Health Information Management

Q/A: Should we report a mammogram?

APCs Insider, August 9, 2013

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Q: We perform a mammogram after a breast procedure, like placement of a needle localization wire or metallic clip. We have reported this separately in the past, and had not received a National Correct Coding Initiative (NCCI) edit. We heard that we shouldn’t be reporting the mammogram. Should we or not?

A: The NCCI instructions for reporting a mammography after a breast procedure changed in 2013. When guidance is utilized for the procedure, then that includes all guidance. Chapter 9 of the NCCI manual notes:

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.

It is important to note that there are no NCCI edits for these code pairs in the hospital files, so without internal diligence on the part of the provider, these codes will pass through the claims processing systems without interruption.

Editor’s note: Denise Williams, RN, CPC-H, vice president of revenue integrity services at Health Revenue Assurance Associates, Inc., in Plantation, Fla., answered this question.

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