tci Part B Insider - 2013 Issue 9

Reader Question: Diagnostic vs. Screening X-rays

Question: If we routinely perform extra radiological views on patients with a history of breast cancer, does that mean the exam is diagnostic even if the patient presents for screening? Answer: Routine performance of extra views for patients with a history of breast cancer is not sufficient to support coding a diagnostic mammogram rather than a screening. To ensure proper coding, review the payer’s definitions of screening and diagnostic mammography. Also review the rules for when the radiologist may convert a screening exam to diagnostic without an additional physician order. Diagnostic: For Medicare, "diagnostic mammography is a radiologic...

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