Modifier -GG is used to indicate that both a screening mammography and a diagnostic mammography were performed on the same patient, on the same day. This modifier is added to the diagnostic mammography code to show that the procedure transitioned from a screening to a diagnostic test. Most payers will reimburse both the screening and diagnostic mammography services when reported together.
When to Use Modifier GG
This modifier should be used when the interpretation of a screening mammogram leads to the decision to perform a diagnostic mammogram on the same day. In such cases, both the screening and diagnostic mammograms are reimbursed.
Important Tips for Using Modifier -GG:
- Informational Purpose: Modifier -GG is for informational purposes only. Always submit any other applicable modifiers before using modifier -GG.
- Different Dates: Do not use modifier -GG if the mammograms are performed on different dates.
- Quality Issues: Modifier -GG should not be used if the diagnostic mammogram is needed because the initial screening mammogram was of poor quality or due to a problem with the initial procedure.
- Use Modifier -GH When Appropriate: If the diagnostic mammogram is a conversion from a screening mammogram on the same day (and not two separate services), use modifier -GH instead of modifier -GG.
- Medicare Guidelines: Medicare allows additional mammogram films without requiring a new order from the treating physician.
Diagnostic and Screening Mammograms for Modifier GG
A diagnostic mammogram is a radiologic procedure performed on a man or woman who has symptoms of breast disease, a personal history of breast cancer, or a personal history of biopsy-proven benign breast disease. This procedure includes the physician’s interpretation of the results.
77065– Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral
77066– Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral
A screening mammogram is a radiologic procedure offered to a woman without any signs or symptoms of breast disease, aimed at the early detection of breast cancer. It also includes the physician’s interpretation of the results. For a screening mammogram to be considered valid, it must include at least two views of each breast: a cranio-caudal view and a medial-lateral oblique view.
77067 – Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed
Medicare Coverage Guidelines:
- Under age 35: Medicare does not cover screening mammograms for women under the age of 35.
- Ages 34-39: Medicare will cover only one screening mammogram for women aged 34 but under 40.
- Ages 40 and older: For asymptomatic women aged 40 or older, Medicare may cover a screening mammogram if at least 11 months have passed since the last screening.
Medicare and Screening Mammography: The term “screening mammography” refers to a radiologic procedure performed on an asymptomatic woman for the purpose of early detection of breast cancer. Medicare does not provide coverage for screening mammograms for men.
Medicare Coverage for Diagnostic Mammograms: Medicare will cover a diagnostic mammogram if one of the following conditions is met:
- The patient exhibits specific signs and symptoms indicating the need for a mammogram.
- The patient has a history of breast cancer.
- The patient is asymptomatic, but based on the patient’s history and other factors, the physician determines a diagnostic mammogram is appropriate.
Claim Submission with Modifier GG
When both screening and diagnostic mammography codes are submitted, include modifier -GG on the diagnostic mammography code. To comply with National Correct Coding Initiative (NCCI) edits, append modifier -59 (distinct procedural service) to the screening mammography code.
By using the appropriate modifiers, coders ensure accurate tracking and reimbursement for both screening and diagnostic mammography services performed on the same day.
Reference:
https://www.acr.org/-/media/ACR/Files/Advocacy/2021-Breast-Imaging-Frequently-Asked-Questions