Radiology

For the Week of February 8, 2016

Is a separate code allowed for post-procedure mammograms?

This Medicare policy has changed yearly since 2013 from not allowing it at all, to allowing it with stereotactic, ultrasound, and magnetic resonance (MR) guided procedures, to allowing it only with ultrasound and procedures guided by MR. 

The 2016 NCCI Policy Manual, Chapter 9, has reverted back to the 2014 policy statement that allows separate coding of a post-procedure mammogram with all but the mammogram-guided localization. Item 11 says the following: 

If a breast biopsy, needle localization wire, metallic localization clip, or other breast procedure is performed with mammographic guidance (e.g., 19281, 19282), 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 by the defined modality required to perform the procedure.