Gastro Coders: Be Aware of Medicare Screening Reqs Or Risk Payment Denial

Posted on 12. Apr, 2010 by Editor.

Following 10-year-rule eliminates G0121 rejection.

If you slip up on screening colonoscopy claims’ frequency guidelines and eligibility requirements, Medicare will pay you zilch.

Use this guidance to capture every screening dollar your gastroenterologist deserves.

Home in on Eligibility Requirements for Average-Risk Test

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Ob-gyn Coding: Order, Not Implant, Decides Diagnostic vs. Screening Mammogram

Posted on 07. Apr, 2010 by Editor.

Examine Medicare’s coverage guidelines.

Question: My ob-gyn sees a patient who has breast implants or breast augmentation and orders a mammogram. Should I count the mammography as a screening or a diagnostic test?

Louisiana Subscriber

Answer: Implants and augmentation don’t equate to a diagnostic mammogram every time. The ordering physician decides whether the patient requires a diagnostic mammogram.

Diagnostic: To be a diagnostic mammogram (such as 77056, Mammography, bilateral), the ob-gyn must …

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How to Code for Screening Mammogram When Radiologist Finds Problem?

Posted on 06. Dec, 2009 by .

Watch out: Results don’t turn screening into diagnostic

Question: A patient presented for a screening mammogram, and the radiologist determined the patient needed an ultrasound for a closer look. The patient returned for that test at a later date. Should I code the original mammogram as 77056 instead of 77057 because the radiologist found a possible problem?

Answer: If the patient presents for and undergoes a screening mammogram, you should code for a screening, even if the radiologist discovers an abnormality. In the case you describe you would report 77057 (Screening mammography, bilateral [2-view film study of each breast]) rather than 77056 (Mammography; bilateral). When the patient returns for the ultrasound, you would report 76645 (Ultrasound, breast[s] [unilateral or bilateral], real time with image documentation). Remember that Medicare requires a separate order for the ultrasound for nonhospital patients.

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