2013 Medicare Eliminates Reporting of Post-Procedure Mammography

Prior to 2013 post-procedure mammography was separately billable if the procedure was performed utilizing a separate modality or piece of equipment.  Per the new guidelines published for 2013, the post-procedure mammogram will not be separately billable regardless of the type of radiologic guidance utilized for the procedure.

As of January 1, 2013, the following information will be effective per the National Correct Coding Initiative (NCCI) Manual for Medicare Services for 2013.

From Chapter 9, Subsection D-

11. If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with radiologic guidance (e.g., 76942, 77012, 77021, 77031, 77032), the physician should not separately report a post procedure mammography code (e.g., 77051, 77052, 77055-77057, G0202-G0206) for the same patient encounter. The radiologic guidance codes include all imaging required to perform the procedure.

Break Away from the Static

ADVOCATE recommends that any post-procedure imaging interpretation be included in the report for the procedure rather than on a separate report.  This will eliminate any erroneous billing of the post-procedure mammogram and lower the risk of unnecessary denials and/or audits.

Best regards,
Jennifer Bash, RHIA, CPC, CIRCC, RCC 
Senior Coding Specialist