Monday, June 13, 2016

Screening Mammogram revenue code 0400, 0521 - covered ICD CODE - Modifier GG

Revenue Codes
Code Description

0400 Other Imaging Services - General Classification
0401 Other Imaging Services - Diagnostic Mammography
0403 Other Imaging Services - Screening Mammography
0521 Freestanding Clinic - Clinic Visit by Member to RHC/FQHC
0524 Freestanding Clinic - Visit by RHC/FQHC Practitioner to a Member in a SNF or Skilled Swing Bed in a Covered Part A Stay


For screening mammography (77057, 77063 or G0202):

For claims with dates of service on or after January 1, 2002, when a screening mammography and a diagnostic mammography are performed on the same date of service, for the same patient, append modifier -GG to the diagnostic mammography procedure code. Both the screening mammography and the diagnostic mammography procedure codes should be reported on the same claim:

Group 1 Codes
Z12.31* Encounter for screening mammogram for malignant neoplasm of breast


For diagnostic mammography (77055, 77056, G0204, G0206 or G0279) billed with or without Modifier GG:


C43.52 Malignant melanoma of skin of breast
C43.59 Malignant melanoma of other part of trunk
C44.501 Unspecified malignant neoplasm of skin of breast
C44.509 Unspecified malignant neoplasm of skin of other part of trunk
C44.511 Basal cell carcinoma of skin of breast
C44.519 Basal cell carcinoma of skin of other part of trunk
C44.521 Squamous cell carcinoma of skin of breast
C44.529 Squamous cell carcinoma of skin of other part of trunk
C44.591 Other specified malignant neoplasm of skin of breast
C44.599 Other specified malignant neoplasm of skin of other part of trunk
C45.9 Mesothelioma, unspecified
C50.011 Malignant neoplasm of nipple and areola, right female breast
C50.012 Malignant neoplasm of nipple and areola, left female breast
C50.019 Malignant neoplasm of nipple and areola, unspecified female breast
C50.021 Malignant neoplasm of nipple and areola, right male breast
C50.022 Malignant neoplasm of nipple and areola, left male breast
C50.029 Malignant neoplasm of nipple and areola, unspecified male breast
C50.111 Malignant neoplasm of central portion of right female breast
C50.112 Malignant neoplasm of central portion of left female breast
C50.119 Malignant neoplasm of central portion of unspecified female breast
C50.121 Malignant neoplasm of central portion of right male breast
C50.122 Malignant neoplasm of central portion of left male breast
C50.129 Malignant neoplasm of central portion of unspecified male breast
C50.211 Malignant neoplasm of upper-inner quadrant of right female breast
C50.212 Malignant neoplasm of upper-inner quadrant of left female breast
C50.219 Malignant neoplasm of upper-inner quadrant of unspecified female breast
C50.221 Malignant neoplasm of upper-inner quadrant of right male breast
C50.222 Malignant neoplasm of upper-inner quadrant of left male breast
C50.229 Malignant neoplasm of upper-inner quadrant of unspecified male breast
C50.311 Malignant neoplasm of lower-inner quadrant of right female breast
C50.312 Malignant neoplasm of lower-inner quadrant of left female breast
C50.319 Malignant neoplasm of lower-inner quadrant of unspecified female breast
C50.321 Malignant neoplasm of lower-inner quadrant of right male breast
C50.322 Malignant neoplasm of lower-inner quadrant of left male breast
C50.329 Malignant neoplasm of lower-inner quadrant of unspecified male breast
C50.411 Malignant neoplasm of upper-outer quadrant of right female breast
C50.412 Malignant neoplasm of upper-outer quadrant of left female breast
C50.419 Malignant neoplasm of upper-outer quadrant of unspecified female breast
C50.421 Malignant neoplasm of upper-outer quadrant of right male breast
C50.422 Malignant neoplasm of upper-outer quadrant of left male breast
C50.429 Malignant neoplasm of upper-outer quadrant of unspecified male breast
C50.511 Malignant neoplasm of lower-outer quadrant of right female breast
C50.512 Malignant neoplasm of lower-outer quadrant of left female breast
C50.519 Malignant neoplasm of lower-outer quadrant of unspecified female breast
C50.521 Malignant neoplasm of lower-outer quadrant of right male breast
C50.522 Malignant neoplasm of lower-outer quadrant of left male breast
C50.529 Malignant neoplasm of lower-outer quadrant of unspecified male breast
C50.611 Malignant neoplasm of axillary tail of right female breast
C50.612 Malignant neoplasm of axillary tail of left female breast
C50.619 Malignant neoplasm of axillary tail of unspecified female breast
C50.621 Malignant neoplasm of axillary tail of right male breast
C50.622 Malignant neoplasm of axillary tail of left male breast
C50.629 Malignant neoplasm of axillary tail of unspecified male breast
C50.811 Malignant neoplasm of overlapping sites of right female breast
C50.812 Malignant neoplasm of overlapping sites of left female breast
C50.819 Malignant neoplasm of overlapping sites of unspecified female breast
C50.821 Malignant neoplasm of overlapping sites of right male breast
C50.822 Malignant neoplasm of overlapping sites of left male breast
C50.829 Malignant neoplasm of overlapping sites of unspecified male breast
C50.911 Malignant neoplasm of unspecified site of right female breast
C50.912 Malignant neoplasm of unspecified site of left female breast
C50.919 Malignant neoplasm of unspecified site of unspecified female breast
C50.921 Malignant neoplasm of unspecified site of right male breast
C50.922 Malignant neoplasm of unspecified site of left male breast
C50.929 Malignant neoplasm of unspecified site of unspecified male breast
C56.1 Malignant neoplasm of right ovary
C56.2 Malignant neoplasm of left ovary
C56.9 Malignant neoplasm of unspecified ovary
C77.3 Secondary and unspecified malignant neoplasm of axilla and upper limb lymph nodes
C78.00 Secondary malignant neoplasm of unspecified lung
C78.01 Secondary malignant neoplasm of right lung
C78.02 Secondary malignant neoplasm of left lung
C78.1 Secondary malignant neoplasm of mediastinum
C78.2 Secondary malignant neoplasm of pleura
C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct
C79.2 Secondary malignant neoplasm of skin
C79.31 Secondary malignant neoplasm of brain
C79.32 Secondary malignant neoplasm of cerebral meninges
C79.40 Secondary malignant neoplasm of unspecified part of nervous system
C79.49 Secondary malignant neoplasm of other parts of nervous system
C79.51 Secondary malignant neoplasm of bone
C79.52 Secondary malignant neoplasm of bone marrow
C79.60 Secondary malignant neoplasm of unspecified ovary
C79.61 Secondary malignant neoplasm of right ovary
C79.62 Secondary malignant neoplasm of left ovary
C79.81 Secondary malignant neoplasm of breast
C80.0 Disseminated malignant neoplasm, unspecified
C80.1 Malignant (primary) neoplasm, unspecified
D03.52 Melanoma in situ of breast (skin) (soft tissue)
D03.59 Melanoma in situ of other part of trunk
D04.5 Carcinoma in situ of skin of trunk
D05.00 Lobular carcinoma in situ of unspecified breast
D05.01 Lobular carcinoma in situ of right breast
D05.02 Lobular carcinoma in situ of left breast
D05.10 Intraductal carcinoma in situ of unspecified breast
D05.11 Intraductal carcinoma in situ of right breast
D05.12 Intraductal carcinoma in situ of left breast
D05.80 Other specified type of carcinoma in situ of unspecified breast
D05.81 Other specified type of carcinoma in situ of right breast
D05.82 Other specified type of carcinoma in situ of left breast
D05.90 Unspecified type of carcinoma in situ of unspecified breast
D05.91 Unspecified type of carcinoma in situ of right breast
D05.92 Unspecified type of carcinoma in situ of left breast
D22.5 Melanocytic nevi of trunk
D23.5 Other benign neoplasm of skin of trunk
D24.1 Benign neoplasm of right breast
D24.2 Benign neoplasm of left breast
D24.9 Benign neoplasm of unspecified breast
D48.5 Neoplasm of uncertain behavior of skin
D48.60 Neoplasm of uncertain behavior of unspecified breast
D48.61 Neoplasm of uncertain behavior of right breast
D48.62 Neoplasm of uncertain behavior of left breast
D49.1 Neoplasm of unspecified behavior of respiratory system
D49.2 Neoplasm of unspecified behavior of bone, soft tissue, and skin
D49.3 Neoplasm of unspecified behavior of breast
D49.6 Neoplasm of unspecified behavior of brain
D49.7 Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system
I80.8 Phlebitis and thrombophlebitis of other sites
M70.80 Other soft tissue disorders related to use, overuse and pressure of unspecified site
M70.88 Other soft tissue disorders related to use, overuse and pressure other site
M70.89 Other soft tissue disorders related to use, overuse and pressure multiple sites
M70.90 Unspecified soft tissue disorder related to use, overuse and pressure of unspecified site
M70.98 Unspecified soft tissue disorder related to use, overuse and pressure other
M70.99 Unspecified soft tissue disorder related to use, overuse and pressure multiple sites
M79.5 Residual foreign body in soft tissue
M79.81 Nontraumatic hematoma of soft tissue
M79.89 Other specified soft tissue disorders
M79.9 Soft tissue disorder, unspecified
N60.01 Solitary cyst of right breast
N60.02 Solitary cyst of left breast
N60.09 Solitary cyst of unspecified breast
N60.11 Diffuse cystic mastopathy of right breast
N60.12 Diffuse cystic mastopathy of left breast
N60.19 Diffuse cystic mastopathy of unspecified breast
N60.21 Fibroadenosis of right breast
N60.22 Fibroadenosis of left breast
N60.29 Fibroadenosis of unspecified breast
N60.31 Fibrosclerosis of right breast
N60.32 Fibrosclerosis of left breast
N60.39 Fibrosclerosis of unspecified breast
N60.41 Mammary duct ectasia of right breast
N60.42 Mammary duct ectasia of left breast
N60.49 Mammary duct ectasia of unspecified breast
N60.81 Other benign mammary dysplasias of right breast
N60.82 Other benign mammary dysplasias of left breast
N60.89 Other benign mammary dysplasias of unspecified breast
N60.91 Unspecified benign mammary dysplasia of right breast
N60.92 Unspecified benign mammary dysplasia of left breast
N60.99 Unspecified benign mammary dysplasia of unspecified breast
N61 Inflammatory disorders of breast
N62 Hypertrophy of breast
N63 Unspecified lump in breast
N64.0 Fissure and fistula of nipple
N64.1 Fat necrosis of breast
N64.2 Atrophy of breast
N64.3 Galactorrhea not associated with childbirth
N64.4 Mastodynia
N64.51 Induration of breast
N64.52 Nipple discharge
N64.53 Retraction of nipple
N64.59 Other signs and symptoms in breast
N64.81 Ptosis of breast
N64.82 Hypoplasia of breast
N64.89 Other specified disorders of breast
N64.9 Disorder of breast, unspecified
N65.0 Deformity of reconstructed breast
N65.1 Disproportion of reconstructed breast
R59.0 Localized enlarged lymph nodes
R59.1 Generalized enlarged lymph nodes
R59.9 Enlarged lymph nodes, unspecified
R92.0 Mammographic microcalcification found on diagnostic imaging of breast
R92.1 Mammographic calcification found on diagnostic imaging of breast
R92.2 Inconclusive mammogram
R92.8 Other abnormal and inconclusive findings on diagnostic imaging of breast
R93.9 Diagnostic imaging inconclusive due to excess body fat of patient
S20.00XA Contusion of breast, unspecified breast, initial encounter
S20.01XA Contusion of right breast, initial encounter
S20.02XA Contusion of left breast, initial encounter
S21.001A Unspecified open wound of right breast, initial encounter
S21.002A Unspecified open wound of left breast, initial encounter
S21.009A Unspecified open wound of unspecified breast, initial encounter
S21.011A Laceration without foreign body of right breast, initial encounter
S21.012A Laceration without foreign body of left breast, initial encounter
S21.019A Laceration without foreign body of unspecified breast, initial encounter
S21.021A Laceration with foreign body of right breast, initial encounter
S21.022A Laceration with foreign body of left breast, initial encounter
S21.029A Laceration with foreign body of unspecified breast, initial encounter
S21.031A Puncture wound without foreign body of right breast, initial encounter
S21.032A Puncture wound without foreign body of left breast, initial encounter
S21.039A Puncture wound without foreign body of unspecified breast, initial encounter
S21.041A Puncture wound with foreign body of right breast, initial encounter
S21.042A Puncture wound with foreign body of left breast, initial encounter
S21.049A Puncture wound with foreign body of unspecified breast, initial encounter
S21.051A Open bite of right breast, initial encounter
S21.052A Open bite of left breast, initial encounter
S21.059A Open bite of unspecified breast, initial encounter
S28.211A Complete traumatic amputation of right breast, initial encounter
S28.212A Complete traumatic amputation of left breast, initial encounter
S28.219A Complete traumatic amputation of unspecified breast, initial encounter
S28.221A Partial traumatic amputation of right breast, initial encounter
S28.222A Partial traumatic amputation of left breast, initial encounter
S28.229A Partial traumatic amputation of unspecified breast, initial encounter
S29.001A Unspecified injury of muscle and tendon of front wall of thorax, initial encounter
S29.009A Unspecified injury of muscle and tendon of unspecified wall of thorax, initial encounter
S29.091A Other injury of muscle and tendon of front wall of thorax, initial encounter
S29.099A Other injury of muscle and tendon of unspecified wall of thorax, initial encounter
S29.8XXA Other specified injuries of thorax, initial encounter
S29.9XXA Unspecified injury of thorax, initial encounter
S39.001A Unspecified injury of muscle, fascia and tendon of abdomen, initial encounter
S39.091A Other injury of muscle, fascia and tendon of abdomen, initial encounter
S39.81XA Other specified injuries of abdomen, initial encounter
S39.91XA Unspecified injury of abdomen, initial encounter
T85.41XA Breakdown (mechanical) of breast prosthesis and implant, initial encounter
T85.42XA Displacement of breast prosthesis and implant, initial encounter
T85.43XA Leakage of breast prosthesis and implant, initial encounter
T85.44XA Capsular contracture of breast implant, initial encounter
T85.49XA Other mechanical complication of breast prosthesis and implant, initial encounter
T85.79XA Infection and inflammatory reaction due to other internal prosthetic devices, implants and grafts, initial encounter
Z03.89 Encounter for observation for other suspected diseases and conditions ruled out
Z08 Encounter for follow-up examination after completed treatment for malignant neoplasm
Z77.123 Contact with and (suspected) exposure to radon and other naturally occuring radiation
Z77.128 Contact with and (suspected) exposure to other hazards in the physical environment
Z77.9 Other contact with and (suspected) exposures hazardous to health
Z85.3 Personal history of malignant neoplasm of breast
Z85.831 Personal history of malignant neoplasm of soft tissue
Z85.89 Personal history of malignant neoplasm of other organs and systems
Z91.89 Other specified personal risk factors, not elsewhere classified
Z92.89 Personal history of other medical treatment
Z98.82 Breast implant status
Z98.86 Personal history of breast implant removal

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