening mammography code for a unilateral screening study is documented in a 1998 letter from the AMA’s CPT Information Services, which the use of the screening mammography code and the reduced services modifier (52) accurately describes the procedure performed. However, it is recommended that radiology practices check with their local Medicare administrative contractor and other third-party payers regarding the use of the 52 modifier in this situation, as some payers have stated they prefer the RT or LT modifier be used in place of the 52 modifier
Thanks!!

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